The Effects of Tai Chi Chuan Relaxation and Exercise on Stress Responses and Well-Being: An Overview of Research

Abstract

The rationale of this article is to review, analyze, and discuss studies concerning the role of Tai Chi in stress management and well-being, linking those studies to research on exercise, yoga, and relaxation with regard to physiological and psychological wellness. All studies reported in PsychLit and Medline between 1996 and 1999 directly related to the subject, plus other studies relevant for the analysis, are addressed in this review. Studies reviewed in this article characterize Tai Chi as a form of moderate exercise. Although Tai Chi may not be suitable for achieving aerobic fitness, it may enhance flexibility and overall psychological well-being. Cognitively, there are indications that Tai Chi exercise may lead to improvements in mood. However, it is not clear whether the positive effects of Tai Chi are due solely to its relaxation and meditation component, or whether they are the consequence of various peripheral factors, since it is known that stress reduction often occurs when we indulge in activities we find pleasurable and satisfying. An important finding is that all studies on the benefits of Tai Chi for senior adults have revealed positive results.

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International Journal of Stress Management, Vol. 7, No. 2, 2000
The Effects of Tai Chi Chuan Relaxation and
Exercise on Stress Responses and Well-Being:
An Overview of Research
Erica S. Sandlund1 and Torsten Norlander1,2
The rationale of this article is to review, analyze, and discuss studies concern-
ing the role of Tai Chi in stress management and well-being, linking those
studies to research on exercise, yoga, and relaxation with regard to physiologi-
cal and psychological wellness. All studies reported in PsychLit and Medline
between 1996 and 1999 directly related to the subject, plus other studies rele-
vant for the analysis, are addressed in this review. Studies reviewed in this
article characterize Tai Chi as a form of moderate exercise. Although Tai Chi
may not be suitable for achieving aerobic fitness, it may enhance flexibility and
overall psychological well-being. Cognitively, there are indications that Tai Chi
exercise may lead to improvements in mood. However, it is not clear whether
the positive effects of Tai Chi are due solely to its relaxation and meditation
component, or whether they are the consequence of various peripheral factors,
since it is known that stress reduction often occurs when we indulge in activities
we find pleasurable and satisfying. An important finding is that all studies on
the benefits of Tai Chi for senior adults have revealed positive results.
KEY WORDS: Tai Chi; stress management; progressive relaxation; aerobic exercise; yoga; medi-
tation.
INTRODUCTION
Relaxation research has generated a number of subfields involving stretch-
ing and autogenic exercises (Smith, 1993). Further examples would be relax-
1Karlstad University, Sweden.
2Correspondence should be directed to Dr. Torsten Norlander, Department of Psychology, Karlstad
University, SE-651 88 Karlstad, Sweden; e-mail: at.norlander6mailbox.swipnet.se.

