03/06/2015

改善憂鬱症從日常生活做起

改善憂鬱症從日常生活做起

蘇冠賓
中國醫藥大學 精神醫學教授兼任醫學院副院長
台灣營養精神醫學研究學會 理事長

很多病人會問醫師,「除了吃藥,還有沒有其他輔助的方法可以的改善病情」?「運動、陽光、吃魚,到底對憂鬱症有沒有幫助」?本文將探討這些相關議題,嘗試把「研究結果轉譯到臨床運用的可行性」,結合藥物治療及心理治療,對憂鬱症的整合性療法做簡易的介紹。

正統醫學首重實証,而實証醫學又以「隨機分配且有控制組」的研究最為可信(註一)。憂鬱症的治療中,因為藥廠可以投入研發實驗的經費最高,而且政府對藥物上市的規範也最清楚,所以「抗憂鬱症藥物(antidepressants)」實証研究資料最為豐富。其次,「心理治療」雖然缺乏很好的「隨機分配且有控制組」的研究,但由於臨床效果明顯,也被廣泛接受。至於其他療法是否建議病人實踐,也都應該根據實証醫學的結果。

對於「運動、光照、和魚油」,我們都可以找到支持這些建議的「隨機分配且有控制組」的傑出研究,但是也有另外一些研究並不支持(複雜性疾病臨床實驗上的常態現象),或者某些研究方法根本不適合臨床上的建議(例如:特定認証的運動訓練師、特殊的營養素組合或劑量、特殊的光照儀器等等)。因此,臨床醫師要能夠傾聽病人的期待,思考「研究結果轉譯到臨床運用的可行性」,指引病人促進健康。


(作者與國際合作團隊發表論文,推動以大腦保健為目的日常生活介入,Ref. 4)



首先,「魚油」保健和病患的「飲食及營養」息息想關,「營養醫學」已漸受主流精神醫學之重視(注二)。不論病患是否實際服用魚油補充品(N-3脂肪酸),僅僅是病患開始注意營養攝取或避免飲食中人工添加物、毒素或污染,也都有益改善生活型態和身心均衡。N-3脂肪酸的抗憂成分以EPAeicosapentaenic acid)為主,建議治療劑量在每天服用含 EPA 超過1為原則,四週後效果不夠時可以加至2,服用時應該在醫師的評估下,留意腸胃不適或凝血功能上的影響。基本上,良好的魚油濃縮和精鍊過程可以去除重金屬污染,所以如果服用的是魚油膠囊則比吃魚更加安全。病患可以自行選購優良製藥 GMP的任何產品,只要成分穩定,療效應該不會受到製造廠商或原料來源的影響。值得注意的是,台灣的衛生單位並沒有對N-3脂肪酸的販售做嚴格把關,台灣市面上多數的產品並沒有經過衛生單位抽檢,品質不一,因此選擇時要格外留意。

我們最近成立了「國際營養與精神醫學研究學會(ISNPR)」,目的在推動營養科學在精神醫學上的應用研究,以造福病患,提供病供更多有效療法的選擇(Ref. 2, 3)。除了魚油之外,維生素中的B1 (thiamine)、B9 (folate)、B12DS-腺苷基甲硫氨酸(S-adenosylmethionine,即SAMe)、膽鹼(choline)、鐵質(iron)、鋅(zinc)及鎂(magnesium),也都有充分的研究支持其抗鬱的功能。

「運動」方面,個人在看診當中,總是會與症狀較穩定的病人討論「適合個人的運動方式」。運動最重要的是「循序漸進」,避免運動傷害;對於生理機能不佳者不要強求,對於藉口一堆者也不要勉強。能跑步的病人,常常表示數週規律的跑步,除了改善憂鬱,也可以減少憂慮及焦慮相關的身體症狀(例如便祕、腸躁、胸悶、心悸、痠痛等)、改善疲勞增強體力、改善睡眠品質及體重過重;老人家若有退化性關節問題,可以考慮「慢呼吸」、靜坐冥想、合併「慢節奏」的伸展、深蹲、太極或游泳。如果能夠找到受過心理 相關訓練的專業瑜珈治療師,瑜珈對於憂慮焦慮、壓力失眠的治療也都有不錯的臨床試驗佐証。

