Exercise-based therapies

DEFINITION: Physical activities to enhance overall health and wellness and to treat specific medical disorders.

• PRINCIPAL PROPOSED USES: Anxiety, attention deficit disorder, back pain, cardiovascular fitness, depression, fatigue, flexibility, neck pain, physical conditioning, strength training
• OTHER PROPOSED USES: Arthritis, asthma, osteoporosis, cancer, diabetes, fibromyalgia, gastrointestinal disorders, heart disease, high blood pressure, infertility, insomnia, menstrual pain, neuromuscular disorders, osteoporosis, sinusitis, heart disease

Overview

According to a 2017 Pew Research Center survey, about half of Americans said they exercised at least a few times a week. Another study in 2023 found around 58 percent of Americans stated they exercised at least three times a week. Exercise-based activities are considered outside the scope of conventional exercise practices. Although pain relief was the most common reason for its use, exercise-based complimentary and alternative medicine (CAM) is used throughout the spectrum of medical conditions. A survey of the medical literature revealed seven exercise-based CAM activities, namely yoga, Tai Chi, Qigong, Pilates, the Alexander technique, the Feldenkrais method, and the Trager approach.

According to a 2017 survey conducted by the National Center for Complementary and Integrative Health and the CDC's National Center for Health Statistics, yoga is the most popular exercise-based CAM activity. A five-thousand-year-old practice that originated in India, yoga seeks to integrate the mind, body, and spirit through physical poses, breathing exercises, meditation, and spiritual philosophy. Pilates is another popular exercise system in the West. This one-hundred-year-old form of exercise is designed to strengthen core muscles while focusing on posture and proper breathing. Often, props and apparatus are used.

Tai Chi, originally conceived as a martial art in China five hundred years ago, is now practiced primarily for general physical fitness. Although many forms exist, in the West, Tai Chi uses a series of slow, graceful movements to enhance strength, stamina, and balance. Tai Chi is part of a larger, five-thousand-year-old system of traditional Chinese mental, spiritual, and physical training called Qigong. Other components of Qigong include physical poses, meditation, and breathing exercises.

The Feldenkrais method, the Alexander technique, and the Trager approach are lesser known exercise-based CAM activities. These are movement therapies in which practitioners are guided in their posture and physical actions to improve balance, reduce pain, and increase emotional well-being.

Mechanisms of Action

Four of the seven forms of exercise-based CAM can be considered forms of general physical exercise. Yoga, Pilates, Tai Chi, and Qigong involve various degrees of cardiovascular, strength, and flexibility training. Thus, they promote stamina, bone health, healthy weight, muscle tone, balance, and strength. Yoga, Tai Chi, and Qigong also involve meditation. Although scientific research is ongoing, it appears that meditation decreases heart rate, increases blood flow to the organs, and improves mood regulation because of changes in the nervous system. No clinical data are available to determine the exact mechanism of action of the Alexander technique, the Feldenkrais method, or the Trager approach.

Uses and Applications

Exercise-based CAM is most commonly used to improve and maintain overall fitness. Other common therapeutic uses are to reduce stress, relieve pain, and improve flexibility. Exercise-based CAM experts claim, however, that these exercise systems are helpful in treating a variety of conditions, such as asthma, osteoporosis, menstrual pain, depression, cancer, high blood pressure, diabetes, arthritis, insomnia, neuromuscular disorders, fatigue, attention deficit disorder, gastrointestinal disorders, infertility, sinusitis, and heart disease.

Scientific Evidence

Determining whether exercise-based CAM is effective in the management and prevention of illness is challenging. A limited number of well-designed clinical trials are available. The wide variety of practices within these different styles makes obtaining a consensus difficult.

In 2020, Harvard Health Publishing reported that women who do Tai Chi have some modest improvements in bone density, indicating that the exercise was beneficial in treating osteoporosis in postmenopausal women. Tai Chai has also been shown to have positive effects on people with hypertension and heart disease. Additionally, these studies suggest that Tai Chi may be effective in enhancing the immune system of the elderly.

A review of the medical literature reveals promising evidence that yoga may help treat a variety of medical conditions, including mood disorders, hypertension, insomnia, back pain, and osteoporosis, and may improve overall physical conditioning. Several studies have indicated that yoga reduces hot flashes in menopausal women, as well as other symptoms. Furthermore, numerous studies have demonstrated that yoga diminishes sex performance anxiety and enhances female sexual desire. Many health practitioners use yoga in conjunction with conventional medicine in the treatment of cancer to reduce anxiety, pain, and insomnia, although scientists continue to debate the exact mechanisms of action involved.

