A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women 1


      Chan K, Qin L, Lau M, Woo J, Au S, Choy W, Lee K, Lee S. A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women. Arch Phys Med Rehabil 2004;85:717–22.


      To evaluate the potential benefits of programmed Tai Chi Chun (TCC) exercise on the weight-bearing bones of early postmenopausal women.


      Age-matched and randomized prospective intervention.


      University medical school.


      One hundred thirty-two healthy postmenopausal women (mean age, 54.0±3.5y) within 10 years of menopause onset were recruited and randomized into the TCC exercise group (n=67) or the sedentary control group (n=65).


      Supervised TCC exercise was performed by the TCC group for 45 minutes a day, 5 days a week, for 12 months; control subjects retained a sedentary life style.

      Main outcome measures

      Bone mineral density (BMD) was measured in the lumbar spine and proximal femur by using dual-energy x-ray absorptiometry and in the distal tibia by using multislice peripheral quantitative computed tomography (pQCT). All BMD measurements were repeated after 12 months in both groups. Fracture rate was also documented.


      Baseline measurements showed homogeneity in age, anthropometric variables, and menstruation status between the TCC and control groups. Exactly 81.6% of the subjects in the TCC group and 83.1% of subjects in the control group completed the 12-month follow-up study. BMD measurements revealed a general bone loss in both TCC and sedentary control subjects at all measured skeletal sites, but with a reportedly slower rate in the TCC group. A significant 2.6- to 3.6-fold retardation of bone loss (P<.01) was found in both trabecular and cortical compartments of the distal tibia in the TCC group as compared with the controls, as measured by pQCT. A total of 4 fracture cases were documented during follow-up, including 3 subjects in the control group and 1 in the TCC group.