5 of the best exercises you can ever do (Health Report from Harvard Medical School)

最後是「光照」療法,在光照量不足的國家有販售專門用來做光照治療的機器,在台灣陽光明媚,似乎沒有那個需求。然而,對於足不出戶或長期在室內工作的病患,可以建議在早晨或下午的陽光之下,「刻意」曝露至少十分鐘,其療效不僅僅是光照和維生素D的合成,就如同運動及魚油一樣,也還有促進免疫功能、改善新陳代謝、甚至保健心血管健康各方面的好處。

很多病人會問醫師,「除了吃藥,還有沒有其他輔助的方法可以的改善病情」?「運動、陽光、吃魚,到底對憂鬱症有沒有幫助」?由於憂鬱症的複雜性,沒有任何一種神奇的療法可以對所有病患都有效。如果病人對單一療法效果不足(例如藥物治療或心理治療),醫師不妨用開放的態度、實証醫學的精神、以及最高的安全標準,來接納病患嘗試整合性療法。哈佛醫學院也在其官方網頁,宣導醫護人員認識了解實証醫學基礎下的日常生活介入,包括飲食型態、運動習慣、壓力管理、社交和溝通技巧...等(Ref 5)。

(哈佛健康網宣導醫護人員認識了解實証醫學基礎下的日常生活介入,Ref 5)

醫師若能運用專業,協助病患做四到六週詳細的評估,一旦效果不錯,可以增加臨床經驗;如果效果不明顯,也可以建議病人不要浪費時間和金錢。由於所有憂鬱症治療(包括藥物或心理治療)的療效效應空間(effect size)相當有限,所以即使研究証實某項治療有效,也要避免讓病患對新療法有過度期待,雖然有許多病患從營養醫學的新療法中獲得極大的幫助,卻也有病患和家屬因為不實廣告的過度渲染而付出極大的代價,因此,接觸最正確、客觀的資訊,才是善用整合療法的最好策略。

有些醫護人員會說:「因為我不懂這些、而且我也沒有時間做這些...,講這些的人都不是正統,因為只有藥物治療有科學根據!」這樣的態度都是造成病患及病屬對精神醫療質疑的主因。精神科醫師大多不希望被誤解為「過度強調藥物」的醫師,然而在極為不足的健保制度及資源環境下,充分「了解並善用其他實証療法」來幫助病患,的確是「健保制度偏差」環境下的台灣精神科醫師很大的挑戰!臨床醫師能以開明和實証的態度,來提供多元性和整合性的照護絕對遠比單一治療更能成功協助病患邁向康復大道。


附註:
1.       上網蒐尋的關鍵字為:randomized, controlled, double-blind, placebo, sham, randomized-controlled trial (RCT)
2.        Sarris J, Logan A, Akbaraly T, Amminger GP, Balanzá-Martínez V, Freeman MP, Hibbeln J, Matsuoka Y, Mischoulon D, Mizoue T, Nanri A, Nishi D, Ramsey D, Rucklidge JJ, Sanchez-Villegas A, Scholey A, Su KP, Jacka FN. Nutritional Medicine as Mainstream in Psychiatry. Lancet Psychiatry 2015 Mar; 2(3): 271-4
3.        Sarris J, Logan A, Akbaraly T, Amminger GP, Balanzá-Martínez V, Freeman MP, Hibbeln J, Matsuoka Y, Mischoulon D, Mizoue T, Nanri A, Nishi D, Ramsey D, Rucklidge JJ, Sanchez-Villegas A, Scholey A, Su KP, Jacka FN. International Society for Nutritional Psychiatry Research consensus position statement: nutritional medicine in modern psychiatry. World Psychiatry (Accepted)
4.        Sarris J, Nishi D, Xiang YT, Su KP, Bannatyne A, Oliver G, Kua EH, Ng CH. Implementation of psychiatric-focused lifestyle medicine programs in Asia. Asia Pac Psychiatry. 2015 Dec;7(4):345-54. 
5.       Home » Harvard Health Blog » Intensive lifestyle change: It works, and it’s more than diet and exercise - Harvard Health Blog (Monique Tello, MD, MPH, Intensive lifestyle change: It works, and it’s more than diet and exercise) https://www.health.harvard.edu/blog/intensive-lifestyle-change-it-works-and-its-more-than-diet-and-exercise-2017082112287

