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No cane, but able

Apr. 18, 2004
Judy Siegel-Itzkovich
The Jerusalem Post

The ancient Chinese art of Tai Chi can help even the elderly and infirm improve their balance, walking and general health.

Around their first birthday, human beings learn - by trial and error - how to walk. When they enter old age, do they need to learn how to walk over again, this time in a systematic way? Arieh Lev Breslow, an Israeli teacher of the ancient Chinese martial art called Tai Chi, says they do - especially if they suffer from chronic diseases that cause imbalance, stiff joints or weakened leg muscles.

Although most complementary medical techniques have never been scientifically proven effective, Tai Chi has. Last month, a meta-analysis of previous studies on patients suffering from chronic health conditions - published in the Archives of Internal Medicine (one of the Journal of the American Medical Association publications) - found that Tai Chi has beneficial effects on balance, flexibility and cardiovascular health. The technique, which combines deep breathing with relaxation and postures that flow from one to another through slow movements, has been found to promote good health, memory, concentration, digestion, balance and flexibility, and even to ameliorate anxiety and depression.

Dr. Chenchen Wang, a physician at the Tufts-New England Medical Center in Boston, and colleagues analyzed 47 studies identified by a search of English and Chinese databases of medical literature that reported on the effects of Tai Chi in patients with various chronic conditions.

"Overall, these studies reported that long-term Tai Chi practice had favorable effects on the promotion of balance control, flexibility and cardiovascular fitness, and reduced the risk of falls in elders," the authors wrote.

The researchers, funded partially by the US National Institutes of Health, found that those who practice Tai Chi - both healthy people and patients who had undergone bypass surgery or suffered from heart failure, high blood pressure, a heart attack, arthritis or multiple sclerosis - had improved heart and breathing function compared to a control group who did not do Tai Chi. The sickly elderly who participated in the program also showed improved balance, strength and flexibility and fewer falls, while the healthy subjects showed reduced pain, stress and anxiety. But the team could not pin down the mechanisms behind the benefits.

Numerous other studies showing the benefits of Tai Chi in reducing frailty and falls in the elderly have been published in recent years, including one in the Journal of the American Geriatrics Society back in 1996.

Tai Chi, says Breslow, "means 'supreme ultimate ' and also 'the great pivot.' In it, you learn to pivot your body properly, with correct posture and body integration. Although its origins are three millennia old, dating back to the Yellow Emperor's classic on medicine, Tai Chi as we know it today can be traced back to China 400 years ago.

Breslow was born in Nebraska, where he received a BA in economics. He moved to California in 1971 after earning a master's in European history from the University of Wisconsin. He wrote a book on Chinese culture and history called Beyond the Closed Door, and then, moving to the West Coast, his interests turned to Tai Chi. He lived in California for a decade and became observant. He settled in Israel in 1981 and, having become modern Orthodox, studied at a variety of yeshivot, from Pardes and Darchei Noam to Ahavat Torah.

"There was really no Tai Chi in Israel then, so I began teaching it to fellow yeshiva students who were interested. This is a martial arts technique that never involved religion, so it was perfectly kosher. Tai Chi shies away from religion, belts and degrees. You are known by your own skills and your teacher," says Breslow.

"My teacher was Benjamin Lo, who was born in China, left in 1948 when the revolution took place, and reached San Francisco in 1973. He became well known from his teaching, and also translated Chinese Tai Chi classics into English."

Lo, who gave Breslow his certification, is still alive and active, and Breslow returns to California from time to time to see him and learn more.

"Tai Chi is like the Torah, in that there is is always more to learn. You never finish learning. I went to see Benjamin a month ago."

BRESLOW, WHO founded and runs the Jerusalem School of Tai Chi Chuan in the tony Baka quarter, has taught thousands of Israelis, and some of them have become teachers themselves.

"Some study for a year, while others have been with me for as long as 20 years. My youngest pupil is 20 - I don't teach children or teenagers, as they are too active and it's hard for them to slow down - and the oldest is 93. Israeli teachers of Tai Chi need to be certified by Netanya's Wingate Institute of Physical Education, which has a special program.

"There are people here who claim to be Tai Chi teachers but are not certified. If a client suffers harm from an uncertified teacher, he should complain to the Health Ministry."

