Journal of Physical Activity and Health, 2009, 6, 230-238

© 2009 Human Kinetics, Inc.

Meditative Movement as a Category of Exercise:

Implications for Research
Linda Larkey, Roger Jahnke, Jennifer Etnier, and Julie Gonzalez

Introduction: Meditative Movement (MM) is Mind–body approaches to health are those prac-
proposed as a new category of exercise defined tices (eg, meditation, breathing techniques) that gener-
by (a) some form of movement or body posi- ate states of mental and physical relaxation or those (eg,
tioning, (b) a focus on breathing, and (c) a psychotherapy, support groups) that strive to improve
cleared or calm state of mind with a goal of (d) attitudes and emotions regarding health.1 Some mind–
deep states of relaxation. Review: Two forms body practices incorporate movements that could be
of exercise meeting this definition, Qigong and considered physical exercise at varying levels of exer-
Tai Chi, are reviewed to examine health bene- tion. Mind–body practices that incorporate movement
fits found in the research literature, recap ele- are increasingly being used as complementary
ments that should be assessed in MM research, approaches to health and healing,2 and the body of
and suggest where aspects of MM intersect research that theorizes and tests how these practices
with, and are distinguished from, conventional may work to affect health is growing. What most distin-
forms of exercise. Results: Relevant dimen- guishes these mind–body practices from traditional
sions of the key elements of MM, such as fre- forms of exercise is that they generally include a focus
quency, duration, type of movement, degree of of the mind on the body and breathing as vehicles for
exertion, description of breathing, and achieve- accomplishing deep states of relaxation. These include,
ment of relaxed state are recommended to be but are not limited to, familiar forms such as yoga, Tai
clearly described and measured to consistently Chi, Qigong, and other less familiar forms such as Sign-
define the category across studies and clarify Chi-Do,3 Neuromuscular Integrative Action,4 and
how MM may affect health outcomes in simi- Eurhythmy.5
lar, and perhaps different, ways than conven- Just as aerobic exercise has become defined over
tional exercise. Conclusions: If these sug- the years as an umbrella construct that incorporates
gested standards are used, we will gain a better many different forms of exercise, there is a need to begin
understanding of which elements are necessary to define an umbrella construct for emerging forms of
for achieving targeted outcomes. Over time, as exercise that incorporate meditation and breath practice
MM is studied as a category of exercise, to initiate and sustain purposeful states of relaxation.
research may progress more efficiently to Aerobic exercise is defined as any form of physical
define the domains of physiological and psy- activity that generates increased heart rate and breath
chological benefit. volume to meet the oxygen demands of the muscles
being activated.6 The equivalency of many different
Keywords: stress, breathing exercises, Tai Chi, forms of aerobic exercise has been established based not
Taiji, Qigong only on the level of exertion generated in the activity,
but also on the underlying similarity in mechanisms of
action and related outcomes on cardiovascular function-
ing. Disparate activities such as bicycle riding, jogging,
and dancing then could be treated as equal partners in
Larkey is with the College of Nursing and Healthcare Innova- research on aerobic-exercise effects on health outcomes
tion, Arizona State University, Phoenix, AZ 85004. Jahnke is as long as the dimensions of the aerobic activity were
with The Institute of Integral Qigong and Tai Chi, Santa Bar- measured and accounted for in the analyses.
bara, CA 93117. Etnier is with the Dept of Exercise and Sport In developing a definition of a new category of
Science, University of North Carolina, Greensboro, NC 27410. exercise that focuses on a different set of required
Gonzalez is with the University of Arizona, Arizona Cancer dimensions such as meditation and focused breathing,
Center, Phoenix, AZ 85012. those dimensions should also be described, measured,

230
 Meditative Movement as Exercise   231

and assessed so that they can be consistently examined (eg, inhaling as arms slowly rise and exhaling as they
relative to health outcomes. This is a first step in estab- float downward), or for breathing-only exercises in
lishing a working definition of this category of exercise which patterns of quick or slow, deep or short breaths
and in developing an understanding of possible mecha- are combined to create specific effects.