6.       哈佛大學這幾年一直非常積極在推動Lifestyle intervention(例如營養、太極運動)在身心疾病的預防與輔助療法!(1) The no-drug approach to mild depression by Harvard Health Publishing (https://www.health.harvard.edu/mind-and-mood/the-no-drug-approach-to-mild-depression); (2) Omega-3s for anxiety? (https://www.health.harvard.edu/mind-and-mood/omega-3s-for-anxiety); (3) Eating more fruits and vegetables may help men with memory loss (https://www.health.harvard.edu/mind-and-mood/eating-more-fruits-and-vegetables-may-help-men-with-memory-loss); (4) Omega-3 fatty acids for mood disorders (https://www.health.harvard.edu/blog/omega-3-fatty-acids-for-mood-disorders-2018080314414); (5) An Introduction to Tai Chi: https://www.health.harvard.edu/staying-healthy/the-active-ingredients-of-tai-chi; https://www.health.harvard.edu/exercise-and-fitness/an-introduction-to-tai-chi

6.      哈佛大學 Harvard Health Blog 對運動之建議:The new exercise guidelines: Any changes for you? Lauren Elson, MDLauren Elson, MD (https://www.health.harvard.edu/blog/the-new-exercise-guidelines-any-changes-for-you-2018121415623)





         

7 comments:

  1. 哈佛大學這幾年一直非常積極在推動Lifestyle intervention在身心疾病的預防與輔助療法!
    來自哈佛大學醫學院對於憂鬱防治的「非藥物推廣」及「太極運動」的介紹

    The no-drug approach to mild depression by Harvard Health Publishing (https://www.health.harvard.edu/mind-and-mood/the-no-drug-approach-to-mild-depression)

    Omega-3s for anxiety? (https://www.health.harvard.edu/mind-and-mood/omega-3s-for-anxiety)

    Eating more fruits and vegetables may help men with memory loss (https://www.health.harvard.edu/mind-and-mood/eating-more-fruits-and-vegetables-may-help-men-with-memory-loss)

    Omega-3 fatty acids for mood disorders (https://www.health.harvard.edu/blog/omega-3-fatty-acids-for-mood-disorders-2018080314414)

    An Introduction to Tai Chi:
    https://www.health.harvard.edu/staying-healthy/the-active-ingredients-of-tai-chi
    https://www.health.harvard.edu/exercise-and-fitness/an-introduction-to-tai-chi

    ReplyDelete
  2. Harvard Health Blog 對運動之建議:The new exercise guidelines: Any changes for you? Lauren Elson, MDLauren Elson, MD (https://www.health.harvard.edu/blog/the-new-exercise-guidelines-any-changes-for-you-2018121415623)


    It’s likely you already know that regular exercise helps prevent chronic disease, such as diabetes and heart problems, while improving your overall health, mood, and quality of life. It can sharpen mental function, boost concentration, and help you sleep. And the new exercise and physical activity guidelines issued by the federal government’s Office of Disease Prevention and Health Promotion show that the dose required to gain these benefits is not hard to achieve. The new guidelines are better tailored for age and ability, too.

    What should your exercise goals be?
    The amount of exercise and mix of activities recommended varies depending on age and ability, as described more fully below. It ranges from a high of three hours daily — for preschoolers, who tend to love activity — to 150 minutes a week.

    Unfortunately, 80% of the population is not meeting the guidelines. Each year in the US, an estimated 10% of premature deaths and $117 billion in healthcare costs are associated with inadequate physical activity.

    Besides saving money on healthcare, there are many personal benefits to staying active. The new guidelines highlight other new evidence-based findings related to physical activity and exercise.

    What changed in the new exercise guidelines?