140 Sandlund and Norlander
ation with the help of certain devices such as the flotation tank (Norlander,
Bergman, & Archer, 1998; Norlander, Bergman, & Archer, 1999), and the phys-
ioacoustic method (Norlander, Sandholm, & Anfelt, 1998). A number of other
studies have supported the hypothesis that exercise has beneficial effects on
stress responses (e.g., Greist, 1987; Sime, 1987; Morgan & Goldston, 1987). A
review of literature concerning exercise and mental health by Plante and Rodin
(1990) reveals that 75% of the correlational studies conducted identified signifi-
cant relationships between exercise and positive mood. As the awareness of
both relaxation and exercise in modern stress research has increased, the
method termed Tai Chi Chuan has come to be of interest to scientists in psy-
chology, medicine, and exercise physics, and the number of studies being con-
ducted all over the world is growing rapidly. Since Tai Chi has the unique
feature of combining the exercise of rhythmic movement and self-defense prac-
tice with a kind of yogic relaxation through deep breathing, self-awareness, and
the attempted connecting of mind and body, it is interesting from several re-
search perspectives. In this article, all studies directly concerned with Tai Chi in
connection with stress and well-being reported in Psychlit and Medline
databases during 1996–1999 will be reviewed. Further, in order to give some
historical perspectives, a representative look at earlier studies are included.
Tai Chi Chuan, meaning “supreme ultimate boxing,” originated in China
about 300 years ago as a martial art based on the Taoist philosophical principles
of Yin and Yang (the opposite forces) and breathing techniques. Today it is
widely practiced in different styles, primarily as a means for relaxation and
moderate exercise, all over the world. Among the martial arts, Tai Chi is notice-
able with its flowing, slow, dance-like movements and its function as a system
of calisthenics and self-defense, as well as being a vehicle for meditation and
spiritual well-being. Depending on the practitioners’ preferences, different as-
pects of the art can be emphasized, but the attempted integration of mind and
body in every motion through respiration, mental, and visual concentration and
dynamic relaxation is crucial in Tai Chi (Dunn, 1987). The dynamics of Tai Chi
emphasize movement in graceful patterns. Besides deep, diaphragmatic breath-
ing, Tai Chi is characterized by complete weight shifts, moving from deep
relaxation to full speed and force, and for balance and whole body connection.
The art of Tai Chi rests on five basic principles:
(a) Relaxation. Attempts are made to apply just enough strength for every
movement or task, thereby conserving energy and maintaining stamina.
(b) Separating Yin and Yang. This principle refers to the philosophy of
opposites in nature, for example force versus relaxation, speed versus
stillness, weight shifts, and so on.
(c) Turning the waist. A strong and flexible waist is essential in connecting
the upper and lower body. Ultimate power also originates from muscles

The Effects of Tai Chi Chuan 141
connected to the waist which then transfers it to smaller muscles and
extremities.
(d) Keeping the back erect. Keeping the body perpendicular to the ground
in order to achieve balance comfort, relaxation and optimal energy is a
principle used in yoga as well as other martial arts.
(e) Total body involvement. Synonymous with body synchronization—that
the whole body moves together and not limb by limb—is said to be
achieved through adherence to the other four principles.
Since ancient times Tai Chi practitioners have declared a number of bene-
ficial effects from its frequent use: relief from muscular tension, reduced anxi-
ety, stress, and pain, and increased balance, self-awareness, and strength. Tai
Chi is said to provide a buffer against arthritis, malfunctioning metabolism, and
other illnesses (Dunn, 1987). According to Qu (as cited in Yan, 1995) there are
two major reasons for these experiences. First, participants have to be very
focused and concentrated when practicing, and by doing so they exclude other
distractions and stressors and experience an inner peacefulness. Second, the
nature of the art, with smooth, slow and rhythmic movements, facilitates mus-
cular relaxation and flexibility.
However, there is still little scientific evidence regarding special health
benefits of Tai Chi. Empirical studies have shown that yoga and other forms of
meditative disciplines (see Roberts, 1973), as well as different kinds of relax-
ation techniques, have positive effects as coping strategies in reducing stress
and tension (e.g., Benson, 1975; Everly & Rosenfeld, 1981). Additional studies
on exercise and wellness indicate that moderate exercise has favorable effects
on reducing stress, anxiety, and depression, and enhancing mood and self-es-
teem (e.g., Greist et al., 1979). Studies on other martial arts in relation to well-
being (e.g., Konzak & Boudreau, 1984) have shown positive results in terms of
both mental and physical fitness. It may be that since Tai Chi combines exer-
cise, yoga techniques, and relaxation, some of the favorable effects demon-
strated by research in those areas might occur in Tai Chi as well. This will
require empirical testing, as attempted by an increasing number of researchers.
RESEARCH ON TAI CHI
Comparisons Between Tai Chi and Other Forms of
Exercise and Relaxation
Tai Chi practitioners claim that one should practice Tai Chi in a mindful
manner and learn the philosophy behind the movements in order to deal with
stress effectively (Chan, 1992). A study that emphasized the cognitive aspect of