nisms of action. Finally, the last element that is important to these
Our goals for this article are threefold. First, we practices is the deep state of relaxation, not only a sug-
will present a working definition of Meditative Move- gested goal, but a required element, intrinsic to the prac-
ment (MM), which is proposed as a new category of tices. In some forms, vigorous movement is used to
exercise. Second, we will provide evidence that 2 forms create a state of relaxation after the movement is slowed
of MM, Tai Chi and Qigong, are associated with a or stopped. In other forms, the movement or postures
number of common health benefits. By so doing, our are intended to generate relaxation concurrent with the
intent is to demonstrate that although Tai Chi and movement. In either case, going into a deep state of
Qigong have unique characteristics that may differenti- physical and mental relaxation is a key element of
ate them, their similar effects in terms of health out- MM.
comes point to the need for guiding research that cuts These practice elements taken together, a focus of
across MM forms. Third, we recommend ways to mea- the mind, movement, a focus on breathing, and the
sure the defining components of MM. Our goal is to attainment of a deeply relaxed state, comprise the
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provide guidance for researchers to more clearly dimensions we use to define MM. Single elements, such
describe, define, and operationalize the key components as breathing techniques or meditation, have demon-
of their MM activity so that in the future we will have strated beneficial effects related to stress reduction.7,8
available the necessary information to begin to compare When these components are combined (as in yoga,
findings across studies. Qigong, or Tai Chi), the broader practices have been
shown to be predictive of a wide range of health benefits
that may or may not be achieved with any single
Meditative Movement: element.
A Working Definition In an effort to begin to delineate some of the pos-
sible implications of grouping such forms together into
Our definition of MM begins with a requirement for one category of exercise and to examine what defines
focus of the mind (ie, attention, awareness) in medita- them, what benefits may arise, and how these might
tive practice. Meditation forms vary widely, making differ from other forms of exercise, 2 closely related
standardized research on meditation challenging,7 but forms, Qigong and Tai Chi, will be presented as exam-
most include either keeping the awareness focused on a ples of forms of MM that have been demonstrated to
specific target such as an image, an ideal, a mantra, or result in the same health effects.
the breath itself or, conversely, clearing the mind to the
point of quiet emptiness. Often in forms of MM, it is
recommended that the mind be engaged in the move- Two Forms of MM With Common
ment practice in the present moment, to the exclusion of Health Benefits
all other thoughts. Any of these forms are considered
valid versions of meditation in our definition of MM. Qigong and Tai Chi are close relatives having common
In addition to meditation, MM usually includes theoretical roots and much overlap in the components of
some form of body movement that is typically described practice. Teachings of Qigong and Tai Chi (both compo-
as slow, relaxed, and flowing, but may range from a high nents of Traditional Chinese Medicine, or TCM) recom-
level of dynamic movement to quiescent static postures, mend, “Mind the body and the breath, and then clear the
with or without specific choreography. Dynamic prac- mind to distill the Heavenly elixir within.”9 That is, the
tice without specific choreography includes such prac- combination of awareness and correction of the posture,
tices as Spontaneous Qigong, in which all body parts the flow of breath, and stilling of the mind to achieve
are shaken in spurious movements, whereas other forms deep states of relaxation is thought to comprise a state
of Qigong and Tai Chi are highly choreographed of being required for the proper practice of Qigong, and
dynamic practice. Examples of static postures include these guidelines similarly characterize the correct prac-
Qigong standing meditation and hatha yoga in which tice of Tai Chi. Thus, both of these practices are clearly
the body is held in a variety of stationery positions for a representative of the category of exercise MM, as
period of time. proposed.
