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Subjective Experiences of Older Adults Practicing Taiji and Qigong

Subjective Experiences of Older Adults Practicing Taiji and Qigong SAGE-Hindawi Access to Research Journal of Aging Research Volume 2011, Article ID 650210, 11 pages doi:10.4061/2011/650210 Research Article Subjective Experiences of Older Adults Practicing Taiji and Qigong 1, 2 3 4 5 Yang Yang, Sharon DeCelle, Mike Reed, Karl Rosengren, 6 7 Robert Schlagal, and Jennifer Greene Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA Center for Taiji & Qigong Studies, P.O. Box 308, NY 10028, USA 319 S. Randolph Street, Champaign, IL 61820, USA 1104 West Daniel Street, Champaign, IL 61821-4516, USA Department of Cognitive Psychology, Northwestern University, Evanston, IL 60208, USA College of Education, Appalachian State University, Boone, NC 28608, USA College of Education, University of Illinois at Urbana-Champaign, 230C Education Building, 1310 S. 6th Street, Champaign, IL 61820, USA Correspondence should be addressed to Yang Yang, yyang5@illinois.edu Received 11 March 2011; Accepted 14 April 2011 Academic Editor: J. Woo Copyright © 2011 Yang Yang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article presents a qualitative study following a 6-month Taiji (T’ai Chi)/Qigong (Ch’i Kung) intervention for older adults. The researchers conducted in-depth interviews of eight selected participants who elected to continue practicing Taiji after the intervention ended, in order to explore their subjective experiences of Taiji’s effects and their motivations for continuing to practice. We created a Layers Model to capture the significance and meaning of the multidimensionality of their reported experiences. Participants not only reported simple benefits along five dimensions of experience (physical, mental, emotional, social and spiritual) but also described complex multidimensional experiences. Overall findings indicate that participants derived a very wide variety of perceived benefits, the most meaningful being a felt sense of body-mind-spirit integration. Our results support the important role of qualitative studies in researching the effects of Taiji and Qigong. 1. Introduction Although not all Taiji studies report on the continuance rates for participants at the end of a Taiji intervention, those Over the past 20 years, Taiji has emerged as a popular and that do report high levels of subsequent adherence. Wolf much-researched exercise intervention, especially for older et al.’s [13] study cited a continuance rate of over 50%. adult populations. Although most Taiji research has inves- In the Wenneberg et al. [19] study, 9 of 16 participants tigated physical effects, many studies have reported positive continued Qigong. In their study of patients with chronic findings for both psychological and physical function. Most heart failure, Yeh et al. [4] reported that 14 of 15 participants of the studies that have evaluated psychological benefits have planned to continue Taiji. Two studies cited higher exercise used a quantitative approach and standardized psychological continuance with Taiji compared to a control group, either measures, with significant positive effects noted in a variety an aerobic exercise group [20] or a home exercise group of areas assessed, including improved quality of life/mood [21]. Other studies reported low drop-out rates for Taiji [1–5]; reduction in perceived stress and pain [6–9]; increased classes. Gavin and Myers [22]reported, “Itisnoteworthy self-efficacy [2, 10, 11]; reduced fear of falls and increased that tracking for three years, the drop-out rate for the balance confidence [12–15]; enhanced immune response ongoing Taiji (community) class was only 34%, considerably [16–18]. lower than the 46–52% dropout rate for more traditional 2 Journal of Aging Research exercise classes” (page 137). In a 6-month post-intervention intervention ended. Our study was small and the focus follow-up study, Li et al. [23] reported that more than 50% narrow. Our intent was an exploration of respondents’ of a previously sedentary sample had remained physically personal experiences of Taiji in order to gain understanding active. The Gavin and Myers [22] study also reported a of the perceived effects and motivations that empowered high continuance rate: of the 107 people who had enrolled them to continue practice: just what were they experiencing in a beginning Taiji class and were tracked over a 1-year during the six-month study that influenced them to keep period, 67% said they planned to enroll in a subsequent class. practicing Taiji after the intervention was over? This decision of participants to continue practicing Taiji or Qigong after an intervention has ended is an important 2. Method finding that has not been addressed. Such a trend is of interest, because sedentary lifestyles are a major public 2.1. Taiji Intervention Participation. Taiji (T’ai Chi)/Qigong health concern; a majority of Americans do not engage in (Ch’i Kung) are complex practices that have existed for many recommended levels of physical activity despite decades of centuries in China. Traditionally, the purpose of pursuing research showing its benefits [24, 25]. these practices is to unify the mind, body, and spirit in These low drop-out and high continuance reports sup- order to move toward greater harmony with oneself and port the premise that Taiji elicits an unusually positive the environment, and thus toward improved health and response in participants, yet, despite many calls for research functioning [29, 30]. A complete traditional Taiji curriculum that investigates the role of subjective experience and includes Qigong (standing, sitting, lying down meditation, meaning regarding older people and exercise [26], very few and simple movements, all with an emphasis on meditation), studies have used interviews to gather subjective information Form (the classic movements that are the familiar hallmark regarding participants’ responses to Taiji. The importance of Taiji), and Push-hands (two-person dynamic training, the of a sense of carryover of Taiji into everyday life and/or “martial art” application of Taiji) [30, 31]. We did not have a wide range of perceived benefits has been alluded to in adequate time to include Push-hands due to the limitations several studies. By asking six questions to generate binary of the 6-month time frame. Three one-hour classes per week outcome variables, Kutner et al. [27] found that both were designed and taught by Yang Yang with three of his their intervention (Taiji) group and their control (balance long-term students assisting. training) group reported increased confidence in balance We began with two dynamic Qigong exercises (Heaven and movement, but only the Taiji participants reported and Earth Open and Close and Lower the Qi and Cleanse effects in daily activities and overall life. Wenneberg et al. Internally) and with static sitting and standing Qigong [19] conducted semistructured interviews to examine the meditation. We gradually increased the amount of static subjective experiences of patients with muscular dystrophy sitting and standing practice, until by the 13th week of the who practiced Qigong. Using a computer program, they study participants were completing one 10-minute sitting coded their data into six categories that included three and two 10-minute standing meditations each class. categories of perceived benefits: mental/stress reduction Form work was comprised of 7 movements taken from effects, increased body awareness and physical effects, and the Chen Style 48-Movement Form distilled by Grandmaster psychosocial effects of group training. They reported that Feng Zhiqiang. The intention was to create a form that one third of the patients described very positive results; was short and thus easy to remember and yet engaged a another third reported moderate benefits in relaxation and wide range of motion of the entire body and incorporated stress reduction; the final third experienced minor effects. In weight shifts and stepping in all directions. Movements were conclusion, they noted also selected for their adaptability and accessibility, as it was The most prominent finding ... is the wide deemed essential that participants be able to enter the study variation of experience and perceived effects at nearly any level of physical ability and experience progress. among participants ... [the] blending together The seven movements are Preparatory Form, Lazy About of mental and physical methods may in part Tying Coat, Fist Under Elbow, Step Back and Whirl Arms on explain the wide range of experienced benefits Both Sides, Part Horse’s Mane, Wave Hands Through Clouds, (page 593). and Close. The fundamental skills of Taiji—relaxation, align- ment, footwork, efficiency, coordination, accuracy of force Docker [28] interviewed seven older participants in production, and control—were emphasized, and parallels community Tai Chi clubs in Northern England. Her findings were drawn to daily activities. We gradually included more showed participants reported “a variety of physical and information about integrating mind and spirit into the mental benefits” as well as “intriguing special effects ... of practice, stressing the importance of a tranquil, peaceful a spiritual or mystical nature” concluding that “practicing mind and a light and happy spirit in nurturing the body’s (tai chi) may be attractive to older people not only because vital energy. Traditional Chinese music [32]was played of its suitability as a moderate intensity exercise ... but also during classes to help cultivate tranquility. because it may fulfill other social, emotional, developmental or spiritual needs” (page 114-115). The purpose of the present study was to further inves- 2.2. Methodological Framework. In designing this study, our tigate the subjective experiences of older participants who hope was that through open-ended, in-depth interviews, we elected to continue practicing Taiji on their own after our would gain insights into the nature of the experiences that Journal of Aging Research 3 led to respondents’ ongoing commitment to Taiji practice. of the first four interviews, we used the data from these four Our methodology is grounded in social constructionism to create an interpretive model. [33, 34]. In this framework, it is the meaning that individuals Our five dimensions—physical, mental, emotional, construct their lived experiences that are assumed to shape social, and spiritual—were initially conceived as “fuzzy” cat- and guide human action, and so social inquiry is appropri- egories [39], and so it was assumed that there might be some ately focused on understanding these meanings. Because the overlapping assignments of the data. Yet, we were surprised interpretive reconstruction of meanings depends, in part, on to discover that the vast majority of the data segments who is the listener, our aim was to offer a keenly interested required multiple-dimension assignment (e.g., physical and ear and to encourage a full telling of participants’ Taiji mental; emotional, social, and spiritual) in order to fully experiences, while muting our own views and perceptions as capture their meaning. We then created a horizontal table much as possible [35, 36]. of the 31 mathematically possible categories (e.g., possible combinations of the five dimensions) and arranged all the data in this table in order to search for themes in each of the 2.3. Sampling. At the end of our six-month quantitative 31 categories. Upon detailed examination and comparison Taiji intervention [15, 18], we purposefully selected and of the contents of the statements in each category, we found obtained written informed consent from a sample of eight that the multidimensionality of the data seemed to be their “information-rich cases” [37, page 231]. These were subjects most dominant and meaningful characteristic. The number who were continuing Taiji classes on their own, and who, of dimensions characterizing the data segments appeared during the six-month study, were observed to be verbally to emerge as a more compelling story of the meaning enthusiastic and articulate about their participation. The of participants’ experiences than a listing of exactly which rationale for selecting these participants was to maximize categories were involved, or even of exactly what was said the potential richness of the interview information to be in each category. The meaning of the data came into focus obtained [37]. The study was approved by the institutional when we began to look at it in terms of investigating the review board of the University of Illinois. meaning of its surprisingly substantial multidimensionality. Our interpretive framework emerged directly from this 2.4. Interviews. The interviews were semistructured using “discovery”. the general interview guide approach [37, page 342–344] as Because all the three coders had practiced Taiji, in order a framework. We began each interview with an invitation to to minimize possible interpretive bias, we then had an tell the story of their Taiji experience; subsequent questions experienced outside qualitative researcher (Greene) with no and probes pursued participant motivations for joining the previous Taiji experience examine our data and findings to class, experiences during the class, and any reported changes give objective input and feedback. After re-analyzing and in aspects of daily life and general health and well-being. fine-tuning our model, lastly, we went back and coded the An assistant Taiji teacher (Reed) and a physical therapist remaining four interviews as a form of both multiplicative who was also a Taiji student (DeCelle), each, conducted and structural corroboration of our findings [40, 41]. four interviews. Conversations of 60- to 90-minutes were recorded in the interviewees’ homes and then transcribed. 3. Results 2.5. Analysis. In designing our analysis, we were influenced 3.1. Interpretive Framework. We created the Layers Model by a series of dialogues we had conducted with Taiji as a way to capture the meaning of the multidimension- participants in a 2000 pilot study; results from this suggested ality of respondents’ statements. The model is based on a broad five-category model of physical, mental, emotional, the overlapping of the five dimensions—physical, mental, social, and spiritual benefits from Taiji participation. We emotional, social, spiritual—and how they combine to create elected to start with these five descriptive categories as an five overlapping layers of one-, two-, three-, four-, and initial framework for organizing and coding the interviews five-dimensional statements. Upon reviewing the substantive as they seemed to capture the key elements from our pilot content of all of the statements contained in each layer, the study and from other studies (e.g., [19, 28]), as well as being Layers Model evolved from a descriptive representation of congruent with the work of Spirduso, 1994 [38]. the material in each layer to a “prototype” model that offers a Following an initial reading of all of the interviews, the conceptual framework for examining the collective meaning three members of the coding team (Yang, DeCelle, Reed) of the statements in each layer. ranked the interviews in terms of information richness [37] We combined the four- and five-dimensional statements and began coding with the richest interview. The process into one layer, Layer 4, to reframe the model as a continuum began with each coder independently assigning each data representing four increasingly complex layers of experience. segment (phrase, sentence, or passage) to the appropri- ate dimension of experience—physical, mental, emotional, social, or spiritual. We then met to agree on a group coding. Layer 1 (Simple Benefits). Statements that reference a single- After completing the group coding of the first interview, dimension. These comments describe physical or mental we went on to the next interview, repeating this process of effects that often were related to the interviewees’ original individual then group coding. After completing the coding motivations for joining the study. 4 Journal of Aging Research Layer 2 (Complex Benefits). Statements that reference two socioeconomic status. Four lived in a senior retirement dimensions. In this layer, benefits begin to carry over into community, and four in their own homes; four lived with everyday life, and the interviewees express the beginnings of spouses, and four lived alone. All were motivated to join the improved mind-body connection and an increase in general intervention for physical reasons (1) one with moderately self-awareness. severe back pain that limited her activities of daily living (ADL’s) and generated problems with sleeping; (2) one with long-standing back pain and severe arthritis, along with Layer 3 (Immersion). Statements that reference three dimen- a feeling of not having much more time “left”; (3) one sions. In this layer, there is expression of increasingly signif- with limitations in various ADL’s including gardening and icant carryover of benefits into everyday activities and there dressing, self-described as “beginning to feel like an old is a clearly expressed mind-body connection with associated lady”; (4) another self-described as never having been very positive emotions. The interviewees report that Taiji begins physical and worried about “losing touch with my body”; (5) to permeate the way they think and feel about themselves; one with hip and knee pain secondary to arthritis “that was they report a more positive attitude and significant changes getting pretty painful” who was “hoping to get stronger and in self-confidence and self-concept. get moving again”; (6) one primarily for gait issues related to balance and strength, “I was beginning to stumble when I Layer 4 (Complex Integration). Statements that reference walked and I thought this might help”; (7) one self-described four- and/or five-dimensions. In this layer, interviewees as having become “fairly sedentary” and thought “it might express experiencing Taiji as an opportunity and a tool to be a way to get moving again without causing problems with grow and nurture themselves; they describe a sense of a my knees and shoulders”; (8) another with “problems with complex mind-body-spirit connection and most report a my legs, especially my knees”. conscious sense of a more integrated spirituality. 3.3. Experiences of Taiji and Qigong. In this section we We then created a Layers Diagram as a visual represen- present interview data within the Layers Model. tation of the Layers Model. It shows the overlapping of the layers and the progression from the lightly shaded single- Layer 1 (Simple Benefits). In Layer 1, interviewees report category statements in the outer Layer One, to the slightly simple changes stemming from their practice of Taiji. darker double-category statements of Layer Two, the more These are single-category statements. These reported changes darkly shaded triple-category statements of Layer Three, and typically refer to a physical benefit that was related to the finally the four and five category statements in the darkest individual’s primary motivation for participation in the shaded Layer Four center of the figure. Table 1 shows the study. relationship between the initial 31 possible categories, the Layers Model and the Layers Diagram. My balance was already pretty good but I could This representation seems obvious in retrospect, but was still see an improvement. Climbing stairs—I actually a “Eureka!-” like realization when it finally emerged know I said on the questionnaire “yes, I’m at the very end of our analytic process. We believe it provides confident about it.” Still ... now I feel more a parsimonious way of visualizing the entire project and thus ... confident ... balance has improved ... my of mapping all the data and our interpretive understanding strength has improved. (Jamie) of it. Because, in qualitative studies, the goal is to construct Positive changes in physical function were reported by all. an interpretation that resonates with the participants’ own Helga made it clear that physical benefits do not have to be interpretations of their experiences [42], in order to establish dramatic for useful improvement to be noted. the credibility of our interpretations, we conducted a formal “member check” [36]. Each of the interviewees (seven of I realize at my age that deterioration is setting the eight as one was deceased at that point) was asked in .... I think if you’re just holding your own, to read this account and comment on the accuracy of you’re lucky .... I fatigue a lot easier, sooner our interpretations. Each participant expressed unqualified .... I can realize I’m losing ground on that, and agreement that this is an accurate representation of her/his yet .... It has helped ... not a pie-in-the-sky experiences and their meaningfulness. sort of thing ‘cause my arthritis is continuing to deteriorate in my knees, but I find that I have 3.2. Participants. What follows is a brief description of the more strength in my legs and better balance. participants and their initial motivations for doing Taiji. (Specific