142 Sandlund and Norlander
exercise was done by a group of researchers from different East Coast univer-
sities (Brown et al., 1995). The main purpose of the study was to see if exercise
that involved cognition led to greater psychological benefits than noncognitive
exercise. One hundred thirty-five sedentary, healthy, older adults (aged 40–69
years) exercised three times a week for 16 weeks for a total of 48 exercise
sessions. Participants were randomly assigned to one of five experimental con-
ditions: (1) Moderate intensity walking (MW), 65–75% of maximum heart rate;
(2) Low intensity walking (LW), 45–55% of maximum heart rate; (3) Low
intensity walking plus relaxation response (LWR, relaxation tape); (4) Mindful-
ness exercise (ME)—Tai Chi exercise; (5) Control (C). The walking groups
used an indoor walking track while the Tai Chi group participated in group
sessions with an instructor. The dependent measures for physiological changes
were aerobic capacity and body composition, and psychological measures in-
volved mood, self-esteem, and life-satisfaction and personality inventories. The
results showed that women in the ME group achieved a significantly greater
decrease in anger and total mood disturbance than the LW, LWR, and C groups,
and also a greater reduction in tension and confusion than those in the LW and
LWR groups. Compared to the LWR condition, the women in the ME group
also showed a significantly greater decrease in depression. Decreases in anger,
trait anxiety, negative affect, and increase in anger control were observed for all
the experimental conditions, and the same findings also were obtained for life
satisfaction and self-esteem post-testing. For the male participants, the MW
conditions had more favorable effects on mood than the other conditions, and
all four conditions showed more positive effects after testing than before on the
life-satisfaction, self-esteem (physical ability), and personality inventories. The
findings indicated that gender is an important factor in exercise, since men
reacted positively to the MW training whereas women seemed to benefit more
from the Tai Chi program with regards to mood improvement. The hypothesis
that exercise modes that contained a cognitive component would result in more
beneficial psychological outcomes was partially rejected, since the LWR condi-
tion did not lead to changes in mood, self-esteem, and so on. The researchers
concluded that “mindful exercise programs” such as Tai Chi will benefit those
individuals who feel comfortable with that kind of activity, or those who, due to
illness or various physiological limitations, are not suited for vigorous exercise.
Jin conducted a study (1991) that compared four different methods for
stress reduction: brisk walking, meditation, reading, and Tai Chi, and like an-
other study (Brown et al., 1995) this research emphasized the physical and
cognitive components of the art. Ninety-six healthy males and females (48 of
each) were recruited from different Tai Chi clubs in Melbourne, Australia, and
randomly assigned to one of the four treatment conditions. A “blind” experi-
menter who had the subjects come in twice to the laboratory conducted the
experiment. The participants were then subjected to both mental and emotional

The Effects of Tai Chi Chuan 143
stress: arithmetic and other difficult mental tests under time pressure and loud
noise, and an emotionally stressful movie. After the second session, the groups
continued with one hour of each of the experimental activities. The dependent
variables were measured by means of heart rate, urine, blood pressure, and
tension/mood scales (POMS and STAI-Y). The participants’ expectations were
also taken into account in a short survey. The results showed that the exercise
intensity of Tai Chi and brisk walking was considered as moderate and resulted
in a release of noradrenaline, which may be beneficial to health. All four condi-
tions appeared to be effective in reducing mood disturbance, and the Tai Chi
group showed a significantly greater reduction in state anxiety compared to the
reading group, a result that might have been influenced by the high expecta-
tions in the Tai Chi condition.
Channer, Barrow, Barrow, Osborne, and Ives (1996) studied changes in
hemodynamic parameters following Tai Chi Chuan and aerobic exercise in pa-
tients recovering from acute myocardial infarction. Patients (N 4126) were
randomly assigned to three groups—Tai Chi, aerobic exercise, or a nonexercise
support group—following acute myocardial infarction. Measurements on heart
rate and blood pressure were recorded during eight weeks. Results indicated
lower diastolic blood pressure only in the Tai Chi group, but significant trends
in systolic blood pressure occurred in both exercise groups.
Szabo, Mesko, Caputo, and Gill (1999) compared post-exercise affect after
sessions of aerobic dance, weight training, martial arts, Tai-Chi and yoga, and
as a control, music appreciation. One obvious problem with this study was that
there was no pure Tai Chi condition. However, results indicated that the com-
bined Tai Chi and yoga group reported higher levels of “tranquillity” than all
other exercise groups. Further, they reported lower psychological distress, fa-
tigue, and exhaustion as compared to the martial arts group.
Stress-Management and Tai Chi
The above studies suggest positive psychological effects of Tai Chi inter-
vention, although the degree of benefit may be based on individual differences
and preferences. Mack (1980) proposes that Tai Chi is a stress-management
strategy. He based this idea on a study targeting African Americans in the
United States, who constantly live with the stressor of the negative sociopoliti-
cal, cultural, and religious attitudes associated with their skin color. In dealing
with this genetic stressor, the only strategy shown to have effects is “a style of
flexible stress-management that is self-directed and contingent on the specific
demands that are faced” (Mack, 1980, p. 28). The choice of Tai Chi was based
primarily on its meditative nature; meditation is believed to reduce anxiety,
hypertension and blood pressure, fear and anger.