MM also includes a focus on breathing to bring the There continues to be skepticism among mainstream
mind and consciousness to a restful state but also to exercise physiologists and sports medicine researchers
bring additional oxygenation and/or “energy” to the regarding the degree to which the efficacy of these forms
body. The breathing may be passive with a simple of exercise relative to fitness and overall health outcomes
reminder to keep the mind in a state of watching the has been established. However, the growing evidence
breath. In other forms, breathing is prescribed in very from research on the health benefits of Qigong and Tai
specific ways, either for patterning with the movement Chi (including more than 70 randomized, controlled
 232   Larkey et al

trials10) and the commonalities in the findings make apy alone20,21 suggests significant reduction in systolic
them excellent examples to use to support our contention blood pressure. Additional evidence for Qigong effects
that MM should be considered a new category of on BP parallels the findings for Tai Chi, including
exercise. reports that a significant reduction can been achieved
Although the underlying mechanisms of action with Qigong compared with wait-list controls22,23 and
may not currently be understood for how these 2 repre- that significant reductions are obtained for Qigong at
sentative forms of MM may achieve results, Qigong and similar levels to conventional exercise.24
Tai Chi have fairly consistently been shown to have
similar health benefits. Four categories of outcomes will Mental Health
be reviewed briefly in turn, demonstrating similar effects
of both Qigong and Tai Chi. These particular domains Four RCTs have demonstrated potential for Tai Chi to
of research have been selected for brief review relative improve various aspects of mood or psychological state.
to the accumulating evidence of effects as a result of In 1 study, Tai Chi was found to reduce stress after an
both Qigong and Tai Chi. Other outcomes, particularly acute stressor,25 and in 2 others, effects of Tai Chi were
cardiovascular, respiratory function, and fitness examined over time, resulting in significant declines in
effects,11,12 have been studied in the empirical literature, depression/anger26 and anxiety17 and improved mental
some using strong study designs reported in critical health.27 A pre–post Tai Chi design (no control group)
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reviews.13,14 However, these are less useful because suggested a reduction in depression and anger and cor-
studies on these outcomes are predominated by either relations with predicted reductions in salivary cortisol
Qigong or Tai Chi, thus negating our ability to compare levels and increased noradrenaline excretion in urine.28
findings for the 2 forms of MM. In a previously mentioned study that primarily
Furthermore, the selection of outcomes to be tested effects of Qigong on blood pressure, emotions
reviewed is based on the existence of high-quality evi- were found to be significantly improved for those prac-
dence that supports these common health benefits. Thus, ticing Qigong compared with wait-list controls.23 In
for this discussion, we have limited our selection of patients with fibromyalgia, the practice of Qigong
empirical articles to those that give adequate detail on resulted in reductions of depression compared with a
research design and control methods and that use ran- control group,29 and significant reductions in depression
domized, controlled trials (RCT) or some form of con- were found in hypertensive patients practicing Qigong
trol group (ie, matched controls). A few pre–post inter- or conventional exercise compared with controls.24
vention designs are cited and are described as such. Very Finally, in a recently completed RCT, Qigong was found
few published studies of Tai Chi or Qigong are based on to have the same effects on enhancement of mood as a
stringent design elements such as establishing an effec- conventional walking group control, providing similar
tive placebo control, blinding study staff, or presenting support for the concept that Qigong improves mood to
intent-to-treat analyses, so these were not set as criteria the extent that it imitates mild to moderate aerobic exer-
for inclusion nor will they be reported. Because several cise effects.30
reviews of the research literature on Qigong and Tai Chi
have been recently published, some of these review arti- Functional Balance
cles are used as a basis of discussion, supplemented by