demographic details have been omitted to safeguard Positive changes in strength and balance were cited by confidentiality. Interviewees selected their own aliases for seven of the eight. (The one exception reported no initial the quotation section.) At the time of the study, all eight strength or balance deficits.) interviewees were retired, aged 82, 82, 79, 79, 75, 74, 70, and 67. One was male. Seven were college graduates including In the beginning (doing the Qigong) some of the four with advanced degrees, and one was a high school muscles in my legs would really, really hurt ... graduate. Six were of moderately high and two of moderate and now I can’t make it hurt anymore ... and Journal of Aging Research 5 Table 1: Layers diagram, Layers Model, possible category combinations. Possible statement category Layers Model Layers diagram combinations P Simple benefits diagram Layer 1 (five possible single-category statements) So Sp P+M Complex benefits diagram P+E P+So P+Sp Layer 2 (10 possible double-category statements) M + E M+So M+Sp E+So E+Sp So + Sp P+M+E Immersion diagram P+M+So P+M+Sp P+E+So Layer 3 (10 possible triple-category statements) P + E + Sp P+So +Sp M+E+So M+E+Sp M+So+Sp E+So +Sp P+M+E+So Complex integration diagram P+M+E+Sp P+E+So +Sp Layer 4 (5 possible four-category statements) and one possible five-category statement P+M+So +Sp M+E+So +Sp P+M+E+So+Sp 6 Journal of Aging Research Table 1: Continued. Possible statement category Layers Model Layers diagram combinations Full layers diagram All four layers All Statements in all 31 categories Statement categories: P: physical; M: mental; E: emotional; So: social; Sp: spiritual. I’m standing three times as long .... Now I can Increased relaxation and calmness were also mentioned put my socks and jeans on just like I always used by all eight as valuable and useful effects. In this double- to, standing up instead of sitting down. (Grace) category layer, interviewees also talked about more inher- ently complex issues such as energy level and sleep. You learn to stand on one foot, and I can do that Ihavemoreenergy .... The Taiji practice so much better now. Believe it or not, I couldn’t continues to keep my energy level up higher do it all before. (Arlene) than it would be otherwise, certainly higher than it was. I’m able to do more than I used to and do what Iusedtodomoreeasily. (Grace) Pain relief was another issue motivating participation; improvement was noted by seven of the eight (the eighth Jamie reported that, “My sleep is better .... Ilovethe full reported no initial pain), especially Jamie. “I’m at the point night’s sleep .... I used to wake up at 3:00 every morning and where I don’t have any pain ... and I’m back to being as active couldn’t go back to sleep ... now it’s fine.” as I was. Quickness is back—I don’t have to be slow and Respondents described experiencing the beginning of a careful.” Improved flexibility was noted by three respondents, body-mind connection from different perspectives. for example, “I was having stiffness getting in and out of bed, and I don’t have that anymore. I mean I can just roll over and You know, early on, in the Qigong ... I had this roll out of bed, everything’s fine now” (Ruth). mental picture of these endorphins that go to This layer also contained some benefits coded as mental, your brain and make you feel better after you with four participants reporting improved ability to concen- exercise, so I would be sitting there thinking, trate. “OK you little endorphin, go down to that knee, work yourself in there and make yourself at Layer 2 (Complex Benefits). In Layer 2, interviewees express home.” I tried to send them to various parts their sense of the benefits of Taiji in a more complex of my body, and after a while, I could feel it. way, mostly combining the mental and physical dimensions. (Helga) All the interviewees reported a carryover of benefits into A number of physical-mental category statements relate everyday life. “I go up the stairs better. I’m very aware of to an increased awareness of a heightened mind-body where my feet are ... before, I don’t think I really knew where connection. my feet were unless I was looking” (Anna). I’ve become much more aware of my body Because of Taiji you are more aware of how you .... I’ve observed muscles loosening up that I stand, how you sit, how you move .... It has probably couldn’t have identified as even being really helped me ... in the daily things I want to there before ... they stay relaxed more ... and get done and being more focused; and of course I’m usually aware of when they start to tense up, the more focused you are, the better it goes, the and I can “untense” them. (Anna) better job you do, and the quicker you get it done .... Let’s say I’m in the kitchen preparing The greatest thing ... is becoming aware of my ameal ... it goes much smoother and it’s easier. body. It has really helped my posture. I can tell In other words everyday things are better, easier. now when I’m slumping—it just doesn’t feel (Grace) right. (Sally) Journal of Aging Research 7 Every time I do the Qigong I have this rush confidence, and not worrying so much about what cannot of heat going through my body—it amazed me be changed. According to Jamie, “I feel more upbeat ... more the first time it happened. I imagine my blood optimistic ... more hopeful .... I’ve upped my lifespan from going through ... I relax the muscles because I’m 80 to 100. How’s that!” thinking I want the blood to have lots of space Interviewees spoke of Taiji permeating many aspects for flowing through ... it’s using your mind to of daily life including social contexts. Anna talked about connect more clearly to the body. (Jaime) how she was much more able to handle stressful family encounters. A sense of improvement in functional ability was fre- I got so I could turn that stuff [negative feelings] quently expressed along with a positive emotional response off faster ... before Taiji there were times when I to the perceived physical improvement. could hardly get rid of it at all ... [now] it’s like, It is amazing how much everyone in the group I am not letting this stop me—Irefuse! [talking about a particularly recent stressful encounter] has improved on that one leg standing, and it makes people feel so good that they can do that! ... and I took care of it in terms of getting past it I remember when we were first tested and they in less than 5 minutes! asked me to stand on one leg with my eyes At this level, participants also express a deeper sense of closed. Well, I thought that was the craziest thing integration that begins to include spirit into the mind-body to even think about! Now I can do it for 30 sense of self. seconds plus without any problem. (Grace) I look forward to the standing Qigong, and the release of everything around you ... I imagine Layer 3 (Immersion). In Layer 3 there are triple-category that I’m standing in water, in the ocean ... it has statements, most of which were mental-physical-emotional. such a calming effect on me and this helps me so In this layer, respondents remark that the relevance of Taiji that I can get up and go. (Helga) has permeated many aspects of their lives. Interviewees frequently made statements that added an emotional com- At this level, these elders began to express a sense of ponent to the physical-mental benefits they experienced, surprise at the scope of the benefits they felt. Many of them usually commenting on how very good the mind-body mused about the mechanism—how it works—and began connection felt to them. “I feel, my body feels sort of though thinking that it might be more complicated than they had it’s being worked on from the inside out, and it feels so very previously thought. There was a clear sense of surprise good to do that” (Jamie). that such a simple activity could produce such exceptional Each interviewee had her/his own experience of a benefits and have such broad application. layering of the physical-mental-emotional categories. All reported experiencing significant changes in self-concept and Icouldn’tbelieve it.Atfirst, Imeanitlooked confidence and a more holistic sense of overall abilities and like, “Why should we even do this?!” But I potential. can see now after doing it that it is giving me strength. I mean it’s the ability to walk better, I notice that, well I notice me more .... There sit better, turn better ... it isn’t just a forceful are times in Qigong that—I hear myself shift to strength, it’s a strength within, it’s an inner ... it adifferent place .... This experience of being has caused my body to follow through with my lined up, when things get lined up differently mind when it says to do something. (Ruth) inside me—there is this most unusual sensation I do not like to exercise. That is NOT my favorite of like everything coming together, it’s like thing, and I am not a disciplined person .... but something goes ahhhaah .... It’s a full body this is something ... it’s just so different from sensation that’s almost spiritual. (Anna) individual exercise. I mean it IS individual, but, All were more optimistic about themselves and about you just receive so much from this ... it’s very their own aging process. Each of the eight expressed the belief different to quiet your mind and not be thinking that she/he had significantly improved her quality of life, about things .... I don’t know how to explain it increased her/his lifespan, or both. ... it can be very spiritual. (Sally) I quit Curves when Taiji came along. I’d rather I will keep doing this—it’s wonderful! My do Taiji. There’s just no comparison between husband is just astounded that I’ll devote three the two, no comparison. That’s strictly exercise. [group] sessions a week to it .... I have the This is something entirely different .... It’s sense that I’m not going to go downhill nearly as just absolutely amazing what it does to your quickly as I might have. It’s a very positive way body and mind .... and you don’t realize how to feel. (Grace) important it is until you go through it .... All of these participants talked in some way about People who haven’t done it, until they actually seeing themselves differently, as having more potential, more do, they really don’t believe you. (Arlene) 8 Journal of Aging Research I’m really interested in trying to figure out why The thing that comes close to being spiritual it’s so useful and so successful .... I’ve been for me is the closing Qigong movement, where so active all my life—it surprises me that the you raise your arms and you gather in energy. standing could be so helpful. I don’t have to I can see