While continuing to teach all adult age groups, Breslow - who lives in Efrat with his wife Anne and their three daughters - has devoted much time to helping seniors. He wrote The Walking Manual for Seniors and the Physically Challenged: A Restorative Program to Improve Balance and Strengthen Legs, which includes exercises for knee and hip extensions, toe raises, knee and side leg lifts to strengthen legs. He has also produced a separate video and DVD with warm-up and flexibility exercises, lessons on Tai Chi walking and ways to massage the legs in order to soothe painful joints and muscles. (The manual, video and DVD are each NIS 70, and private sessions cost NIS 40 an hour.) The multimedia material shows a 92-year-old man in Efrat working out with Breslow.

"My specialty with seniors is to help them walk better - to help them strengthen their legs with exercises. I think that my taking the principles of Tai Chi on shifting weight and balance and turning it into walking exercises is unique."

There are 60 to 120 different movements, he says, and that requires a lot of memory. Most seniors don't have the ability to remember so many movements, and it can also be very physically demanding. But Breslow simplifies and customizes Tai Chi for these clients.

"I have patients with intermittent claudication that makes it difficult for them to walk more than a few steps, with Parkinson's disease, osteoporosis, arthritis and multiple sclerosis, and they improve and feel less stiff. I've also worked with people with early Alzheimer's disease, but I can't say how much it has helped, because if the mind is not strong, it's difficult to benefit from Tai Chi.

"THE HEALTH funds don't yet cover the cost of the courses, but I have been invited to meet with the Maccabi Health Services' chief gerontologist about becoming part of the health fund's complementary medicine program."

He has also demonstrated his techniques to the supervisor in charge of day centers for the elderly run by the Welfare Ministry, and will teach his program to sports counsellors in these centers.

"Tai Chi is done very slowly, with the mind focusing on what has to be done, so it's great for the elderly," Breslow says. "I teach seniors to compensate with their minds for the weakness of their bodies, and how to shift their weight. Healthy people don't have to think about how they walk - but older people need to focus on their legs. They shift weight and can find where weakness and balance problems are."

The technique, he continues, emphasizes a good vertical posture.

"I teach them to imagine that they are attached to a string that holds their head up and a belt around their waist so that when they walk, they imagine they're being pulled by the center of body up and forwards. They then walk the way they were made to walk. They focus on this for a while, and it becomes natural."

He recommends that seniors who want to walk buy well-cushioned shoes that fit comfortably and provide enough room to wiggle the toes while being snug in the heels. When you step forward, always start with the heel, then roll your weight onto the bottom of the foot. If you're stepping first with the flat part or the ball of your foot, you'll be unbalanced with each step. Allow your weight to sink into your ankles and knees as if they were springs, he continues, to get a sense of buoyancy. Your arms should swing naturally at the sides, and breathe deeply to relax.

Younger people with balance, vertigo or postural problems can also benefit, as can pregnant women.

"It is so gentle and focused that almost anybody can do it, even if they have heart problems. You need some strength in your legs to balance and shift your weight, and arms must be able to swing for momentum and balance, but you don't need to be musclebound," he adds.

Breslow notes that even haredi Jews do Tai Chi. There's an octogenarian rabbi in Jerusalem's Bayit Vegan quarter who had trouble walking. He couldn't even get to his synagogue for learning and services; walking was so painful, he could hardly get out of the house.

"I gave him private lessons at his home, and now his legs are strong enough for him to walk to shul." Breslow also worked with an elderly woman who had fallen several times, and bruised herself. "She was terrified of walking, and thus didn't move, so she got weaker. I took her outside without her cane, and we walked together on the sidewalks, but I made sure she didn't fall. She regained her confidence and really improved."

People of all ages have to exercise, Breslow declares.

"If you don't use it, you lose it, it is said. People can walk at their own pace in shopping walls if they don't like cold, rainy weather. Walk up the steps to your apartment. Swimming is fine, but it isn't weightbearing exercise, so it isn't as effective. If you feel insecure about going yourself, ask a friend or relative to go with you. Exercise daily. The more you walk, the better you'll get at it, and the faster your quality of life will improve."

Copyright © 2004, The Jerusalem Post