our updated review of original research. Wang, Collet, and Lau14 provide an extensive review of
11 studies examining the effects of Tai Chi on physical
function and balance, factors implicated in preventing
Blood Pressure falls (see conclusions of the FICSIT analyses).31 In gen-
In a recent review of Tai Chi research among older eral, all of these studies demonstrated improvements in
adults, 3 studies included blood pressure (BP) as a key factors related to risk for falls as a result of practicing
outcome variable, demonstrating evidence for a reduc- Tai Chi. Among these studies, 2 RCTs showed signifi-
tion of BP in response to Tai Chi practice, suggesting it cant improvements in balance, strength, and stability in
“is probably as beneficial as aerobic exercises in reduc- a younger population (age 20 to 45)32 and these same
ing blood pressure.”15 Other studies with similar quality factors plus flexibility in older adults (mean age of 76)
of design (randomized or matched controls) also showed after practicing Tai Chi for 12 to 15 weeks.33 Additional
that BP is reduced significantly for those practicing Tai recent empirical evidence has demonstrated the superi-
Chi compared with no-exercise controls16,17; this reduc- ority of Tai Chi over conventional stretching exercises
tion is similar to the effects of aerobic exercise.18 for improving functional balance,34 and in a study of
A recent review19 addressed the large body of lit- sedentary, middle-age women, Tai Chi performers dem-
erature on effects of Qigong on hypertension, most of onstrated improved balance over controls matched on
which is published in Chinese and provides limited age and body size.16
information on study design. Meta-analysis conducted The potential of Qigong for preventing falls has
on 2 criterion-selected studies of Qigong as an adjuvant only begun to emerge. In a RCT of elderly patients
to hypertensive medications compared with drug ther- with coronary artery disease, balance (as assessed by
 Meditative Movement as Exercise   233

performance on the 1-leg stance) and coordination were randomized to the intervention receiving influenza vac-
significantly improved in the group practicing Qigong cine showed a significant increase in the magnitude and
over usual-care control patients.35 Furthermore, a group duration of antibody response compared with wait-list
of fibromyalgia patients demonstrated significantly controls.47
greater improvements in “movement harmony,” a proxy
for balance, after practicing Qigong and as compared Summary
with a control group.36 In a RCT that combined Qigong
and Tai Chi in a 6-month intervention, several Although there is an imbalance in the number and type
mechanisms purportedly related to balance were of studies conducted on the 4 health outcomes reviewed,
significantly improved in the treatment group compared the growing evidence suggests that Qigong and Tai Chi
with wait-list controls, including vestibular ratios of the demonstrate similar outcomes for blood pressure,
Sensory Organization Test and quiet stance Base of mental health outcomes, functional balance, and immune
Support.37 One of the theorized mechanisms for function. These are presented as first steps in identifying
improving balance is through leg strengthening resulting common health outcomes that may be important to
from the leg-bent position of many Tai Chi exercises; explore for MM forms in general. We turn now to impor-
many Qigong forms include similar soft lunges and leg tant parameters of MM, as informed by the more detailed
bending in the series of movements, making it rather examples of Qigong and Tai Chi practice and outcomes
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likely that if more studies were to be conducted for that could potentially be controlled and/or reported for
Qigong, a similar result might be found. purposes of standardizing and generalizing further
research.
Immune Function
Research examining the effects of Tai Chi on immune Measurement of the Defining
function is growing, with existing empirical evidence Components of MM
supporting the benefits of Tai Chi for this outcome. In a
recent RCT, the effects of a modified form of Tai Chi The relationship between health outcomes and the vari-
practice on immune function were examined in patients ous elements of Qigong, Tai Chi, or any other MM form
with exposure to varicella zoster and subsequently vac- cannot be adequately determined without clearer mea-
cinated (shingles). Results demonstrated that those in sures of the dimensions that compose these practices.