myself getting just a little piece of hike up a mountain .... In fact, climbing the that cosmos out there ... and also the power mountain wouldn’t be as effective ... Ican do of cleansing yourself as you push that energy it in a hotel room, just about any place .... I’ve in and down through you; you reach out into done it at the airport, looking out the window. the ultimate universe and gather a part of it (Jamie) inside. This to me is separate from God in my own beliefs, but it’s something that offers Echoing Jamie, many of the participants expressed the an opportunity for my spirit to express itself, importance of finding it very easy to integrate into everyday connecting myself ... to a spirit within that is life. “It’s available anytime and anywhere I want to do it ... part of a bigger whole. (Helga) whenever the spirit moves me” (Harry). “It’s almost like this Respondents reported that this enhanced mind-body- little magic pill or something that I can now say to my mind spirit connection was very meaningful for them. Grace “Quiet, calm, you can do this,” and it’s like, wow, I can do this described this linking of the spirit with the physical-mental- anyplace” (Sally). emotional as a very new experience for her. Layer 4 (Complex Integration). Layer 4 expressions involve TheTaiji givesyou ... a way to create a spiritual a complex integration of multiple categories: four or five moment that is also very healthful in a physical dimensions overlap in the interviewees’ statements, notably way .... I can’t say I’m more spiritual, but I’m mental-physical-emotional-spiritual. This layer involves a more aware of my spirituality .... Inever in sense of Taiji as an organizing, integrating experience. my whole world would have thought, you know, Interviewees spoke of transformative changes, along with when we’re doing our meditation, and you look a firm commitment to continuing Taiji practice for very out there and see the beautiful trees, and you different reasons than when they began. know that’s God’s energy, and it’s going to be part of me ... like when we do that washing your This is a life change for me. I want to continue organs, and gather that energy with our hands to do it for as long as I’m able, because I think ... and I can actually feel my fingers growing— it’s extremely helpful. When I talk to people I that’s God’s energy washing through me ... that say, “I’ve started Taiji and it’s changed my life.” sense of being very spiritual and physical at the (Jaime) same time ... it’s just not comprehensible to the world! I can’t imagine Taiji not being in my life now. It has just been such a delight and such a At this level, interviewees observed that the Taiji philos- revelation. (Sally) ophy (actively cultivating tranquility, wisdom, energy, and health through a mind-body-spirit connection) permeated This has affected every area of my life ... it’s been their thinking. They reported experiencing a significant exhilarating in many ways .... I’ve experienced increase in their capacity to feel healthier; all conveyed more a variety of feelings and sensations that come as optimism about themselves, about aging, and about their total surprises to me .... I never plan to stop. It quality of life. contributes too much to me in too many ways to ever stop. (Anna) Because of this, I am learning some new trust in myself that’s spiritual in some respects .... In Layer four, these respondents experienced Taiji as Taiji has supported a whole place of believing in an opportunity to learn, grow, and nurture themselves; it myself and listening more strongly to my own became an important tool for them in their daily lives. thoughts, rather than trying to fit into some other way of thinking. (Anna) My personal experience with it is that partic- ipation in Taiji has affected every area of my At this level, some expressed a strong appreciation for life. It’s, to me, Taiji is spiritual, it’s emotional, their fellow students and the group aspect of the experience. it’s psychological. It affects all of those, and it’s Anna, the most social of the eight, was the most eloquent physical. It has basically solidified a whole bunch about this. of stuff I have been dealing with most of my life. (Anna) Every person in this group contributes some- thing to me—to me personally, as well as to Respondents frequently and explicitly linked spirit to the group. There’s just this real safety of all body and mind and emotions and reported a conscious sense of us with each other ... we’re just joyful ... of a more connected spirituality. everybody’s very peaceful. Journal of Aging Research 9 In this layer, interviewees reflect on the complexity of All eight of our interviewees referenced at least four the whole process, marveling at how so simple a thing could individual dimensions in describing their experiences. Six be “affecting everything.” For all of them, musings about respondents referenced all five dimensions in their obser- the mechanism, about how it all might work, became more vations. Six reported a spiritual experience from their Taiji complex, surprising, mysterious and indirect than previously practice, with five of these six expressing surprise about thought. Helga was the most philosophical: that. Two reported no spiritual experience, with one of these stating that he/she was “not religious”, and the other There’s something that has to be fundamental, stating that spirituality for her/him was a separate issue something universal—the movements and the tied to their Christian religion. One of these two reported mental attitude seem to provide people with that a “sense of peacefulness” was his/her most important an avenue for their own self-expression, their Taiji experience, and the other talked about the unique and internal expression. Not the outside, but how special importance of Taiji as “both and inner and outer you feel on the inside ... it probably comes experience”—wordings very similar to the other six who did from the base of the understanding of that report spiritual experiences. Seven of the eight respondents person of him or herself ... and what they think made complex four-dimensional statements that referenced of their own improvement ... and it may be four dimensions in one expressed thought (See Table 2). improvement of many, many fronts or different Five respondents (four in the first group and one in the fronts for different people. second) made complex five-dimensional statements; four of these five were our only participants with advanced degrees. Anna, as the free spirit of the eight, had the loosest, most Educational level here may represent verbal fluency or actual freewheeling interpretation of her experience. She viewed differences in experience, or both. Otherwise there was no it as a complex phenomenon that she experienced with appreciable difference between the dimensional content and surprise, enthusiasm, and a zen-like trust. coding of the two sets of four interviews, thereby providing corroboration for our interpretive model [40, 41]. Who knows what all this is about? I don’t even Our findings are not intended to be a definitive expli- trytointerpret.Thisiswonderful!... Andit’s cation of Taiji’s effects but to further the exploration and affecting everything! .... I’m going to live the discussion of its multifactorial properties. The Layers Model rest of my life differently .... I’m so glad I’m gradually emerged as both an organized, descriptive display doing this! of the data and a model that captured the meanings and significance of our respondents’ statements [43]. Our initial Another hallmark of this layer is a strong sense of grati- tude for the experience. visual conception of the Layers Model was as a three- dimensional spatial model showing how the five dimensions I think that this is just grand! To learn something overlap to create all 31 categories (a Venn diagram); the when you are in your late 70 s that you can present two-dimensional spatial diagram evolved from that use for however long you happen to live—I as a simpler and clearer illustration of only the layering mean what greater gift could you expect? You effect, as that seemed to optimally illustrate our findings. know you don’t think about 70-year-olds really A strength of the model is that it can function both ways. learning new things that they can carry on Because the model emerged from data specific to this project, ... this is so unexpected. This has made me its usefulness beyond this study is yet to be determined. feel much younger, much younger—let’s say 10 One possible limitation is that at higher levels of complexity, years .... Someone who hasn’t done this has no it may be measuring verbal fluency as well as subjective comprehension about how much better it has experience. We feel the strength of the model is that it made me feel (Grace). illustrates and illuminates the multidimensionality of our respondents’ experiences—a quality that appears to be the hallmark of their experience. This finding resonates with 4. Discussion previous interview studies of Taiji/Qigong which allude to participants’ description of a wide variety and complexity of We found that although each interviewee had his or her own unique experience of Taiji and Qigong there were strong experience and/or strong carry-over into everyday function commonalities among the eight respondents. All began with as important benefits [19, 27, 28]. Other limitations of our motivations related to physical problems and concerns, and, study include the small sample size, the purposeful selection all reported significant functional improvement. All also process, and the subjective nature of the data analysis. reported experiencing benefits in at least three other dimen- Further studies are needed to substantiate the usefulness of sions, and all reported integrated mind-body experiences our interpretive findings. that were, in their own subjective assessments, powerful and This study raises questions about the nature of both unexpected. Ultimately, all of the interviewees felt that these our respondents’ experiences and the nature of Taiji itself. complex integrative experiences were the most important The challenges of measuring complex interventions like Taiji and meaningful outcome of their participation in Taiji. And and Qigong has been theorized in several recent studies so as they practiced Taiji and experienced more complex [44]. 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Subjective Experiences of Older Adults Practicing Taiji and Qigong

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Hindawi Publishing Corporation