    Overall, move more, sit less. Work toward reducing the amount of time you spend sitting every day. If you have a desk job, get up to walk around regularly, or try chair yoga or a few desk exercises.

    ReplyDelete
  3. Mindfulness And Meditation Will Now Be Part Of The Curriculum In 370 Schools In England

    http://www.trueactivist.com/mindfulness-and-meditation-will-now-be-part-of-the-curriculum-in-370-schools-in-england-t1/

    by: True Activist Posted on March 29, 2019

    Most of the time, when children act out by kicking and screaming expletives, it is because they do not understand what they are going through, and cannot find a better way to release their feelings. When a child acts out, know that it is most likely because they are struggling to understand complex emotions that they are feeling for the first time in their lives.

    Schools in England have started to tackle this problem in a new way, and that is by teaching mindfulness and meditation in the classroom to improve the youth’s overall mental health. In 370 schools across the country, children will be taught how to meditate, techniques for muscle relaxation and breathing exercises for mindfulness. The secondary school students will also get a more hands-on education to learn about awareness and how to increase this in their everyday lives. This program is being done under the mental health study that the British government is running up until 2021.


    https://cdn.mindful.org
    Apart from the increasing number of young children that are showing signs of early onset depression and anxiety, NHS reports have also shown that 1 in 8 British children have mental disorders. Despite these facts, only 1 out of 5 children with mental issues are able to get access to treatment.

    England isn’t the only country that has added mindfulness as a subject among schools. In 2016, a school in Baltimore decided to replace detention for an area where the children could go to an practice some breathing and stretching exercises instead. This is a way to keep the students calmer in order to increase their focus within the classroom.


    https://cdn.mindful.org
    A student that was sent to the ‘mindful moment room’ for pushing and name-calling a fellow classmate describes it to CNN as: “I did some deep breathing, had a little snack, and I got myself together. Then I apologized to my class.”

    The school believes this is an improved manner the problem, rather than punishing and embarrassing the child in front of their peers, which was probably the cause of the problem from the very beginning.

    Teaching children how to deal with emotions will most likely be very foreign and uncomfortable, but it will reap the benefits in the end. The goal is to have the children master the habit of clearing their mind from stress and anxiety, and being present and more focused in class.

    Do you think all schools should teach mindfulness and meditation?

    ReplyDelete
  4. Proper posture the tai chi way (Harvard University)

    https://www.health.harvard.edu/staying-healthy/proper-posture-the-tai-chi-way

    If you're like most people, your posture could use some improvement. But how do you do that? The classic advice is to stand straight, with your head up, shoulders back, and belly in. While these are reasonable adjustments, tai chi takes a different approach that may be more effective. It aims to align the body in ways that afford safe, unstrained, and graceful postures—not the military-like, one-size-fits all, rigid stances many think of as good posture.

    Instead, in tai chi, good posture centers around the principle of verticality. That means the head is centered over the torso, the torso rests over the hips, and the hips are centered over the legs and feet, your base of support. Here's how to do it.

    1. The spine is literally the backbone of verticality, so let's start there. Tai chi classics say, "The spine should be like a necklace of pearls hanging from heaven." Your goal should be to elongate the spine while still allowing for its natural curves. This can reduce wear and tear on the discs between your vertebrae. In this position, your head will also sit squarely on top of your spine instead of jutting forward— a common profile that you will see if you take the time to observe others. Your head weighs about 10 to 12 pounds, but just a slight tilt forward more than doubles the amount of strain on your neck muscles. Get into typical texting position, and your muscles must work five times as hard. No wonder your neck and upper back are tight and achy. Proper alignment helps prevent that.

    2. The next area to focus on comprises the waist and pelvic region, which connect the upper body and lower body. In tai chi classics, this area is called the "commander." It's the central, coordinating hub where all movements originate. Muscle imbalances in this area have been associated with pain in the back, knee, and even neck, along with affecting your gait and balance. Maintaining tone and flexibility in the muscles and other soft tissues of the hip and pelvic area facilitates good posture and movement patterns and reduces pain.