the Tai Chi group showed significantly improved cell- Clues as to the mechanisms of action of Qigong and Tai
mediated immunity (CMI) to varicella zoster virus Chi come from some of the outcomes-related research
(VZV) compared with a health education control delineated earlier. Changes in mental health and blood
group.27 This study extended the findings of an earlier pressure seem to parallel outcomes found following aer-
study of older adults performing Tai Chi, resulting in obic exercise; functional balance outcomes are similar to
significant improvements in CMI to VZV compared what might be found for mild strength training. Immune
with wait-list controls.38 Improvements in thyroid-­ function has been variously related to conventional exer-
stimulating hormone, follicle-stimulating hormone, tri- cise, showing both immune-building as well as proin-
iodothyronine,39 and lymphocyte production40 have flammatory processes, depending on type and intensity
been noted in response to Tai Chi groups as compared of exercise (with moderate, regular exercise generally
with control groups, providing indication of homeosta- found to promote immune function),48 whereas immune-
sis supportive of immune function. In addition, pre–post related responses to Qigong and Tai chi are only begin-
Tai Chi intervention designs have shown an improve- ning to be explored. To identify the common elements of
ment in levels of IgG41 and natural killer cells,42 thus MM that may be related to these important health end-
suggesting an impact on immune function. points, either as a function of conventional exercise or as
Similar results have been found for Qigong. Qigong unique contributors, it becomes necessary to control for
practice by healthy subjects and cancer patients has and/or report the factors that may be influencing out-
been shown to influence circulating numbers and func- comes. This will serve to standardize the method in
tional activities of white blood cells, comprising lym- which the MM activity is described and defined and will
phocytes, monocytes, and natural killer cells.43,44 Stud- improve our ability to compare between studies and to
ies in healthy subjects reveal enhanced immune identify potential underlying mechanisms.
cell-mediated delayed hypersensitivity,45 as well as At least 3 guidelines are needed to begin the pro-
related in vitro increases in lymphocytes producing the cess of standardizing research in MM. First, if a proto-
Th1 cytokine interferon gamma (IFN-) versus the Th2 col is developed with an exercise form considered to be
cytokine interleukin (IL)-10.46 This shift infers a benefi- MM, the required components that qualify the form as
cial swing toward Th1 cell-mediated immune activation MM should be assessed as a means of defining the par-
in contrast to immune suppression mediated by Th2 ticular form of MM. Second, those factors that might
cytokines.46 Most recently, a study that combined the resemble and compete with the effects of conventional
practices of Qigong and Tai Chi found that participants exercise should be assessed to discriminate the effects
 234   Larkey et al

of such mediators of health benefits. Finally, additional Type of Movement.  Speed of execution and emphasis
factors drawn from the principles and theories of the on flowing motion varies by style and specific exercise
particular practice should be assessed to maintain across many forms of MM, but generally, the motions
research fidelity with what is seen as unique and integral are flowing and gentle. In a recent test of a sham Qigong
to the practice.49 For example, we propose examining protocol compared with true Qigong, Larkey and col-
“Qi” in Qigong and Tai Chi or “Prana” in yoga to see if leagues51 developed a 9-item scale for observers to rate
these are related to the achievement of health outcomes. movement for such characteristics as flowing movement
These 3 domains of assessment to standardize research and relaxed appearance (alpha coefficient = .87). This
are each addressed in turn: manipulation checks of fac- instrument may form a basis for the further develop-
tors that define the practice, competing explanatory ment of observational tools to assess the type of move-
variables, and theoretical foundations unique to the ment used in a MM practice. Furthermore, these com-
practice. ponents may also be assessed using self-report measures
that have not yet been developed. Other aspects of
movement that are peculiar to some forms of MM
Assessing Required Components should be regularly described and assessed, such as the
Defining the Form of MM shaking motions recommended as warm-ups in Qigong
and yoga or static postures that stretch and squeeze parts
Factors expected to be characteristic of MM should be
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of the body.