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Copyright © 2011 Yang Yang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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2090-2204
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2090-2212
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10.4061/2011/650210
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SAGE-Hindawi Access to Research Journal of Aging Research Volume 2011, Article ID 650210, 11 pages doi:10.4061/2011/650210 Research Article Subjective Experiences of Older Adults Practicing Taiji and Qigong 1, 2 3 4 5 Yang Yang, Sharon DeCelle, Mike Reed, Karl Rosengren, 6 7 Robert Schlagal, and Jennifer Greene Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA Center for Taiji & Qigong Studies, P.O. Box 308, NY 10028, USA 319 S. Randolph Street, Champaign, IL 61820, USA 1104 West Daniel Street, Champaign, IL 61821-4516, USA Department of Cognitive Psychology, Northwestern University, Evanston, IL 60208, USA College of Education, Appalachian State University, Boone, NC 28608, USA College of Education, University of Illinois at Urbana-Champaign, 230C Education Building, 1310 S. 6th Street, Champaign, IL 61820, USA Correspondence should be addressed to Yang Yang, yyang5@illinois.edu Received 11 March 2011; Accepted 14 April 2011 Academic Editor: J. Woo Copyright © 2011 Yang Yang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article presents a qualitative study following a 6-month Taiji (T’ai Chi)/Qigong (Ch’i Kung) intervention for older adults. The researchers conducted in-depth interviews of eight selected participants who elected to continue practicing Taiji after the intervention ended, in order to explore their subjective experiences of Taiji’s effects and their motivations for continuing to practice. We created a Layers Model to capture the significance and meaning of the multidimensionality of their reported experiences. Participants not only reported simple benefits along five dimensions of experience (physical, mental, emotional, social and spiritual) but also described complex multidimensional experiences. Overall findings indicate that participants derived a very wide variety of perceived benefits, the most meaningful being a felt sense of body-mind-spirit integration. Our results support the important role of qualitative studies in researching the effects of Taiji and Qigong. 1. Introduction Although not all Taiji studies report on the continuance rates for participants at the end of a Taiji intervention, those Over the past 20 years, Taiji has emerged as a popular and that do report high levels of subsequent adherence. Wolf much-researched exercise intervention, especially for older et al.’s [13] study cited a continuance rate of over 50%. adult populations. Although most Taiji research has inves- In the Wenneberg et al. [19] study, 9 of 16 participants tigated physical effects, many studies have reported positive continued Qigong. In their study of patients with chronic findings for both psychological and physical function. Most heart failure, Yeh et al. [4] reported that 14 of 15 participants of the studies that have evaluated psychological benefits have planned to continue Taiji. Two studies cited higher exercise used a quantitative approach and standardized psychological continuance with Taiji compared to a control group, either measures, with significant positive effects noted in a variety an aerobic exercise group [20] or a home exercise group of areas assessed, including improved quality of life/mood [21]. Other studies reported low drop-out rates for Taiji [1–5]; reduction in perceived stress and pain [6–9]; increased classes. Gavin and Myers [22]reported, “Itisnoteworthy self-efficacy [2, 10, 11]; reduced fear of falls and increased that tracking for three years, the drop-out rate for the balance confidence [12–15]; enhanced immune response ongoing Taiji (community) class was only 34%, considerably [16–18]. lower than the 46–52% dropout rate for more traditional 2 Journal of Aging Research exercise classes” (page 137). In a 6-month post-intervention intervention ended. Our study was small and the focus follow-up study, Li et al. [23] reported that more than 50% narrow. Our intent was an exploration of respondents’ of a previously sedentary sample had remained physically personal experiences of Taiji in order to gain understanding active. The Gavin and Myers [22] study also reported a of the perceived effects and motivations that empowered high continuance rate: of the 107 people who had enrolled them to continue practice: just what were they experiencing in a beginning Taiji class and were tracked over a 1-year during the six-month study that influenced them to keep period, 67% said they planned to enroll in a subsequent class. practicing Taiji after the intervention was over? This decision of participants to continue practicing Taiji or Qigong after an intervention has ended is an important 2. Method finding that has not been addressed. Such a trend is of interest, because sedentary lifestyles are a major public 2.1. Taiji Intervention Participation. Taiji (T’ai Chi)/Qigong health concern; a majority of Americans do not engage in (Ch’i Kung) are complex practices that have existed for many recommended levels of physical activity despite decades of centuries in China. Traditionally, the purpose of pursuing research showing its benefits [24, 25]. these practices is to unify the mind, body, and spirit in These low drop-out and high continuance reports sup- order to move toward greater harmony with oneself and port the premise that Taiji elicits an unusually positive the environment, and thus toward improved health and response in participants, yet, despite many calls for research functioning [29, 30]. A complete traditional Taiji curriculum that investigates the role of subjective experience and includes Qigong (standing, sitting, lying down meditation, meaning regarding older people and exercise [26], very few and simple movements, all with an emphasis on meditation), studies have used interviews to gather subjective information Form (the classic movements that are the familiar hallmark regarding participants’ responses to Taiji. The importance of Taiji), and Push-hands (two-person dynamic training, the of a sense of carryover of Taiji into everyday life and/or “martial art” application of Taiji) [30, 31]. We did not have a wide range of perceived benefits has been alluded to in adequate time to include Push-hands due to the limitations several studies. By asking six questions to generate binary of the 6-month time frame. Three one-hour classes per week outcome variables, Kutner et al. [27] found that both were designed and taught by Yang Yang with three of his their intervention (Taiji) group and their control (balance long-term students assisting. training) group reported increased confidence in balance We began with two dynamic Qigong exercises (Heaven and movement, but only the Taiji participants reported and Earth Open and Close and Lower the Qi and Cleanse effects in daily activities and overall life. Wenneberg et al. Internally) and with static sitting and standing Qigong [19] conducted semistructured interviews to examine the meditation. We gradually increased the amount of static subjective experiences of patients with muscular dystrophy sitting and standing practice, until by the 13th week of the who practiced Qigong. Using a computer program, they study participants were completing one 10-minute sitting coded their data into six categories that included three and two 10-minute standing meditations each class. categories of perceived benefits: mental/stress reduction Form work was comprised of 7 movements taken from effects, increased body awareness and physical effects, and the Chen Style 48-Movement Form distilled by Grandmaster psychosocial effects of group training. They reported that Feng Zhiqiang. The intention was to create a form that one third of the patients described very positive results; was short and thus easy to remember and yet engaged a another third reported moderate benefits in relaxation and wide range of motion of the entire body and incorporated stress reduction; the final third experienced minor effects. In weight shifts and stepping in all directions. Movements were conclusion, they noted also selected for their adaptability and accessibility, as it was The most prominent finding ... is the wide deemed essential that participants be able to enter the study variation of experience and perceived effects at nearly any level of physical ability and experience progress. among participants ... [the] blending together The seven movements are Preparatory Form, Lazy About of mental and physical methods may in part Tying Coat, Fist Under Elbow, Step Back and Whirl Arms on explain the wide range of experienced benefits Both Sides, Part Horse’s Mane, Wave Hands Through Clouds, (page 593). and Close. The fundamental skills of Taiji—relaxation, align- ment, footwork, efficiency, coordination, accuracy of force Docker [28] interviewed seven older participants in production, and control—were emphasized, and parallels community Tai Chi clubs in Northern England. Her findings were drawn to daily activities. We gradually included more showed participants reported “a variety of physical and information about integrating mind and spirit into the mental benefits” as well as “intriguing special effects ... of practice, stressing the importance of a tranquil, peaceful a spiritual or mystical nature” concluding that “practicing mind and a light and happy spirit in nurturing the body’s (tai chi) may be attractive to older people not only because vital energy. Traditional Chinese music [32]was played of its suitability as a moderate intensity exercise ... but also during classes to help cultivate tranquility. because it may fulfill other social, emotional, developmental or spiritual needs” (page 114-115). The purpose of the present study was to further inves- 2.2. Methodological Framework. In designing this study, our tigate the subjective experiences of older participants who hope was that through open-ended, in-depth interviews, we elected to continue practicing Taiji on their own after our would gain insights into the nature of the experiences that Journal of Aging Research 3 led to respondents’ ongoing commitment to Taiji practice. of the first four interviews, we used the data from these four Our methodology is grounded in social constructionism to create an interpretive model. [33, 34]. In this framework, it is the meaning that individuals Our five dimensions—physical, mental, emotional, construct