From community classes to the clinic
Not long after we began running community classes, our participants, mostly older people with MSK conditions, told us they felt better, and many recognised movements their therapists had prescribed. Eventually we were invited to see our local community therapy team who had heard a lot about us from our participants. We started our journey into the research spending time reading papers so we could explain to the therapists what the mechanisms and benefits might be. We found that benefits often show up over fairly short periods, long before anyone becomes proficient at tai chi and the research seems to agree: most trials run for a few weeks or months with beginners, often using simplified, seated or otherwise adapted forms, and still report benefits.
We realised it wasn't so different from other activities therapists use. A video game or exergame for balance rehabilitation, or a game of dominoes on a stroke ward, offers an opportunity to assess many different skills such as gross and fine motor control, attention, turn-taking and an opportunity to sit at a table with other people living with a similar condition. When an occupational therapist makes a cup of tea with a patient the objective is not to make the most perfect cup of tea or begin training for a Japanese tea ceremony. The process and participation are the point, with all their component parts such as the attempt at sequencing, reaching to the cupboard, the grip on the kettle, the standing balance at the counter, attention, fatigue levels etc.
Therapists use a range of different activities as tools to support rehabilitation, combining interests and goals to be able to offer something meaningful to the person in front of us. Different tools for different goals.
Over the years, we've come to think tai chi and qigong work in the same way. In China and other countries, tai chi and qigong are activities people do in the morning, in the park or a local space, with friends and acquaintances. The benefits come not because someone one day reaches some level of perfection, but because they do it regularly and experience what Wayne and Kaptchuk call the eight active ingredients (Wayne and Kaptchuk 2008), which we explore in Part 3.
This is the first of three posts sharing what we've learnt since that first presentation. Since then, we've continued to work with therapists and community participants, including online classes for wheelchair users and people living with limb loss. We hope you'll find it helpful when you're deciding whether tai chi and qigong are right for you.
This first part looks at why you can fit tai chi to the patient, and how researchers have done exactly that.
Start with the mechanisms
Some physiotherapists and occupational therapists hesitate before bringing tai chi or qigong into their work. They assume they'd need to have perfected the art themselves and patients who are willing to practise until they can perform the forms perfectly too.
We propose that you try seeing tai chi and qigong just like other activities we use in rehabilitation. If we are going to introduce something as a tool, we need to understand the mechanisms and what the evidence does and doesn't show. Once we have those things we can apply our clinical reasoning and begin to look at how we can adapt the movements and enable participants to experience the mechanisms.
Seen this way, tai chi and qigong can become one more tool in your toolbox. You choose them when they suit the person's goals, you adapt them like anything else you use, and you put them down when something else would serve the person better. We find it helps to let the form serve the person, rather than the other way round.
A worked example
Perhaps the clearest example of fitting the tai chi to the patient comes from Tai Ji Quan: Moving for Better Balance, developed by Fuzhong Li at the Oregon Research Institute. Li argued that some classical features, such as rooted feet, a centred body and a steady head, served martial purposes well but don't necessarily suit balance rehabilitation (Li 2014). So his programme deliberately breaks them. It moves people towards the edge of their base of support, varies speed and range, builds in head and eye coordination, and practises transfers, reaching, turning and walking, often alongside a thinking task. In a trial of 670 older adults at high risk of falling, it reduced falls by 58% compared with stretching and, in a secondary comparison, by 31% compared with a multimodal exercise programme (Li et al. 2018).
Other researchers have adapted tai chi in similar ways. One stroke trial built five seated versions of the same forms, matched to each person's arm strength, and moved people between them as they got stronger (Zhao et al. 2022). Others have used Cloud Hands on its own, with the stronger hand guiding the weaker one (Xie et al. 2018), or let older adults choose when to step up through three levels of short tai chi "snacks" (Liang et al. 2024). And in one COPD trial that did not adapt the form at all, the authors suggested a personalised programme might have done better (Polkey et al. 2018).
We don't mention these to suggest one programme for everyone. They simply show that adapting tai chi to clinical goals, rather than preserving it unchanged, can work very well.
Grade it like anything else
Because tai chi serves as a tool, you can progress it with the same clinical reasoning you'd apply to any activity. A typical route might run:
Seated before standing, or supported before free-standing.
Symmetrical movements before asymmetrical ones.
Weight shifts before stepping, and short steps before longer ones.
Small, slow head turns before larger ones.
Higher stances before lower ones.
Single movements repeated before short linked sequences, and short sequences before longer ones.
You can also run the dials in reverse. On a tired day, a fatigue flare or a dizzy spell, step back down the list. We wouldn't see that as failure. It looks more like skilled self-management, the kind of judgement therapists already help patients learn.
One safety note: not every patient needs pushing up the ladder. For people with energy-limiting conditions such as ME/CFS or Long COVID with post-exertional malaise, capacity sets a ceiling to respect rather than a level to build. There, we'd suggest the skill lies in keeping the practice gentle and within limits, not in progression.
Coming next
In Part 2, we look at the clinical skills you probably already bring to tai chi and qigong, from balance training and graded loading to dual-task work and head and eye coordination, with our best reading of the evidence for each.
If you'd like to explore this in practice, our six-week online course, Tai Chi for Therapists, runs at around two and a half hours a week, with optional live sessions on Wednesday evenings and lifetime access to the materials. Our next cohort starts on 9 November 2026.
Find out more and book your place
We'd love to hear your perspective: what everyday activity do you use as a therapeutic tool?
Sources
Li F (2014). Transforming traditional Tai Ji Quan techniques into integrative movement therapy: Tai Ji Quan: Moving for Better Balance. J Sport Health Sci, 3(1), 9-15. doi:10.1016/j.jshs.2013.11.002
Li F et al. (2018). Effectiveness of a therapeutic Tai Ji Quan intervention vs a multimodal exercise intervention to prevent falls among older adults at high risk of falling: a randomized clinical trial. JAMA Intern Med, 178(10), 1301-1310. doi:10.1001/jamainternmed.2018.3915
Liang IJ et al. (2024). The efficacy of 12-week progressive home-based strength and tai-chi exercise snacking in older adults: a mixed-method exploratory randomised control trial. J Frailty Aging. doi:10.14283/jfa.2024.32
Polkey MI et al. (2018). Tai chi and pulmonary rehabilitation compared for treatment-naive patients with COPD: a randomized controlled trial. Chest. doi:10.1016/j.chest.2018.01.053
Wayne PM and Kaptchuk TJ (2008). Challenges inherent to t'ai chi research: part I, t'ai chi as a complex multicomponent intervention. J Altern Complement Med, 14(1), 95-102. doi:10.1089/acm.2007.7170A
Xie G et al. (2018). Effects of Tai Chi Yunshou exercise on community-based stroke patients: a cluster randomized controlled trial. Eur Rev Aging Phys Act, 15, 17. doi:10.1186/s11556-018-0206-x
Zhao J et al. (2022). Tailored sitting Tai Chi program for subacute stroke survivors: a randomized controlled trial. Stroke. doi:10.1161/STROKEAHA.121.036578