assessed to standardize reporting of elements that might
be relevant and to provide an indication of the degree to Degree of Focus on Breathing and Type of Breath-
which the exercises are being performed with the full ing.  Breathing practices vary greatly among the myriad
quality and range of requirements fitting our definition forms taught in yoga, Tai Chi, and Qigong as well as
of MM. These types of measures are comparable to the less well-known forms of MM practice. For example,
testing of purity and strength of botanicals or drugs in some teachers of Tai Chi or the simplified practice of Tai
clinical trials and should be added to MM studies. For Chi Chih do not present a unified guideline for breath-
example, in a recent study, emphasis on relaxing the ing but mostly suggest that the breathing follow the
mind, motion speed, and conscious control of move- movement naturally. Some Qigong practices include a
ment were proposed as 3 important dimensions of exer- number of sitting or walking exercises accompanied by
cise to define and compare cardiovascular versus mind– breathing in specific patterns, such as the Xi Xi Hu
body (Tai Chi Chuan) exercise effects on memory,50 but breathing (or inhale, inhale, exhale) used in Guolin
there was no direct assessment of these dimensions. By Qigong. In some yoga practice, coordinating the breath
assessing the presence and levels of elements theorized with specific dynamic movements is recommended,
to contribute to particular health benefits, eventually a whereas in teachings associated with static poses, the
volume of studies that collects data on similar dimen- breath is often taught as a focusing tool without a spe-
sions would allow for meta-analytic review. cific prescription for depth or pattern. In contrast,
The measures we recommend to establish quality pranayama is a yoga practice singularly focused on
assurance, implementation fidelity, and assessment of breathing techniques.
elements potentially related to outcomes of MM prac- What is most common, however, is a general
tice include (a) type and degree of meditative focus, (b) instruction for deep abdominal breathing along with
type of movement (relaxed and flowing, static postures, poses and movements, providing lung volumes beyond
spontaneous/shaking, isometric, stretching, or squeez- the muscular oxygen requirements of the exercise. This
ing), (c) degree of focus on breathing and type of breath- component of MM practices has not been well studied
ing, and (d) the achievement of deep relaxation. in terms of the differences between effects of deep
breathing alone and deep breathing that is induced
Type and Degree of Meditative Focus.  The first
during intense aerobic exercise. To explore possible
dimension considered critical to the definition of MM is
effects, it would be important to at least describe the
the focused mind achieved through meditative practice.
breathing practice prescribed for any given intervention
Generally meditation studies take this state for granted
study. Eventually, observational, self-report, or pulmo-
as part of the practice without direct assessment. Partici-
nary measures of depth, speed, volume, and other
pants may vary greatly in their subjective interpretation
parameters of breathing and self-report measures of the
of their achievement of a focused mind and meditative
mental focus on breathing could be included as research
state. Documentation of the recommended techniques
progresses in this area.
for focusing or clearing the mind7 should be included in
studies of MM. One possible way to further assess The Achievement of Deep Relaxation.  Closely related
mind-focusing practices is to develop self-report instru- to the focus of awareness on the body and breath is the
ments that require participants to rate their perceived attainment of deeply relaxed states, the fourth character-
success in whatever mental focus practice is recom- istic we have used to define MM. One tool for objec-
mended (eg, developing scales that measure degree and tively measuring what is believed to be correlated with
amount of time one was able to keep the mind from the deep, relaxed state of meditation is brain wave activ-
wandering). ity. Although it is expensive and often not feasible to
 Meditative Movement as Exercise   235

add such an assessment to studies, measurement studies tion (RPE)56 as a simple tool that could be easily incor-
could be conducted to find the self-report assessments porated across studies with various populations to deter-
most closely correlated to electroencephalographic mine relative intensity of activity.