their lived experiences that are assumed to shape social, and spiritual—were initially conceived as “fuzzy” cat- and guide human action, and so social inquiry is appropri- egories [39], and so it was assumed that there might be some ately focused on understanding these meanings. Because the overlapping assignments of the data. Yet, we were surprised interpretive reconstruction of meanings depends, in part, on to discover that the vast majority of the data segments who is the listener, our aim was to offer a keenly interested required multiple-dimension assignment (e.g., physical and ear and to encourage a full telling of participants’ Taiji mental; emotional, social, and spiritual) in order to fully experiences, while muting our own views and perceptions as capture their meaning. We then created a horizontal table much as possible [35, 36]. of the 31 mathematically possible categories (e.g., possible combinations of the five dimensions) and arranged all the data in this table in order to search for themes in each of the 2.3. Sampling. At the end of our six-month quantitative 31 categories. Upon detailed examination and comparison Taiji intervention [15, 18], we purposefully selected and of the contents of the statements in each category, we found obtained written informed consent from a sample of eight that the multidimensionality of the data seemed to be their “information-rich cases” [37, page 231]. These were subjects most dominant and meaningful characteristic. The number who were continuing Taiji classes on their own, and who, of dimensions characterizing the data segments appeared during the six-month study, were observed to be verbally to emerge as a more compelling story of the meaning enthusiastic and articulate about their participation. The of participants’ experiences than a listing of exactly which rationale for selecting these participants was to maximize categories were involved, or even of exactly what was said the potential richness of the interview information to be in each category. The meaning of the data came into focus obtained [37]. The study was approved by the institutional when we began to look at it in terms of investigating the review board of the University of Illinois. meaning of its surprisingly substantial multidimensionality. Our interpretive framework emerged directly from this 2.4. Interviews. The interviews were semistructured using “discovery”. the general interview guide approach [37, page 342–344] as Because all the three coders had practiced Taiji, in order a framework. We began each interview with an invitation to to minimize possible interpretive bias, we then had an tell the story of their Taiji experience; subsequent questions experienced outside qualitative researcher (Greene) with no and probes pursued participant motivations for joining the previous Taiji experience examine our data and findings to class, experiences during the class, and any reported changes give objective input and feedback. After re-analyzing and in aspects of daily life and general health and well-being. fine-tuning our model, lastly, we went back and coded the An assistant Taiji teacher (Reed) and a physical therapist remaining four interviews as a form of both multiplicative who was also a Taiji student (DeCelle), each, conducted and structural corroboration of our findings [40, 41]. four interviews. Conversations of 60- to 90-minutes were recorded in the interviewees’ homes and then transcribed. 3. Results 2.5. Analysis. In designing our analysis, we were influenced 3.1. Interpretive Framework. We created the Layers Model by a series of dialogues we had conducted with Taiji as a way to capture the meaning of the multidimension- participants in a 2000 pilot study; results from this suggested ality of respondents’ statements. The model is based on a broad five-category model of physical, mental, emotional, the overlapping of the five dimensions—physical, mental, social, and spiritual benefits from Taiji participation. We emotional, social, spiritual—and how they combine to create elected to start with these five descriptive categories as an five overlapping layers of one-, two-, three-, four-, and initial framework for organizing and coding the interviews five-dimensional statements. Upon reviewing the substantive as they seemed to capture the key elements from our pilot content of all of the statements contained in each layer, the study and from other studies (e.g., [19, 28]), as well as being Layers Model evolved from a descriptive representation of congruent with the work of Spirduso, 1994 [38]. the material in each layer to a “prototype” model that offers a Following an initial reading of all of the interviews, the conceptual framework for examining the collective meaning three members of the coding team (Yang, DeCelle, Reed) of the statements in each layer. ranked the interviews in terms of information richness [37] We combined the four- and five-dimensional statements and began coding with the richest interview. The process into one layer, Layer 4, to reframe the model as a continuum began with each coder independently assigning each data representing four increasingly complex layers of experience. segment (phrase, sentence, or passage) to the appropri- ate dimension of experience—physical, mental, emotional, social, or spiritual. We then met to agree on a group coding. Layer 1 (Simple Benefits). Statements that reference a single- After completing the group coding of the first interview, dimension. These comments describe physical or mental we went on to the next interview, repeating this process of effects that often were related to the interviewees’ original individual then group coding. After completing the coding motivations for joining the study. 4 Journal of Aging Research Layer 2 (Complex Benefits). Statements that reference two socioeconomic status. Four lived in a senior retirement dimensions. In this layer, benefits begin to carry over into community, and four in their own homes; four lived with everyday life, and the interviewees express the beginnings of spouses, and four lived alone. All were motivated to join the improved mind-body connection and an increase in general intervention for physical reasons (1) one with moderately self-awareness. severe back pain that limited her activities of daily living (ADL’s) and generated problems with sleeping; (2) one with long-standing back pain and severe arthritis, along with Layer 3 (Immersion). Statements that reference three dimen- a feeling of not having much more time “left”; (3) one sions. In this layer, there is expression of increasingly signif- with limitations in various ADL’s including gardening and icant carryover of benefits into everyday activities and there dressing, self-described as “beginning to feel like an old is a clearly expressed mind-body connection with associated lady”; (4) another self-described as never having been very positive emotions. The interviewees report that Taiji begins physical and worried about “losing touch with my body”; (5) to permeate the way they think and feel about themselves; one with hip and knee pain secondary to arthritis “that was they report a more positive attitude and significant changes getting pretty painful” who was “hoping to get stronger and in self-confidence and self-concept. get moving again”; (6) one primarily for gait issues related to balance and strength, “I was beginning to stumble when I Layer 4 (Complex Integration). Statements that reference walked and I thought this might help”; (7) one self-described four- and/or five-dimensions. In this layer, interviewees as having become “fairly sedentary” and thought “it might express experiencing Taiji as an opportunity and a tool to be a way to get moving again without causing problems with grow and nurture themselves; they describe a sense of a my knees and shoulders”; (8) another with “problems with complex mind-body-spirit connection and most report a my legs, especially my knees”. conscious sense of a more integrated spirituality. 3.3. Experiences of Taiji and Qigong. In this section we We then created a Layers Diagram as a visual represen- present interview data within the Layers Model. tation of the Layers Model. It shows the overlapping of the layers and the progression from the lightly shaded single- Layer 1 (Simple Benefits). In Layer 1, interviewees report category statements in the outer Layer One, to the slightly simple changes stemming from their practice of Taiji. darker double-category statements of Layer Two, the more These are single-category statements. These reported changes darkly shaded triple-category statements of Layer Three, and typically refer to a physical benefit that was related to the finally the four and five category statements in the darkest individual’s primary motivation for participation in the shaded Layer Four center of the figure. Table 1 shows the study. relationship between the initial 31 possible categories, the Layers Model and the Layers Diagram. My balance was already pretty good but I could This representation seems obvious in retrospect, but was still see an improvement. Climbing stairs—I actually a “Eureka!