144 Sandlund and Norlander
The participants consisted of a number of African-American males who in
pretest interviews reported headaches, restlessness, hypertension, constipation,
and ulcerated stomachs. In a 24-week program, they were instructed in Tai Chi
and afterward completed post-test surveys of affect, sense of control, and physi-
ological and psychological experiences. Participants noted a significant differ-
ence in their consciousness of somatic tension, awareness of stressful events,
and a sense of control through behavioral strategies that deal with the tension.
The author attributes the results to the relaxation response elicited by Tai Chi
exercise: “an integrated hypothalamic response, the cortical-thalamic pause
which leads to decreased activity of the sympathetic nervous system and relaxes
the skeletal muscles, decreases blood pressure, respiration and pupil constric-
tion” (Mack, 1980, p. 37). Further, Mack states that Tai Chi relieves somatic
stress more quickly than deep meditation and provides African-American peo-
ple with a “flexible response repertoire” to deal with both situational and ge-
neric stress.
A study by Slater and Hunt (1997) indicated that even a period of brief
Tai Chi training resulted in reduced nightmares among female undergraduates
as compared to a control group. Although this study was small in scale and
primarily investigated the effect of post-vestibular stimulation on dreaming,
its results are interesting in terms of the general well-being produced by Tai
Chi. Jin (1989) was interested in determining the effects of Tai Chi practice on
heart rate, noradrenaline, cortisol, and mood. The researcher recruited 33 Tai
Chi practitioners of each sex between 16 and 75 years old, from two different
schools in Melbourne, Australia. Using a three-way factorial design, the sub-
jects were divided into groups on the basis of experience, time of day, and
phase (before, during, or after Tai Chi intervention.) Participants filled out the
Profile of Mood States (POMS) and Trait Anxiety Inventory form before and
after testing, and their heart rate, noradrenaline excretions, and cortisol concen-
trations were measured pre-testing and post-testing. Elevated heart rates during
testing qualified Tai Chi as a moderate cardiovascular exercise mode. Heart rate
elevation was greater in the group that had more experience, perhaps suggesting
that Tai Chi is a slowly learned skill which will result in more benefits as skills
become more advanced. Cortisol levels dropped compared to pre-testing; Jin
explains this with the fact that the Tai Chi physical workload only represents
50% of VO
2
max
, (indicating a low workload). Mood improved significantly
during Tai Chi, and remained positive one hour after practice. Participants re-
ported less tension, anger, fatigue, depression, confusion, and state anxiety, but
it is not clear if this effect is due to Tai Chi per se or to the fact that Tai Chi
practice serves as a distraction from problems and anxiety.