    3. At the foundation of good posture are your feet, but you rarely hear about them in traditional posture advice. If alignment is off at your feet, though, the imbalance travels up the body, possibly causing painful problems along the way. Western thinking usually attempts to correct these misalignments with products like shoe inserts, but tai chi works to naturally correct imbalances and improve range of motion. While specifics vary with different tai chi movements, in general you should keep your weight centered over the balls of your feet and all of your toes, and point your feet in the direction of your kneecaps. The result is a healthier posture that works for you without forcing your body into uncomfortable positions.
    So, the next time you want to improve your posture, skip the stiff stance and focus on your spine, pelvic region, and feet.

    ReplyDelete
  5. 運動對抗憂鬱症
    科學人2017 年第 185 期 07 月號
    撰文/陳瑀葳

    對憂鬱症患者而言,運動是最經濟、有效又安全的治療方法。

    美國紐約的伊莉莎白於2014年的情人節,自願進入雪城一家精神療養院接受憂鬱症治療。伊莉莎白已經對抗憂鬱症一年多了,在罹患憂鬱症這段期間,她對曾經熱愛的電影、書籍、音樂皆失去了興趣。當時就讀於雪城大學演化生物學研究所的她,越來越常蹺課,不僅逃避去學校,也拒絕接受朋友的關心。在心情最黑暗的時刻,伊莉莎白發覺自己被各種無法抵擋、令人恐懼的妄想圍繞,她必須想辦法制止那些傷害自己、甚至自殺的想法。

    然而,雪城這家精神療養院的治療並沒有幫助到伊莉莎白,醫生開給她的強效抗憂鬱藥物也沒能發揮預期療效。數個月後,伊莉莎白決定到另一家強調全面性療法的醫院接受治療。這裡的醫師不僅採用傳統諮商和藥物治療,也鼓勵病人參與各式各樣的活動,例如散步、手工藝等,伊莉莎白的心理治療師更強烈建議她運動。因此,伊莉莎白每星期有3~5天會到健身房報到,在跑步機上快走或慢跑、重量訓練或是參加倫巴舞(Zumba)課程。

    「運動讓我感受到自己的力量!」現年33歲,搬到羅德島成為科普作家的伊莉莎白說:「我的心情真的好轉許多!運動讓我感受到身體與心智間的美好連結,不論是在跑步機上慢跑或是練習舉重,這些運動都讓我檢視自我並告訴自己:『看!我有這些能力和耐力,我有這些正面特質。』」開始規律運動後,伊莉莎白成功控制了憂鬱症病情,再也沒有嚴重復發。直到今天,伊莉莎白仍然認為,參加倫巴舞課程和騎自行車是幫助她對抗憂鬱症的重要方法。

    我們都知道運動對身體健康的益處:規律運動能大幅降低罹患心血管疾病、癌症、糖尿病和肥胖的風險,也能明顯延長壽命。相較之下,運動對心理健康的影響較少受到注意。對大部份人來說,運動僅是一種維持良好身材或減輕壓力的活動,較少人深入思考:對抗心理疾病,運動是否和藥物或諮商等療法具有同樣效果?

    許多研究運動與心理健康的專家,都肯定運動在治療心理疾病,特別是憂鬱症上扮演重要角色,杜克大學臨床心理學家布魯門塔(James Blumenthal)便說:「大部份的研究證據顯示,對某些病人而言,從事規律運動與藥物治療同樣能減輕憂鬱症症狀,甚至可能比藥物更有效。」德州大學西南醫學中心的精神科醫師崔維帝(Madhukar Trivedi)也指出:「我們已得到大量的研究結果,顯示運動是治療憂鬱症的有效方法;我們探討對抗憂鬱症的有效運動劑量,研究在傳統憂鬱症療法之外加上運動的效果,也探究運動如何改變特定生理指標、以此紓緩憂鬱症狀。這些研究一致指出,運動能帶來強而有力並十分有意義的正面效果。」