-” like realization when it finally emerged know I said on the questionnaire “yes, I’m at the very end of our analytic process. We believe it provides confident about it.” Still ... now I feel more a parsimonious way of visualizing the entire project and thus ... confident ... balance has improved ... my of mapping all the data and our interpretive understanding strength has improved. (Jamie) of it. Because, in qualitative studies, the goal is to construct Positive changes in physical function were reported by all. an interpretation that resonates with the participants’ own Helga made it clear that physical benefits do not have to be interpretations of their experiences [42], in order to establish dramatic for useful improvement to be noted. the credibility of our interpretations, we conducted a formal “member check” [36]. Each of the interviewees (seven of I realize at my age that deterioration is setting the eight as one was deceased at that point) was asked in .... I think if you’re just holding your own, to read this account and comment on the accuracy of you’re lucky .... I fatigue a lot easier, sooner our interpretations. Each participant expressed unqualified .... I can realize I’m losing ground on that, and agreement that this is an accurate representation of her/his yet .... It has helped ... not a pie-in-the-sky experiences and their meaningfulness. sort of thing ‘cause my arthritis is continuing to deteriorate in my knees, but I find that I have 3.2. Participants. What follows is a brief description of the more strength in my legs and better balance. participants and their initial motivations for doing Taiji. (Specific demographic details have been omitted to safeguard Positive changes in strength and balance were cited by confidentiality. Interviewees selected their own aliases for seven of the eight. (The one exception reported no initial the quotation section.) At the time of the study, all eight strength or balance deficits.) interviewees were retired, aged 82, 82, 79, 79, 75, 74, 70, and 67. One was male. Seven were college graduates including In the beginning (doing the Qigong) some of the four with advanced degrees, and one was a high school muscles in my legs would really, really hurt ... graduate. Six were of moderately high and two of moderate and now I can’t make it hurt anymore ... and Journal of Aging Research 5 Table 1: Layers diagram, Layers Model, possible category combinations. Possible statement category Layers Model Layers diagram combinations P Simple benefits diagram Layer 1 (five possible single-category statements) So Sp P+M Complex benefits diagram P+E P+So P+Sp Layer 2 (10 possible double-category statements) M + E M+So M+Sp E+So E+Sp So + Sp P+M+E Immersion diagram P+M+So P+M+Sp P+E+So Layer 3 (10 possible triple-category statements) P + E + Sp P+So +Sp M+E+So M+E+Sp M+So+Sp E+So +Sp P+M+E+So Complex integration diagram P+M+E+Sp P+E+So +Sp Layer 4 (5 possible four-category statements) and one possible five-category statement P+M+So +Sp M+E+So +Sp P+M+E+So+Sp 6 Journal of Aging Research Table 1: Continued. Possible statement category Layers Model Layers diagram combinations Full layers diagram All four layers All Statements in all 31 categories Statement categories: P: physical; M: mental; E: emotional; So: social; Sp: spiritual. I’m standing three times as long .... Now I can Increased relaxation and calmness were also mentioned put my socks and jeans on just like I always used by all eight as valuable and useful effects. In this double- to, standing up instead of sitting down. (Grace) category layer, interviewees also talked about more inher- ently complex issues such as energy level and sleep. You learn to stand on one foot, and I can do that Ihavemoreenergy .... The Taiji practice so much better now. Believe it or not, I couldn’t continues to keep my energy level up higher do it all before. (Arlene) than it would be otherwise, certainly higher than it was. I’m able to do more than I used to and do what Iusedtodomoreeasily. (Grace) Pain relief was another issue motivating participation; improvement was noted by seven of the eight (the eighth Jamie reported that, “My sleep is better .... Ilovethe full reported no initial pain), especially Jamie. “I’m at the point night’s sleep .... I used to wake up at 3:00 every morning and where I don’t have any pain ... and I’m back to being as active couldn’t go back to sleep ... now it’s fine.” as I was. Quickness is back—I don’t have to be slow and Respondents described experiencing the beginning of a careful.” Improved flexibility was noted by three respondents, body-mind connection from different perspectives. for example, “I was having stiffness getting in and out of bed, and I don’t have that anymore. I mean I can just roll over and You know, early on, in the Qigong ... I had this roll out of bed, everything’s fine now” (Ruth). mental picture of these endorphins that go to This layer also contained some benefits coded as mental, your brain and make you feel better after you with four participants reporting improved ability to concen- exercise, so I would be sitting there thinking, trate. “OK you little endorphin, go down to that knee, work yourself in there and make yourself at Layer 2 (Complex Benefits). In Layer 2, interviewees express home.” I tried to send them to various parts their sense of the benefits of Taiji in a more complex of my body, and after a while, I could feel it. way, mostly combining the mental and physical dimensions. (Helga) All the interviewees reported a carryover of benefits into A number of physical-mental category statements relate everyday life. “I go up the stairs better. I’m very aware of to an increased awareness of a heightened mind-body where my feet are ... before, I don’t think I really knew where connection. my feet were unless I was looking” (Anna). I’ve become much more aware of my body Because of Taiji you are more aware of how you .... I’ve observed muscles loosening up that I stand, how you sit, how you move .... It has probably couldn’t have identified as even being really helped me ... in the daily things I want to there before ... they stay relaxed more ... and get done and being more focused; and of course I’m usually aware of when they start to tense up, the more focused you are, the better it goes, the and I can “untense” them. (Anna) better job you do, and the quicker you get it done .... Let’s say I’m in the kitchen preparing The greatest thing ... is becoming aware of my ameal ... it goes much smoother and it’s easier. body. It has really helped my posture. I can tell In other words everyday things are better, easier. now when I’m slumping—it just doesn’t feel (Grace) right. (Sally) Journal of Aging Research 7 Every time I do the Qigong I have this rush confidence, and not worrying so much about what cannot of heat going through my body—it amazed me be changed. According to Jamie, “I feel more upbeat ... more the first time it happened. I imagine my blood optimistic ... more hopeful .... I’ve upped my lifespan from going through ... I relax the muscles because I’m 80 to 100. How’s that!” thinking I want the blood to have lots of space Interviewees spoke of Taiji permeating many aspects for flowing through ... it’s using your mind to of daily life including social contexts. Anna talked about connect more clearly to the body. (Jaime) how she was much more able to handle stressful family encounters. A sense of improvement in functional ability was fre- I got so I could turn that stuff [negative feelings] quently expressed along with a positive emotional response off faster ... before Taiji there were times when I to the perceived physical improvement. could hardly get rid of it at all ... [now] it’s like, It is amazing how much everyone in the group I am not letting this stop me—Irefuse! [talking about a particularly recent stressful encounter] has improved on that one leg standing, and it makes people feel so good that they can do that! ... and I took care of it in terms of getting past it I remember when we were first tested and they in less than 5 minutes! asked me to stand on one leg with my eyes At this level, participants also express a deeper sense of closed. Well, I thought that was the craziest thing integration that begins to include spirit into the mind-body to even think about! Now I can do it for 30 sense of self. seconds plus without any problem. (Grace) I look forward to the standing Qigong, and the release of everything around you ... I imagine Layer 3 (Immersion). In Layer 3 there are triple-category that I’m standing in water, in the ocean ... it has statements, most of which were mental-physical-emotional. such a calming effect on me and this helps me so In this layer, respondents remark that the relevance of Taiji that I can get up and go. (Helga) has permeated many aspects of their lives. Interviewees frequently made statements that added an emotional com- At this level, these elders began to express a sense of ponent to the physical-mental benefits they experienced, surprise at the scope of the benefits they felt. Many of them usually commenting on how very good the mind-body mused about the mechanism—how it works—and began connection felt to them. “I feel, my body feels sort of though thinking that it might be more complicated than they had it’s being worked on from the inside out, and it feels so very previously thought. There was a clear sense of surprise good to do that” (Jamie). that such a simple activity could produce such exceptional Each interviewee had her/his own experience of a benefits and have such broad application. layering of the physical-mental-emotional categories. All reported experiencing significant changes in self-concept and Icouldn’tbelieve it.Atfirst, Imeanitlooked confidence and a more holistic sense of overall abilities and like, “Why should we even do this?!” But I potential. can see now after doing it that it is giving me strength. I mean it’s the ability to walk better, I notice that, well I notice me more .... There sit better, turn better ... it isn’t just a forceful are times in Qigong that—I hear myself shift to strength, it’s a strength within, it’s an inner ... it adifferent place .... This experience of being has caused my body to follow through with my lined up, when things get lined up differently mind when it says to do something. (Ruth) inside me—there is this most unusual sensation I do not like to exercise. That is NOT my favorite of like everything coming together, it’s like thing, and I am not a disciplined person .... but something goes ahhhaah .... It’s a full body this is something ... it’s just so different from sensation that’s almost spiritual. (Anna) individual exercise. I mean it IS individual, but, All were more optimistic about themselves and about you just receive so much from this ... it’s very their own aging process. Each of the eight expressed the belief different to quiet your mind and not be thinking that she/he had significantly improved her quality of life, about things .... I don’t know how to explain it increased her/his lifespan, or both. ... it can be very spiritual. (Sally) I quit Curves when Taiji came along. I’d rather I will keep doing this—it’s wonderful! My do Taiji. There’s just no comparison between husband is just astounded that I’ll devote three the two, no comparison. That’s strictly exercise. [group] sessions a week to it .... I have the This is something entirely different .... It’s sense that I’m not going to go downhill nearly as just absolutely amazing what it does to your quickly as I might have. It’s a very positive way body and mind .... and you don’t realize how to feel. (Grace) important it is until you go through it .... All of these participants talked in some way about People who haven’t done it, until they actually seeing themselves differently, as having more potential, more do, they really don’t believe you. (Arlene) 8 Journal of Aging Research I’m really interested in trying to figure out why The thing that comes close to being spiritual it’s so useful and so successful .... I’ve been for me is the closing