      This is the first prospective and randomized study to show that a programmed TCC exercise intervention is beneficial for retarding bone loss in weight-bearing bones in early postmenopausal women. Long-term follow-up is needed to substantiate the role of TCC exercise in the prevention of osteoporosis and its related fracture.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Blake A.J
        • Morgan J
        • Bendall M.J
        Falls by elderly persons at home.
        Age Aging. 1998; 17: 365-372
        • Burr D.B
        Muscle strength, bone, mass and age-related bone loss.
        J Bone Miner Res. 1997; 12: 1547-1551
        • Calmels P
        • Vico L
        • Alexandre C
        • Minaire P
        Cross-sectional study of muscle strength and bone mineral density in a population of 106 women between the ages of 44 and 87 years.
        Eur J Appl Physiol. 1995; 70: 180-186
        • Hunter S.K
        • Thompson M.W
        • Adams R.D
        Relationships among age-associated strength changes and physical activity level, limb dominance, and muscle group in women.
        J Gerontol A Biol Sci Med Sci. 2000; 55: B264-B273
        • Li G.P
        • Qin L
        • Chan K.M
        Health benefits of Tai Chi Chuan in older individuals.
        in: Maffuli N Sports medicine for specific ages and abilities. Churchill Livingstone, Edinburgh2001: 315-324
        • Lipsitz L.A
        • Nakajima I
        • Gagnon M
        Muscle strength and fall rates among residents of Japanese and American nursing homes.
        J Am Geriatr Soc. 1994; 42: 953-959
        • Qin L
        • Au S.K
        • Chan K.M
        • et al.
        Peripheral volumetric bone mineral density in pre- and postmenopausal Chinese women in Hong Kong.
        Calcif Tissue Int. 2000; 67: 29-36
        • Qin L
        • Au S.K
        • Leung P.C
        • et al.
        Baseline BMD and bone loss at distal radius measured by pQCT in peri- and postmenopausal Hong Kong Chinese women.
        Osteoporos Int. 2002; 13: 962-970
        • Qin L
        • Dambacher M.A
        • Leung P.C
        • Neff M
        Fast and slow bone losers.
        in: Schneider H.P Menopause state of the art. CRC Pr, Boca Raton2003: 1124-1132
        • Cummings S
        • Black D
        • Nevitt M
        • et al.
        Bone density at various sites for the prediction of hip fractures. The Study of Osteoporotic Fractures Research Group.
        Lancet. 1993; 341: 72-75
        • Hui S.L
        • Slemenda C.W
        • Johnston Jr, C.C
        Baseline measurement of bone mass predicts fracture in white women.
        Ann Intern Med. 1989; 111: 355-361
        • Lau E.M
        • Woo J
        • Leung P.C
        Low bone mineral density, grip strength and skinfold thickness are important risk factors for hip fracture in Hong Kong Chinese.
        Osteoporos Int. 1993; 3: 66-69
        • Melton L.J
        • Atkinson E.J
        • O’Fallon M
        • Wahner H.W
        • Riggs B.L
        Long-term fracture prediction by bone mineral assessed at different skeletal sites.
        J Bone Miner Res. 1993; 8: 1227-1233
        • Riis B.J
        • Hansen M.A
        • Jensen A.M
        • Overgaard K
        • Christiansen C
        Low bone mass and fast rate of bone loss at menopause: equal risk factors for future fracture: a 15-year follow-up study.
        Bone. 1996; 19: 9-12
        • Ito M
        • Nakamura T
        • Tsurusaki K
        • Uetani M
        • Hayashi K
        Effects of menopause on age-dependent bone loss in the axial and appendicular skeletons in healthy Japanese women.
        Osteoporos Int. 1999; 10: 377-383
        • American College of Sports Medicine Position Stand
        Exercise and physical activity for older adults.
        Med Sci Sports Exerc. 1998; 30: 992-1008
        • Qin L
        • Au S.Z
        • Choi Y.W
        • et al.
        Regular Tai Chi Chuan exercise may retard bone loss in postmenopausal women.
        Arch Phys Med Rehabil. 2002; 83: 1355-1359
        • Berard A
        • Bravo G
        • Gauthier P
        Meta-analysis of the effectiveness of physical activity for the prevention of bone loss in postmenopausal women.
        Osteoporos Int. 1997; 7: 331-337
        • Greendale G.A
        • Barrett-Connor E
        • Edelstein S
        • Ingles S
        • Haile R
        Lifetime leisure exercise and osteoporosis. The Rancho Bernardo study.
        Am J Epidemiol. 1995; 141: 951-959
        • Kano K
        Relationship between exercise and bone mineral density among over 5,000 women aged 40 years and above.
        J Epidemiol. 1998; 8: 28-32
        • Lan C
        • Lai J.S
        • Chen S.Y
        • Wong M.K
        Tai Chi Chuan to improve muscular strength and endurance in elderly individuals.
        Arch Phys Med Rehabil. 2000; 81: 604-607
        • Marcus R
        • Drinkwater B
        • Dalsky G
        • et al.
        Osteoporosis and exercise in women.
