In looking at the chosen studies, the tai chi styles represented (where specified) include Yang, Sun, Taoist, and Health Qigong. Yang was by far the most common with a large variety of forms ranging from the “fab four” movements (possibly grasp the bird’s tail) all the way up to the 108.

The duration and frequency of tai chi classes varied but some of the protocols include 2 x 45 minute sessions per week for 12 weeks or more; 2,3 & 5 x 60 mins for 16 -24 weeks; 2 x 60 mins for 6 months and 12 months. I only saw one study that had one class per week; most were 2 to 3.

While it’s interesting to see which tai chi forms were taught in the classes, a review conducted by Roger Jahnke et al published in 2010 (4) has shown that tai chi and qigong are nearly identical when it comes to health benefits. The above mentioned tai chi forms were the dominant intervention of these studies, but it’s likely that many qigong forms would achieve the same outcomes as long as they are not too static.

In the poster, Kathy Alvarado identifies one specific feature of tai chi that is particularly relevant for improving balance: “Studies show that tai chi can improve postural stability by providing movements that require maintaining COM [centre of mass] over a constantly changing BOS [base of support].”

The constantly changing base of support is weight shift from one foot to the other. Some qigong forms spend a lot of time in horse stance, so these forms may be less appropriate than the more active forms that involve weight shift.

As the benefits of tai chi practice for Parkinson’s disease become more widely known, it’s likely that more people with PD will be seeking out tai chi and qigong classes. 

Let’s go right to the pointy end. As an instructor, do you have the appropriate training to teach someone with Parkinson’s disease? And further, are you covered by your insurance company if, God forbid, a person with PD has a fall, breaks a hip and sustains concussion? 

Like fitness, tai chi is an unregulated exercise industry. Anyone can teach if they want to and can find some customers. No regulator checks qualifications of teachers. The onus ends up being on the customer, the student, to check whether the teacher is appropriately qualified. 

Parkinson’s Disease is one of many chronic health conditions that are increasing in prevalence and we are going to see more people affected in our classes.

Insurance companies generally will insure instructors if they stay within their scope of practice. If you have no formal qualifications, do you know what your scope of practice is? 

For a Registered Tai Chi Professional, (5) that is, someone with a known standard of training from a course approved by AUSactive, this is the scope of practice:

“Registered Tai Chi Professionals have the skills and knowledge to plan and deliver Tai Chi sessions to individuals and groups for low to moderate risk clientele based on the industry-endorsed pre-exercise screening system. Registered Tai Chi Professionals may work with higher risk clientele (whose conditions are stabilised and managed) after making a written referral to and receiving documented guidance on the exercise program from the clients’ treating medical and or allied health practitioner.” (6)

AUSactive is Australia’s peak body for the exercise and active health sector. (7) They have a new registration category for the Tai Chi Professional, alongside their existing categories for gym instructors, personal trainers, yoga and pilates instructors amongst others. At the time of writing, the tai chi category has not been formally announced, but I understand it will be very soon.

Back to the scope of practice—the good news is registered tai chi instructors can work with higher risk clientele if they have a written referral and documented guidance from a medical or allied health practitioner. For Parkinson’s disease, this would likely be from a neurologist, GP, physiotherapist or exercise physiologist. A verbal assurance from the student is not enough, it needs to be in writing. Best practice would be to develop a relationship with the referring practitioner, follow their guidelines and report back to them occasionally. After all, they may refer you more students, so show them you know what you’re doing.

Even with a written referral, ensure you do your own pre-exercise screening. If you use a form like the Adult Pre-Screening Tool that is endorsed by AUSactive and many other bodies, then Parkinson’s disease symptoms should be picked up by No. 3 and certainly by No. 6. (8) If you don’t do any screening at all, it’s time to start.

Back to insurance—are you covered? The safest thing to do is to ring your insurance company and find out.

As mentioned earlier, research into PD has been conducted using various tai chi forms, and it is likely that all of these forms, along with qigong, will offer similar benefits.

As instructors, it’s important we empower our students to adapt the movements as needed for their own condition. Every individual will be different and we shouldn’t make assumptions on what students with PD are capable of. Give them options for varying the effort required, (as we would for any student) whether progressions or regressions. By that, I mean longer versus shorter stance, lower versus higher stance, compact versus more stretched out arm forms to name a few. 

We might be teaching a long form tai chi, or more easy-to-follow qigong forms, or doing partner work and push hands. There are so many options that we can consider. As long as we keep communicating with our students with Parkinson’s, and their supervising medical or allied health carer, then the tai chi journey will be thoroughly enjoyable and beneficial for everyone.