A gap in the literature exists regarding the use of Pilates in treating medical conditions. Experts do agree that Pilates is effective in improving strength, flexibility, and balance. Although experts in the Feldenkrais method, the Alexander technique, and the Trager approach claim that their movement exercises reduce pain, prevent injury, and improve balance, no well-designed clinical trials have been conducted to determine their efficacy.

With regard to other medical claims about exercise-based CAM, no well-designed randomized controlled trials are available; a review of the medical literature did not support the claims.

Choosing a Practitioner

Hundreds of exercise-based CAM instructor-training programs have been established in the United States. None, however, include provider licensing requirements. Standards of certification for yoga instruction are largely based on the style of yoga studied and practiced. One program, the Yoga Alliance, is a nonprofit organization in the United States that maintains standards for yoga teacher-training programs. Teacher certification with this program requires a minimum of two hundred hours of training.

Several Tai Chi and Qigong organizations provide teacher certification in the United States. Various levels of certification are offered based on hours of training and desired goals. Hundreds of Pilates training programs have been established in the United States too. Although licensing is not required, the Pilates Method Alliance offers a national teacher’s certification program through written examination. Instructors of the Feldenkrais method, the Alexander technique, and the Trager approach are required to complete two-to-four-year training programs that encompass four hundred to sixteen hundred hours of class and fieldwork for certification.

Safety Issues

Exercise-based CAM is generally considered safe for those without serious health conditions or injuries. Persons with spine or joint disease, uncontrolled blood pressure, or severe balance abnormalities should avoid some exercise-based CAM activities. Although uncommon, spine and joint injuries have occurred during CAM exercise activities. To avoid such injuries, participants should adhere to the directions of a certified instructor. Pregnant women, who should exercise caution when considering CAM, typically require modification of certain practices. All potential participants, especially if pregnant, looking into exercised-based CAM as a form of therapy should consult with their health care providers before joining any exercise-based program. It is advisable to choose a certified provider. Typically, a national association that confers the certification will have a list of qualified providers.

Bibliography

"Americans' Health Care Behaviors and the Use of Conventional and Alternative Medicine." Pew Research Center, 2 Feb. 2017, pewresearch.org/science/2017/02/02/americans-health-care-behaviors-and-use-of-conventional-and-alternative-medicine/. Accessed 18 Dec. 2024.

Barnes, P. M., et al. “Complementary and Alternative Medicine Use Among Adults and Children: 2007 United States.” National Health Statistics Reports, 10 Dec. 2008, vol. 12, pp. 1–23.

Jahnke, R., et al. “A Comprehensive Review of Health Benefits of Qigong and Tai Chi.” American Journal of Health Promotion, vol. 24, no. 6, Jul.-Aug. 2010, pp. 1–25. doi: 10.4278/ajhp.081013-LIT-248.

Nagel, Denise. "Health Benefits of Tai Chi and Qiqong." HuffPost, 22 June 2016, huffpost.com/entry/health-benefits-of-tai-ch‗b‗7641712. Accessed 18 Dec. 2024.

“Nationwide Survey Reveals Widespread Use of Mind and Body Practices.” NCCIH, 10 Feb. 2015, nccih.nih.gov/news/press-releases/nationwide-survey-reveals-widespread-use-of-mind-and-body-practices. Accessed 18 Dec. 2024.

"Protect Your Bones with Tai Chi." Harvard Health, 1 Oct. 2020, health.harvard.edu/womens-health/protect-your-bones-with-tai-chi. Accessed 18 Dec. 2024.

Sung, Min-Kyu, et. al. "A Potential Association of Meditation with Menopausal Symptoms and Blood Chemistry in Healthy Women: A Pilot Cross-Sectional Study." Medicine, vol. 99, no. 36, 4 Sept. 2020, doi:10.1097/MD.0000000000022048. Accessed 18 Dec. 2024.

Yang, K. “A Review of Yoga Programs for Four Leading Risk Factors of Chronic Diseases.” Evidence-Based Complementary and Alternative Medicine, vol. 4, no. 4, 2007, pp. 487–91.

“Yoga: Effectiveness and Safety.” NCCIH, 3 Aug. 2023, nccih.nih.gov/health/yoga-effectiveness-and-safety. Accessed 18 Dec. 2024.