CM Fetherston and L Wei
Chronic illnesses pose one of the most significant challenges facing health care systems worldwide. The increasing prev alence of conditions such as metabolic syndrome, asthma, arthritis, diabetes, cardiovascular disease (CVD) and depres sion is expected to consume 80% of Australia's healthcare expenditure by 2020 (National Health Priority Action Council 2006) and is the leading cause of death and disability in the USA, accounting for 70% of all deaths (Kung et al. 2008). The increasing economic burden resulting from this world-wide problem has been compounded by ageing populations, which in the author's home country, Australia, is expected to see a doubling of people aged 65 years and older by the year 2036 [Australia Institute of Health and Welfare (AIHW) 2008]. As a result, effective public health strategies directed at early intervention in, and prevention of, chronic illnesses are now a major health priority.
One of the key intervention strategies outlined by the World Health Organization's (WHO) Innovative Care for Chronic Conditions (ICCC) report (WHO 2001) is to educate and support patients to find strategies that enable them to manage their own conditions as much as possible. This has led to the development of specific programs that guide health professionals in how to encourage self management strategies. Examples of these include the Chronic Disease Self Management Program (Lorig et al. 1999) developed at Stanford
University in the USA and the Flinders Program of Chronic Condition Self Management, which was formerly known as The Flinders Model from Flinders University in Australia (Flinders Human Behaviour & Health Research Unit 2010). Integral to programs such as these are health promotion strategies that assist patients with chronic illness to adopt lifestyles and engage in activities that protect and promote their health. Initiatives such as the Flinders Program are supported by Government and have resulted in a strong level of interest, from both health professionals and the popular media, in behaviours that assist in promoting and-maintaining optimal health. However, health promotion is not only about persuading people to make healthy behavioural and lifestyle changes, but also extends to helping them either access or rearrange circumstances in their physical environments (Egger et al. 2005., p. 14). Clearly, programs offered at the community or neighbourhood level have enormous potential to help people manage chronic conditions and prevent ill health throughout the ageing process.
Neighbourhood and community-based programs range from local council sponsored aerobic exercise and weight loss training, at one end of the continuum, to psychological approaches such as meditation, support groups and psychotherapy at the other. The availability and promotion of these type of programs has encouraged many people to seek out a health pursuit which they view will assist them to achieve their personal health management goals. Often such programs also have the added benefit of providing an opportunity for people with chronic conditions to be part of a supportive environment where they can increase their self-efficacy by develop ing personal skills that assist them to better manage their health. The combination of social opportunities and physical activity also helps people remain socially connected, which in itself, has health benefits. There are a number of interventions that do this by focusing on both the physical and psychological components of health in what is termed the 'mind-body' approach.
The mind-body approaches to health are gaining in popularity, particularly amongst people seeking self management health strategies that have the potential to address multiple health needs across both physical and psychological spectrums (Larkey et al. 2009). One of the most popular of these approaches is tai chi, which is estimated to have approximately 5 million practitioners in the US alone (Wayne & Kaptchuk 2008a) with one particular volunteer based tai chi group that originated in Canada, the International Taoist Tai Chi Society ·(2010) having around 40 000 members in approximately 500 branches throughout more than 25 countries.
The wide ranging appeal of tai chi can be explained by its non-stress exercise style and ability to induce a feeling of relaxation and well-being (Sandlund & Norlander 2000). It is characterised by slow and gentle stretching like movements, often combined with breathing techniques and meditation, which assist to concentrate the mind and generate states of mental and physical relaxation and improve physical strength and fitness. These attributes make it an ideal adjunct health intervention for people suffering with chronic illness.
Tai chi has its roots in the ancient Chinese martial arts, and is also known as tai chi chuan, taiji or taijiquan. Due to its emphasis on mindfulness and movement it is also called 'moving meditation' (Jin 1992, p. 361) or 'meditative movement' (Larkey et al. 2009, p. 231). The philosophy on which tai chi is based is originally derived from Lao Tzu Theory, which dates back to 575 BC. Lao Tzu, who is also referred to as Old Sage or Li Erh, was an ancient Chinese philosopher and founder of Taoism. The central doctrine of this theory advocates a simple honest life, without desire or selfish intentions and promotes 'inner stillness· to achieve longevity.