The Effects of Tai Chi Chuan 145
Tai Chi and Senior Adults
When subjected to stress, the human immune system will decrease in func-
tioning (show immunosuppression) and the production of lymphocytes will in-
crease (Blonna, 1996). Xusheng, Yugi, and Ronggang (1990) wanted to investi-
gate the effect of Tai Chi on humoral immunity in a group of healthy senior
citizens in Shanghai. They divided participants into two groups: a Tai Chi group
with seven years of experience, and a control group that performed no form of
physical activity. Blood samples were taken before and immediately after Tai
Chi exercise (and from the control group as well) and the dependent measures
were the percentage of ZC rosette-forming cells, lymphocytes, and the total
number of white blood cells. At rest, no difference was found between the
exercise and control groups with respect to ZC rosettes. The post-exercise per-
centage of ZC rosettes was elevated, and there was a direct relationship be-
tween the number of lymphocytes and ZC rosettes whether at rest or imme-
diately after Tai Chi exercise. The detection of ZC rosettes can reflect the
capacity of humoral immunity to some extent, since it indicates a higher num-
ber of antibodies produced by B-cells—that is, an immune response that is
important in defending the organism against pathogens and enhancing resis-
tance to disease. So, according to this study, there may be a correlation between
Tai Chi practice and enhanced humoral immunity in older people.
More recent studies have more or less confirmed the beneficial effects of
Tai Chi for senior adults. The majority of studies on Tai Chi conducted between
1996 and 1999 have touched on the health and well being benefits of Tai Chi
exercise for senior adults. In fact, no less than 80% of the studies reported in
PsychLit and Medline have dealt with this aspect. The results show that Tai Chi
can lead to improved balance (Kutner et al, 1997; Schaller, 1996; Wolfson et
al., 1996), reduced fear of falling (Wolf, Barnhart, Ellison, & Coogler, 1997),
higher oxygen uptake (Lan, Lai, Wong, & Yu, 1996), greater flexibility (Chen
& Sun, 1997; Lan, Lai, Wong, & Yu, 1996; Sun, Dosch, Gilmore, Pemberton,
& Scarseth, 1996), muscle relaxation (Chen & Sun, 1997), enhancment of lat-
eral body stability (Jacobson, Ho-Cheng, Cashel, & Guerrero, 1997), reduced
anxiety (Chen & Sun, 1997), lower percentage of body fat (Lan, Lai, Wong, &
Yu, 1996), increased strength (Wolfson et al., 1996), and a healthier blood pres-
sure level (Chen & Sun, 1997; Wolf et al., 1996).
The results of these studies are intriguing; however, there are methodologi-
cal and other limitations in some of them. Nevertheless, we can conclude that
there now is concordance in recent research that Tai Chi in a number of ways is
beneficial for senior adults. The strong focus on the senior population in this
field can also be seen as confirmation that this area is where the major break-
throughs in Tai Chi research have been made.

146 Sandlund and Norlander
DISCUSSION
Summary and Analysis of Research Results
On the basis of our review, the status of Tai Chi research can be summa-
rized as follows.
(a) The majority of studies on Tai Chi in recent years have concerned its
benefits for senior adults. This is also where research has proven tangible re-
sults. It is not yet clear which of the components in Tai Chi makes the exercise
form especially effective for seniors; neither have corresponding effects in
younger and middle-aged people been investigated properly. The previously
quoted study by Brown et al. (1995) indicated that those who are not suited for
vigorous exercise due to illness or various physiological limitations benefited
most from Tai Chi.
(b) The gender aspect is almost entirely absent from research on Tai Chi so
far. One study (Brown, et al., 1995) touched upon gender differences—male
participants appeared to benefit more from exercise in terms of mood enhance-
ment than females, while females showed a greater decrease in total mood
disturbance after a “mindful exercise” (Tai Chi). With respect to Tai Chi, this
does not necessarily indicate a gender difference in benefits due to practice, but
it might show that men prefer a more strenuous form of exercise when placed
under stress than women. Extensive and longitudinal studies directly addressing
the gender aspect are conspicuous by their absence.
(c) Studies that directly compare Tai Chi with other forms of stress man-
agement techniques (exercise, relaxation, meditative disciplines) are few. At-
tempts have been made to classify Tai Chi as a form of exercise, relaxation, and
meditation. Research designs need to draw lessons from related and more ex-
plored areas. In addition, studies reviewed above (e.g., Jin, 1991; Mack, 1980)
characterize Tai Chi as moderate exercise, perhaps not suitable for achieving
aerobic fitness, but enhancing flexibility and overall psychological well-being
(Jin, 1991; Brown et al., 1995; Mack, 1980).
(d) Time is an important factor in a good study of physical and psycho-
logical interventions. In several of the studies of stress management and Tai
Chi, procedures were in effect for only a few weeks, a duration that could be
too short to truly obtain possible beneficial effects. Early stages of practice
might actually increase stress responses. Mack’s study (1980), by contrast, was
conducted across 24 weeks, increasing the chances that Tai Chi was learned
properly and that participants felt more confident and relaxed in their practice.
The problem with longitudinal studies is often that with time, the number of
peripheral variables increases in the lives of the participants, and the reliability
of the study decreases. The Mack study showed positive effects of Tai Chi
practice on stress and anxiety reduction, but the participants all suffered various