    尋求另類療法治療心理疾病

    根據世界衛生組織(WHO)的報告,全球大約有3億5000萬人罹患重鬱症(major depression),重鬱症是造成患者身心障礙、甚至死亡的主要原因之一。重鬱症患者長期處於心情低落的狀態,對從前喜歡的活動不再感興趣,往往也伴隨失眠、疲倦、注意力不集中或感覺人生毫無價值的症狀。然而積極尋求治療的病患並不多,其中對藥物和心理諮商等傳統療法有顯著反應的病患也僅有1/3。除此之外,抗憂鬱藥物往往價格不便宜,並帶來各種嚴重副作用,這些因素讓許多重鬱症患者開始嘗試另類療法,希望透過較便宜、安全且自然的方式來發揮效用。根據2001年一項針對約2000名美國病患的研究發現,一半以上的受訪者表示,他們曾採取瑜珈、針灸或草藥等另類療法試圖減輕憂鬱症狀。

    大約30年前開始,心理學家和臨床醫師便開始探討運動是否能有效治療憂鬱症,布魯門塔便是這類研究的先驅。1980年代,當布魯門塔與同事研究運動對心血管疾病的影響時,無意間發覺運動似乎能改善病患的心情,並減輕憂鬱症狀。這個發現促使他們進一步研究運動對情緒的影響:1999年以156名年長的憂鬱症病患為受試者,追蹤病人連續四個月服用抗憂鬱藥物、規律運動或同時服用藥物與運動的心理健康變化。布魯門塔和同事發現,所有病患皆有顯著進步,但規律運動的受試者復發率較低。

    2009年進行的後續研究,他們讓200名憂鬱症病患分別接受四種不同療法:在專業指導下規律運動、在家自行運動、藥物治療以及僅接受安慰劑的對照組。結果顯示,那些由專家指導運動的病患具有高達45%的緩解率(remission rate),效果與藥物治療極為相似。而在家自行運動組的受試者緩解率為40%,也比對照組的表現優良許多。2015年瑞典科學家所進行的研究再度證實運動的效果:研究人員把946名罹患輕度或中度憂鬱症的患者分配至三種實驗組:一組一週三天從事有氧運動、瑜珈或重量訓練;一組在網路上接受行為認知療法;第三組接受傳統諮商及藥物治療。12週之後,所有患者都有顯著進步,但運動組的受試者表現最好。

    至今已有眾多研究證實運動是減緩憂鬱症的有效方法。2013年由考科藍合作組織(Cochrane,一家公信力極高的非營利實證醫學研究機構)所做的文獻回顧顯示:運動與藥物治療或心理諮商等傳統憂鬱症療法相比,緩解憂鬱症的效果不相上下。2016年一項後設分析研究,更是呼應上述研究結果,研究人員檢視25篇實驗方法最嚴謹的期刊論文,證實運動是對抗憂鬱症的有效方法;尤其在專業指導下規律進行中強度的有氧運動,更有極為正面的療效。

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  6. The active ingredients of tai chi
    https://www.health.harvard.edu/staying-healthy/the-active-ingredients-of-tai-chi

    When Peter Wayne, medical editor of Introduction to Tai Chi from Harvard Medical School, began conducting scientific studies on the health benefits of tai chi, he began noticing that tai chi works in a variety of ways, not just one. Whereas most drugs have a single active ingredient, he observed that tai chi was more like a multidrug combination that uses different components to produce a variety of effects.

    Wayne formulated the idea of the "eight active ingredients" of tai chi, which he and his colleagues now use as a conceptual framework to help evaluate the clinical benefits of tai chi, explore the underlying mechanisms that produce these effects, and shape the way tai chi is taught to participants in clinical trials (and to teachers). While different styles of tai chi emphasize different ingredients, these therapeutic factors are interwoven and synergistic. Here's a summary of one of the active ingredients of tai chi.

    Structural integration. Tai chi looks at the body as an interconnected system, not as a collection of individual parts. As a result, when practicing tai chi, you won't do one exercise for your biceps and another for your glutes. Instead, tai chi integrates the upper body with the lower body, the right side with the left side, and the extremities with the core.