readings of slower brain wave activity, generally, alpha Other conventional exercise factors to control for
or even theta waves as indicative of meditative states and/or report in studies of MM include exposure or dose
being reached.52 In addition, the neurotransmitter pro- of exercise (frequency and duration) and strength train-
file associated with relaxation, also expensive, could be ing effects. As more studies reveal the potential of MM
used as a clinical metric to assess status of the auto- to improve more specific exercise-related factors, for
nomic function. Measures of perceived relaxed states example, leg strength related to balance, it may become
would complement the objective measures of brain important to specifically measure such factors. That is,
function and neurotransmitter profiles in relaxation. measures of muscular strength (eg, 1 or 10 repetition
Together, a deep state of reverie and a profound state of maximum, peak torque) may need to be taken before
physical relaxation would be important to assess to and following MM interventions to directly assess this
qualify a practice as MM. mechanism that might underlie improvements in bal-
ance and functional fitness, if they occur. At least, an
MM Resembling and Competing evaluation of the proportion of movements that involve
moderate or deep knee bending should be documented,
With Conventional Exercise
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along with other suspected mechanisms, to begin devel-

Because MM includes some level of movement similar oping theories of how MM might affect balance.
to conventional exercise, those aspects of the practice
should be assessed for possible mediating effects on Additional Factors Unique and Integral
outcomes. These include the level of aerobic activity or
to Form of MM
exertion and strength building activities. Numerous
studies have assessed energy expenditure during Tai Finally, those aspects of MM that may be unique to par-
Chi, concluding that Tai Chi is a mild to moderate form ticular traditional practices, but are untested regarding
of exercise with a wide range of intensity, ranging from their potential relationship to health outcomes, should
1.5 to 4.6 METs (with the Yang style, at the higher end be assessed. Among the proposed dimensions for defin-
of the METs scale, being the most frequently ing a practice as MM, we do not include a requirement
studied).13,53,54 Various forms of Qigong have not been for a focus on “energy.” Because some traditions treat
as systematically evaluated, but a form of Qigong, called this element as critical (such as Qi in TCM or prana in
“Tai-Chi-Qui-Gong,” has shown results similar to Tai yoga) and others do not even mention it, we suggest that
Chi relative to the range of METs.55 Qigong has also it would be important to find ways to identify if this is
been demonstrated to make physiological demands sim- important to achieving health outcomes. Although the
ilar to those of self-paced walking.12,30 tools to assess the purported correlates of Qi or prana
Such studies that measure aspects of cardiorespira- are still being developed, at least 2 such instruments
tory involvement should not claim that these findings have enjoyed a degree of validation and may prove
represent conclusive comparisons of all forms of useful for evaluating levels of Qi cultivation as well as
Qigong/Tai Chi. Just as there may be differences in the balanced state of the Qi channels.
speed with which one rides a bike, or dance forms that Measuring Qi, or changes in Qi, is challenging
lend themselves to more or less vigorous exertion, so mostly because many Western scientists are unsure what
also, the forms of Qigong and Tai Chi and other MM Qi is or if it even exists. Even when shown to be consis-
practices may vary with individual teachers and styles tently related to physiological conditions, these critics
and in individual practitioners. Level of exertion, then, doubt that imbalances in Qi as measured by such instru-
is an important factor to assess across all MM studies, ments are really valid measures. However, measurement
including those incorporating Qigong or Tai Chi. tools are currently being developed to assess Qi, and we
Target heart rate and estimated maximum heart rate introduce examples of these tools here with information
are often used as a simple way to assure that exertion regarding their current status.
levels are within a moderate and effective range by aero- The first method uses instruments that assess elec-
bic exercise standards, and these might be appropriate trical conductivity along each of the 12 TCM energy
recommended measures for MM studies. However, with channels (or pathways upon which the acupuncture
the multiple comorbidities often occurring with the points are aligned) by introducing current between 2
elderly, medications that affect heart rate may interfere electrodes touching the skin at points along each of the
with this measurement. The Borg Rating of Perceived channels. In studies incorporating such measures, a
Exertion is the preferred method to assess intensity level of conductance is obtained for each organ energy
among those individuals who take medications that channel to evaluate baseline levels and then responses
affect heart rate or pulse, and given the growing popu- are gauged relative to interventions expected to increase
larity of these alternate forms among the elderly, this or balance overall Qi. The patterns of electrodermal
instrument would be useful across studies of MM. Thus, response follow the expected theorized patterns of Qi
we recommend using Borg’s Rating of Perceived Exer- response according to TCM, indicating that, at least,
 236   Larkey et al

these patterns of electrodermal measures correlate with tion and means for measurement) may eventually pro-
expected patterns of Qi. For example, an increase in vide bridging evidence for the relationship between
conductivity along acupuncture channels has been health outcomes and the meridian theory of TCM.