Qigong movement, where so active all my life—it surprises me that the you raise your arms and you gather in energy. standing could be so helpful. I don’t have to I can see myself getting just a little piece of hike up a mountain .... In fact, climbing the that cosmos out there ... and also the power mountain wouldn’t be as effective ... Ican do of cleansing yourself as you push that energy it in a hotel room, just about any place .... I’ve in and down through you; you reach out into done it at the airport, looking out the window. the ultimate universe and gather a part of it (Jamie) inside. This to me is separate from God in my own beliefs, but it’s something that offers Echoing Jamie, many of the participants expressed the an opportunity for my spirit to express itself, importance of finding it very easy to integrate into everyday connecting myself ... to a spirit within that is life. “It’s available anytime and anywhere I want to do it ... part of a bigger whole. (Helga) whenever the spirit moves me” (Harry). “It’s almost like this Respondents reported that this enhanced mind-body- little magic pill or something that I can now say to my mind spirit connection was very meaningful for them. Grace “Quiet, calm, you can do this,” and it’s like, wow, I can do this described this linking of the spirit with the physical-mental- anyplace” (Sally). emotional as a very new experience for her. Layer 4 (Complex Integration). Layer 4 expressions involve TheTaiji givesyou ... a way to create a spiritual a complex integration of multiple categories: four or five moment that is also very healthful in a physical dimensions overlap in the interviewees’ statements, notably way .... I can’t say I’m more spiritual, but I’m mental-physical-emotional-spiritual. This layer involves a more aware of my spirituality .... Inever in sense of Taiji as an organizing, integrating experience. my whole world would have thought, you know, Interviewees spoke of transformative changes, along with when we’re doing our meditation, and you look a firm commitment to continuing Taiji practice for very out there and see the beautiful trees, and you different reasons than when they began. know that’s God’s energy, and it’s going to be part of me ... like when we do that washing your This is a life change for me. I want to continue organs, and gather that energy with our hands to do it for as long as I’m able, because I think ... and I can actually feel my fingers growing— it’s extremely helpful. When I talk to people I that’s God’s energy washing through me ... that say, “I’ve started Taiji and it’s changed my life.” sense of being very spiritual and physical at the (Jaime) same time ... it’s just not comprehensible to the world! I can’t imagine Taiji not being in my life now. It has just been such a delight and such a At this level, interviewees observed that the Taiji philos- revelation. (Sally) ophy (actively cultivating tranquility, wisdom, energy, and health through a mind-body-spirit connection) permeated This has affected every area of my life ... it’s been their thinking. They reported experiencing a significant exhilarating in many ways .... I’ve experienced increase in their capacity to feel healthier; all conveyed more a variety of feelings and sensations that come as optimism about themselves, about aging, and about their total surprises to me .... I never plan to stop. It quality of life. contributes too much to me in too many ways to ever stop. (Anna) Because of this, I am learning some new trust in myself that’s spiritual in some respects .... In Layer four, these respondents experienced Taiji as Taiji has supported a whole place of believing in an opportunity to learn, grow, and nurture themselves; it myself and listening more strongly to my own became an important tool for them in their daily lives. thoughts, rather than trying to fit into some other way of thinking. (Anna) My personal experience with it is that partic- ipation in Taiji has affected every area of my At this level, some expressed a strong appreciation for life. It’s, to me, Taiji is spiritual, it’s emotional, their fellow students and the group aspect of the experience. it’s psychological. It affects all of those, and it’s Anna, the most social of the eight, was the most eloquent physical. It has basically solidified a whole bunch about this. of stuff I have been dealing with most of my life. (Anna) Every person in this group contributes some- thing to me—to me personally, as well as to Respondents frequently and explicitly linked spirit to the group. There’s just this real safety of all body and mind and emotions and reported a conscious sense of us with each other ... we’re just joyful ... of a more connected spirituality. everybody’s very peaceful. Journal of Aging Research 9 In this layer, interviewees reflect on the complexity of All eight of our interviewees referenced at least four the whole process, marveling at how so simple a thing could individual dimensions in describing their experiences. Six be “affecting everything.” For all of them, musings about respondents referenced all five dimensions in their obser- the mechanism, about how it all might work, became more vations. Six reported a spiritual experience from their Taiji complex, surprising, mysterious and indirect than previously practice, with five of these six expressing surprise about thought. Helga was the most philosophical: that. Two reported no spiritual experience, with one of these stating that he/she was “not religious”, and the other There’s something that has to be fundamental, stating that spirituality for her/him was a separate issue something universal—the movements and the tied to their Christian religion. One of these two reported mental attitude seem to provide people with that a “sense of peacefulness” was his/her most important an avenue for their own self-expression, their Taiji experience, and the other talked about the unique and internal expression. Not the outside, but how special importance of Taiji as “both and inner and outer you feel on the inside ... it probably comes experience”—wordings very similar to the other six who did from the base of the understanding of that report spiritual experiences. Seven of the eight respondents person of him or herself ... and what they think made complex four-dimensional statements that referenced of their own improvement ... and it may be four dimensions in one expressed thought (See Table 2). improvement of many, many fronts or different Five respondents (four in the first group and one in the fronts for different people. second) made complex five-dimensional statements; four of these five were our only participants with advanced degrees. Anna, as the free spirit of the eight, had the loosest, most Educational level here may represent verbal fluency or actual freewheeling interpretation of her experience. She viewed differences in experience, or both. Otherwise there was no it as a complex phenomenon that she experienced with appreciable difference between the dimensional content and surprise, enthusiasm, and a zen-like trust. coding of the two sets of four interviews, thereby providing corroboration for our interpretive model [40, 41]. Who knows what all this is about? I don’t even Our findings are not intended to be a definitive expli- trytointerpret.Thisiswonderful!... Andit’s cation of Taiji’s effects but to further the exploration and affecting everything! .... I’m going to live the discussion of its multifactorial properties. The Layers Model rest of my life differently .... I’m so glad I’m gradually emerged as both an organized, descriptive display doing this! of the data and a model that captured the meanings and significance of our respondents’ statements [43]. Our initial Another hallmark of this layer is a strong sense of grati- tude for the experience. visual conception of the Layers Model was as a three- dimensional spatial model showing how the five dimensions I think that this is just grand! To learn something overlap to create all 31 categories (a Venn diagram); the when you are in your late 70 s that you can present two-dimensional spatial diagram evolved from that use for however long you happen to live—I as a simpler and clearer illustration of only the layering mean what greater gift could you expect? You effect, as that seemed to optimally illustrate our findings. know you don’t think about 70-year-olds really A strength of the model is that it can function both ways. learning new things that they can carry on Because the model emerged from data specific to this project, ... this is so unexpected. This has made me its usefulness beyond this study is yet to be determined. feel much younger, much younger—let’s say 10 One possible limitation is that at higher levels of complexity, years .... Someone who hasn’t done this has no it may be measuring verbal fluency as well as subjective comprehension about how much better it has experience. We feel the strength of the model is that it made me feel (Grace). illustrates and illuminates the multidimensionality of our respondents’ experiences—a quality that appears to be the hallmark of their experience. This finding resonates with 4. Discussion previous interview studies of Taiji/Qigong which allude to participants’ description of a wide variety and complexity of We found that although each interviewee had his or her own unique experience of Taiji and Qigong there were strong experience and/or strong carry-over into everyday function commonalities among the eight respondents. All began with as important benefits [19, 27, 28]. Other limitations of our motivations related to physical problems and concerns, and, study include the small sample size, the purposeful selection all reported significant functional improvement. All also process, and the subjective nature of the data analysis. reported experiencing benefits in at least three other dimen- Further studies are needed to substantiate the usefulness of sions, and all reported integrated mind-body experiences our interpretive findings. that were, in their own subjective assessments, powerful and This study raises questions about the nature of both unexpected. Ultimately, all of the interviewees felt that these our respondents’ experiences and the nature of Taiji itself. complex integrative experiences were the most important The challenges of measuring complex interventions like Taiji and meaningful outcome of their participation in Taiji. And and Qigong has been theorized in several recent studies so as they practiced Taiji and experienced more complex [44]. 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