    Alignment and posture are part of this structural integration, and tai chi trains you to find alignments that are safe and unstrained, allowing you to perform graceful movements. You move more efficiently—not just during your tai chi practice, but throughout your day. The result is less stress and load on your joints and better balance.

    Improved posture provides tai chi benefits that extend well beyond your class. When you walk or sit with your shoulders rounded and your torso hunched over, it is hard to take deep breaths. But when you straighten your back, roll your shoulders back and down, and open your chest, you breathe more deeply and efficiently.

    Not only does this integration improve your ability to move without pain, but it also affects your mental health. In two different studies, people who sat or walked more upright during the experiments had a more positive outlook afterward than those who slouched while sitting or walking.

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  7. The Secret to a Happier, Healthier, More Vital Life Is Now Yours!
    https://www.health.harvard.edu/promotions/harvard-health-publications/an-introduction-to-tai-chi

    With so many scientifically backed benefits, we just can’t keep it under wraps any longer. The ancient Chinese practice of tai chi has become widely recognized as one of the most powerful ways to improve both physical and mental health.

    In an increasing number of recent studies, tai chi has been found to heal–almost everything, from lowering blood pressure … to managing stress … to building strength and balance. And, better yet, everyone can benefit–no matter your age or fitness level. No wonder it’s the tried-and-true practice of top-tier professional athletes, weekend warriors, and the elderly!

    And now, we want to make it easy for you to relax … revitalize … and restore your body and mind. Order An Introduction to Tai Chi today–and SAVE 30% off the $29 cover price!

    Enjoy these 7 BIG Benefits:

    Better Balance–Of all tai-chi’s big benefits, it’s the best-documented in medical literature! Studies show that older adults who do hour-long tai chi sessions one to three times a week are 43% less likely to fall, and they cut their risk of injury in half!

    No More Pain–A growing number of clinical trials show that tai chi offers significant relief from back, neck, arthritis, and fibromyalgia pain.

    A Sharper Mind–Tai chi can help reduce age-related cognitive decline … and even slow dementia!

    A Boost in Mood–In 82% of studies, tai chi greatly improved mood and lowered anxiety. Plus, it was shown to be an effective treatment for depression.

    Less Stress–Learn to step back and take a deep, calming breath.

    More Confidence–While gaining muscle and mind control.

    A Healthier Heart–Tai chi may offer advantages over other types of aerobic exercise, especially for people who are sedentary or very out of shape. And that’s not all. It also lowers blood pressure and total cholesterol, reduces chronic inflammation, and tones the sympathetic nervous system.

    Qi Is the Key

    Tai chi is rooted in multiple Asian traditions, including traditional Chinese philosophy and medicine–mind and body. Its two central concepts are yin and yang (opposing yet complementary forces) and qi (vital energy). When your qi freely flows, you are balanced and healthy. Tai chi promotes the flow of qi. (While it is pronounced the same, qi should not be confused with the "chi" in tai chi. The latter is a superlative, meaning "supreme" or "ultimate.")


    Preventing dangerous falls
    Reducing–even ending–back pain
    Strengthening your heart
    Slowing the onset of dementia
    Defeating depression
    Enjoying life stress-free
    Building confidence
    PLUS … Your Special Health Report Reveals:

    Why you can practice almost anywhere–indoors or out–in as little as 30 minutes.
    The routine you can do at work right from your desk.
    How to fit tai chi into your existing exercise plan
    How to regain your focus and feel energized while you stand in the grocery line.

    Whether you’re 50 … 60 … 70 or more … healthy … or frail, you’ll find an exercise routine that’s perfect for getting your qi going.
    Better yet, you find over 125 step-by-step how-to photos. And, to make sure you get the most out of your practice–and reduce the risk of injury–this all-new Special Report gives you links to online videos to watch and follow along. It’s almost like having your own private tai chi class! Plus, if that weren’t enough, it contains dozens of tips and techniques to help you make each move slowly and safely, starting with …

    4 Steps to Steady Yourself Anytime

    Take a few slow, deep breaths.
    Feel your feet on the ground.
    Imagine your feet growing deep roots like a tree.
    Continue for a few more breaths, relaxing your weight deeper into your roots with each exhale.

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