shown in response to Qigong practice.57 Moreover, con-
vergence of measures of electrical conductivity has been
found in response to Qigong practice as predicted as an Conclusion
indicator of “balance” (that is, conductivity measures We suggest that MM should be designated as a new cat-
that are similar among each organ energy channel are egory of exercise based on the similar practice elements,
considered to be reflective of approximately equal Qi similar underlying principles, mechanisms of action,
flow among the channels).58 In keeping with predictions and common health outcomes of these forms of physi-
of TCM, significantly lower electrical impedance levels cal activity. We present the examples of Qigong and Tai
have been found for many acupuncture points, com- Chi as 2 practices with identical theoretical roots as a
pared with the surrounding nonacupuncture skin areas,59 starting point for identifying defining elements and sim-
and conductance is higher between points on the theo- ilar health outcomes. Furthermore, we suggest that as
rized acupuncture energy channels than between points research proliferates on such forms of exercise that are
not on the channels.60 Thus, whether evaluating overall clearly different from conventional exercise, particu-
balance, or fit to the expected changes in the Qi chan- larly those based on different principles than our famil-
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nels in response to certain MM practices, instruments iar models of aerobic exercise and strength training,
that measure electrical impedance/conductance may methods for evaluating these forms are needed.
prove to be useful. Researchers incorporating any form of MM should
Another method of evaluating theorized correlates consider assessing those aspects that parallel conven-
of Qi, the Gas Discharge Visualization (GDV) device, tional exercise parameters (ie, RPE, duration, fre-
purportedly measures the strength of each Qi channel in quency). Aspects of MM that do not parallel conven-
TCM theory and is able to compare each to normal tional modes and measures of exercise should also be
ranges based on normalized scores of hundreds of test assessed to assure quality of interventions and to begin
individuals.61 The GDV is used to photograph biopho- to establish knowledge about which, if any, of these fac-
ton emission from the fingertips. The fingers are placed tors matter for achieving outcomes (eg, flowing and
on a dielectric plate while a very low microampere relaxed movements, patterns of breathing, meditation
signal (1 ms pulse duration) is passed into the fingertip. practices, attainment of deep states of relaxation, and
The movement of electrons across the dielectric plate
balance of Qi). Given that some of the instruments pro-
and the subsequent collision and ionization of the gas
posed here to assess the unique components of MM are
molecules surrounding the fingertip result in the pro-
under development, it is clearly too soon to establish
duction of biophotons around the finger. The camera is
consistent measures across studies. We propose that
used to take a picture of this emission, which often
researchers addressing these forms of exercise begin to
appears as branch-like patterns. The emissions are
work toward developing, validating, and standardizing
“mapped,” according to the principles of TCM, from
measures for these factors.
acupuncture points in the fingertips to their associated
In the meantime, much can be learned from a more
body systems and organs, and the length and density of
critical evaluation of the aerobic and strength training
emissions are purported to represent patterns in the
implications of MM according to conventional models
body’s field of “energy.”
of how exercise works. In the end, we need to address
The GDV parameter most representative of “bal-
the possibility that there are some similar and some dif-
ance” is an index score reflecting the composite scores
ferent mechanisms underlying the health benefits of
of each organ energy channel’s standardized distance
MM, but clearly research designs need to incorporate a
from zero. A favorable balance index has been shown to
broader set of measures to identify these mechanisms.
improve among hypertensive patients after practicing a
single session of Qigong.51 Similar results were found
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