        Med Sci Sports Exerc. 1992; 24: S301-S307
        • Province M.A
        • Hadley E.C
        • Hornbrook M.C
        • et al.
        The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques.
        JAMA. 1995; 273: 1341-1347
        • Wang J.S
        • Lan C
        • Wong M.K
        Tai Chi Chuan training to enhance microcirculatory function in healthy elderly men.
        Arch Phys Med Rehabil. 2001; 82: 1176-1180
        • Wolf S.L
        • Barnhart H.X
        • Kutner N.G
        • McNeely E
        • Coogler C
        • Xu T
        Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques.
        J Am Geriatr Soc. 1996; 44 (Comment in: J Am Geriatr Soc 1996;44:599–600): 489-497
        • Wolfson L
        • Whipple R
        • Derby C
        • et al.
        Balance and strength training in older adults.
        J Am Geriatr Soc. 1996; 44: 498-506
        • Kessenich C.R
        Tai Chi as a method of fall prevention in the elderly.
        Orthop Nurs. 1998; 17: 27-29
        • Wong A.M
        • Lin Y.C
        • Chou S.W
        • Tang F.T
        • Wong P.Y
        Coordination exercise and postural stability in elderly people.
        Arch Phys Med Rehabil. 2001; 82: 608-612
        • Lan C
        • Chen S.Y
        • Lai J.S
        • Wong M.K
        The effect of Tai Chi on cardiorespiratory function in patients with coronary artery bypass surgery.
        Med Sci Sports Exerc. 1999; 31: 634-638
        • Wolf S.L
        • Coogler C.E
        • Xu T
        Exploring the basis for Tai Chi Chuan as a therapeutic exercise approach.
        Arch Phys Med Rehabil. 1997; 78: 886-892
        • Johnston Jr, C.C
        Development of Clinical Practice Guidelines for Prevention and Treatment of Osteoporosis.
        Calcif Tissue Int. 1996; 59: 30-33
        • North American Menopause Society
        Management of postmenopausal osteoporosis.
        Menopause. 2002; 9: 84-101
        • Chen K.M
        • Snyder M
        A research-based use of Tai Chi/movement therapy as a nursing intervention.
        J Holistic Nurs. 1999; 17: 267-279
        • Koh T.C
        Tai Chi Chuan.
        Am J Clin Med. 1981; 9: 15-22
        • Ruegsegger P
        Bone density measurement.
        in: Bröll H Dambacher M.A Osteoporosis: a guide to diagnosis and treatment. Vol 18: rheumatology. Krager, Basel1996: 103-116
        • Bass S
        • Pearce G
        • Bradney M
        • Hendrich E
        • Delmas P.D
        Exercise before puberty may confer residual benefits in bone density in adulthood.
        J Bone Miner Res. 1998; 13: 500-507
        • Bassey E.J
        • Ramsdale S.J
        Increase in femoral bone mineral density in young women following high impact exercise.
        Osteoporos Int. 1994; 4: 72-75
        • Frost H.M
        Why do marathon runners have less bone than weight lifters? A vital-biomechanical view and explanation.
        Bone. 1997; 20: 183-189
        • Taaffe D.R
        • Robinson T.L
        • Snow C.M
        • Marcus R
        High-impact exercise promotes bone gain in well-trained female athletes.
        J Bone Miner Res. 1997; 12: 255-260
        • Qin L
        • Au S.Z
        • Choi Y.W
        • et al.
        Tai Chi Chuan and bone loss in postmenopausal women [letter].
        Arch Phys Med Rehabil. 2003; 84: 621-622
        • Frost H.M
        Why do bone strength and “mass” in aging adults become unresponsive to vigorous exercise? Insights of the Utah paradigm.
        J Bone Miner Metabol. 1999; 17: 90-97
        • Mosley J.R
        Osteoporosis and bone functional adaptation.
        J Rehabil Res Dev. 2000; 37: 189-199
        • Mullender M.G
        • van der Meer D.D
        • Huiskes R
        • Lips P
        Osteocyte density changes in aging and osteoporosis.
        Bone. 1996; 18: 109-113
        • Hassager C
        • Jensen S.B
        • Gotfredsen A
        The impact of measurement errors on the diagnostic value of bone mass measurements.
        Osteoporos Int. 1991; 1: 250-256
        • Ravaud P
        • Reny J.L
        • Giraudeau B
        Individual smallest detectable difference in bone mineral density measurements.
        J Bone Miner Res. 1999; 14: 1449-1456
        • Winters K.M
        • Snow C.M
        Detraining reverses positive effects of exercise on the musculoskeletal system in premenopausal women.
        J Bone Mineral Res. 2000; 5: 2495-2503
        • Vincent K.R
        • Braith R.W
        Resistance exercise and bone turnover in elderly men and women.
        Med Sci Sports Exerc. 2002; 34: 17-23
        • Henderson N.K
        • White C.P
        • Eisman J.A
        The roles of exercise and fall risk reduction in the prevention of osteoporosis.
        Endocrinol Metab Clin North Am. 1998; 27: 369-387
        • Daubney M.E
        • Culham E.G
        Lower-extremity muscle force and balance performance in adults aged 65 years and older.
        Phys Ther. 1999; 79: 1177-1185