Popular Asian Exercise Now Used for Rehabilitation

Aquatic exercise allows patients to maintain and restore function as well as cardiovascular health

HONOLULU—Ai Chi, the aquatic equivalent of Tai Chi, allows many rehabilitation patients with chronic pain conditions regain the health benefits of exercise, according to Bruce E. Becker, M.D., M.S., a physical medicine and rehabilitation (PM&R) physician.

“Ai Chi has been very successful for patients with chronic diffuse body pain,” says Dr. Becker, a clinical professor at the University of Washington and an adjunct clinical associate professor at Washington State University. “Patients with chronic pain often complain that this pain prevents them from exercising. The warm water experience that characterizes Ai Chi reduces pain while exercising and eliminates post-exertion pain.”

Dr. Becker will speak on Nov. 9 at the American Academy of Physical Medicine and Rehabilitation’s 67th Annual Assembly as part of a panel on Ai Chi: an aquatic movement technique for chronic pain rehabilitation.

Ai Chi, developed by a Tai Chi master, is performed while standing in a deep pool of warm water. The movements are a derivative of Tai Chi movements. According to Dr. Becker, Tai Chi works very well as a movement strategy for maintenance of strength and balance.

“My patients feel really good after an Ai Chi session,” Dr. Becker says. “For my patients, Tai Chi is difficult, since many have lower extremity joint problems.”

Dr. Becker does not believe many physicians are aware of Ai Chi. “Physical medicine and rehabilitation physicians are aware of the value of exercise. There has been a significant amount published about Tai Chi in the rehabilitation literature, but Ai Chi generally has been ignored,” he concludes.

Ai Chi appears to be a good solution for many complex problems. Patients with a combination of pain issues, such as fibromyalgia, degenerative lumbar spine disease and hip or knee joint degeneration, do very well with Ai Chi, according to Dr. Becker. Ai Chi allows rehabilitation patients to maintain function in unaffected joints while improving strength across joints that may be damaged or diseased.

“The Ai Chi program is generally a very useful rehabilitative strategy,” Dr. Becker comments. “After a patient has individually worked with a therapist on a rehabilitative strategy and appears ready to phase into an independent program, I put them in an Ai Chi program. Ai Chi has a high retention rate, since patients are able to perform exercises that would be difficult to conduct out of the water.”

Ai Chi essentially brings together a number of potentially therapeutic physiological effects associated with immersion in warm water. During neck-depth immersion, hydrostatic pressure causes blood to move from the extremities up into the chest cavity. Ai Chi has an effect on cardiovascular function that Dr. Becker says is almost the equivalent of aerobic exercise training from a cardiovascular standpoint. The exercise often lowers blood pressure, in part due to hydrostatic pressure and in part due to a reduction in vascular resistance during warm water immersion, but the relaxation effect of breathing control may also play an important role in this reduction.

The buoyancy of water also off loads pressure from the weight bearing joints, which is helpful for patients with spine pain or hip or knee pain as well as postoperative situations.

“There are effects on pain perception that may be driven by the ‘gate theory’ of pain management,” explains Dr. Becker. “Feeding an explosion of impulses to the spinal cord can mask pain awareness. Patients with fibromyalgia, joint pain or other chronic pain conditions often become significantly more comfortable simply through activity.”

Ai Chi programs can be community based or run by hospitals. Dr. Becker enrolls patients in both types of programs while advising them to continue seeing a therapist weekly or monthly to monitor goals and objectives.

The American Academy of Physical Medicine and Rehabilitation is the national medical specialty society of more than 7,500 PM&R physicians, also called physiatrists. PM&R physicians focus on restoring function. They care for patients with acute and chronic pain and musculoskeletal problems like back and neck pain, tendinitis, pinched nerves, and fibromyalgia. They also treat people who have experienced catastrophic events resulting in paraplegia, quadriplegia, or traumatic brain injury and individuals who have strokes, orthopaedic injuries, or neurological disorders such as multiple sclerosis, polio, or ALS.

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Editor’s Note: Dr. Becker has no financial interests, arrangements or affiliations to disclose that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.
 

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