The Effects of Tai Chi Chuan 147
stress-related and psychosomatic symptoms at pre-testing. Their hopes and ex-
pectations that the intervention would relieve their tension also might have af-
fected the results.
(e) Finally, we should not ignore possible individual differences in stress
management. Just as some people do better on exams if they study intensively a
few days before, while others prefer to study just an hour a day for weeks
ahead, so too people differ in their preferences and susceptibilities to various
stress coping strategies. The Pekala and Forbes study (1988) is a good example
of how personality differences can be important in choosing a coping strategy.
They concluded that people with low hypnotic susceptibility benefited more
from progressive relaxation than hypnosis, and that people who had an open
mind toward and felt comfortable with meditative and relaxing exercises would
benefit more from those than other people. This is probably true for Tai Chi as
well as exercise, yoga, or progressive relaxation—people differ in their percep-
tions of the world, affecting susceptibility to different methods. Whatever the
positive outcomes of Tai Chi practice may be, there are some who will benefit
more from it than others. Moreover, since participation in most studies is
strictly voluntary, there is always a risk that participants differ from other indi-
viduals in some aspect (e.g., participants may be more open-minded, have a
higher need for attention than others, and so on) rendering results difficult to
generalize.
SOME SUGGESTIONS FOR FUTURE STUDIES
Since the link between Tai Chi and health still is a quite new field, espe-
cially in the Western world, there is a lot to do when it comes to research
methods and definitions. First, studies that define the skill level and correctness
of Tai Chi needed for health gains (i.e., how should Tai Chi be practiced opti-
mally, and how much experience do we need in order to start benefiting from
practice) would facilitate future studies in this area. This would be necessary
since the studies conducted so far have used participants with very different
levels of proficiency in Tai Chi.
Also, since Tai Chi is classified as a moderate exercise, results from aero-
bic exercise studies may not be directly comparable. What is needed is to know
the minimum duration of training necessary for the body to fully relax when
practicing. William C. C. Chen, the grandmaster of one of the styles of Tai Chi,
states that one has to do the forms for at least ten minutes before feelings of
relaxation and flow will occur (Anderson, 1993). There is also a need for em-
pirical assessment of the neuromuscular activity occurring in doing the form.
There is a need for more longitudinal studies as mentioned in the previous

148 Sandlund and Norlander
section. Methods must be improved so that effects of expectancy and demand
characteristics are minimized.
Studies on the effects of Tai Chi on the immune system are still very
exploratory, but the intriguing and positive results are worth pursuing in larger
studies. Individual differences in benefits from Tai Chi are also important to
study, such as differences in trait anxiety, hypnotic susceptibility, personality
and interest variables, and gender and age factors.
Whether the positive effects of Tai Chi are due solely to its relaxing, medi-
tative, and exercise aspects, or to more peripheral gains, stress reduction often
occurs when we engage in activities in which we find pleasure and believe.
Therefore, Tai Chi may be an efficient means of stress reduction for people who
successfully learn the art and who enjoy its philosophical, martial, and mental
aspects.
ACKNOWLEDGMENTS
This research was supported by grants from Swedish National Center for
Research in Sports, Stockholm.
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