By Karen Danchalski, PT, DPT
Welcome to the first of a four-part series on merging mindful movement into therapy practice! My name is Karen Danchalski. I am a physical therapist working in both a private outpatient clinic and in homecare. As a former dancer, I’ve always been interested in exercise that connects movement with intention and emotion. I first branched out from traditional physical therapy when I pursued a certification in Pilates. I soon discovered the profound benefits of considering posture, breath, alignment, and muscle sequencing even with the most basic of exercises. A few years later, I added another branch of mindful movement to my practice: qigong. This series will focus on using the evidence-based practices of qigong and tai chi with patients and how as therapists we have a unique opportunity to learn and teach this extraordinary practice.
Is Mindful Movement in PT for Me?
Mindful movement such as tai chi, qigong, and yoga have become popular practices for maintaining and improving health; reducing anxiety and stress; and improving flexibility, strength, and balance. But you may have questions about how this pertains to you.
Should physical and occupational therapists incorporate mindful movement into their therapy treatment? Are therapists qualified to teach components of tai chi, qigong, or yoga to their patients? Have these practices been embraced by western medicine or are they on the fringe? I’m of the firm belief that the use of mindful movement in physical and occupational therapy can bring tremendous benefit to the patient and gives the therapist another set of skillful tools. And I’m not the only one.
For decades, western medicine has been shifting from a biological model to a biopsychosocial model. Under the biopsychosocial model, healthcare providers consider the whole patient when treating illness to achieve the best outcomes. In addition to the biological causes of disease, the patient’s psychological, spiritual, and emotional states, beliefs, relationships, and social environment are all considered in treatment planning.
While tai chi, qigong, and yoga can be practiced simply on a physical level, they are most effective when intentional breathing, imagery, mindfulness, and the eastern philosophy of the practice are integrated with the movement. When practiced in a group setting, individuals benefit from a social connection with their community. Some individuals may choose to focus more on the mental or spiritual aspect of the practice while others may focus more on the physical form.
Our current healthcare system encourages patients to take on active roles in self-care. Despite innovations and advances in modern medicine, the number of people living with chronic disease has increased and healthcare costs continue to be a real public health concern. The shift toward self-management of disease, illness prevention, and health promotion is increasingly considered a personal responsibility, and patients are expected to act as partners with their healthcare providers rather than passive recipients of treatment. While there are dozens of forms of exercise to choose from, according to the Global Wellness Institute, mindful movement has been the fastest growing sector in the physical activity market between 2018 and 2023.
Mindful Movement in PT Gaining Acceptance
The U.S Department of Veterans Affairs Whole Health is an exemplary program that puts the patient at the center of a healthcare wheel surrounded by eight areas of mindful awareness: moving the body; physical and emotional surroundings; personal development; food and drink; recharging and sleep; family, friends, and coworkers; spirit and soul; and the power of the mind. The Whole Health program offers numerous educational materials, videos, and podcasts promoting the use of tai chi, qigong, and yoga as examples of improving whole person health.
Harvard Medical School put out a guide to tai chi identifying eight components that promote health: awareness, active relaxation, social support, intention and belief, integration between body systems, strength and flexibility, improving breath, and embracing spiritual and philosophical dimensions. Many other large healthcare organizations including hospital systems, the American College of Sports Medicine, and the Global Wellness Institute have promoted the use of mindful movement practices as “medicine” in promoting health and preventing disease.
The scientific study of mindful movement and Traditional Chinese Medicine began in the 1970s, and research has been steadily growing over the past five decades. The Qigong Institute currently has an online database of over 17,000 abstracts relevant to the study of energy medicine, mindfulness, tai chi, qigong, and yoga. In 2009, the research article Meditative Movement as a Category of Exercise: Implications for Research recommended that mindful movement be considered a new and separate exercise category with similar benefits as other low to moderate forms of aerobic activity. Other defining features of meditative movement include a focus on breathing, a sense of improved body awareness or interoception, and cultivating a calm and clear mind to achieve a deep relaxed state.
In 2010, a systematic review, A Comprehensive Review of Health Benefits of Qigong and Tai Chi, concluded there was sufficient evidence that mindful movement could improve bone density, heart health including lowering blood pressure, physical and mental function, quality of life, self-efficacy, patient-reported outcomes on health, immune function and reduce falls. The review also concluded that both qigong and tai chi could be studied together for research purposes because both produce the same effects. Further research recommendations consist of narrowing down best practices for treatment frequency and duration, standardizing outcome measurement tools, and making better distinctions between treatment groups of healthy people versus those with various illnesses.
Incorporating Mindful Movement
While physical and occupational therapy are conventional interventions, there is a growing space for therapists to include mindful movement in therapy treatment. Therapists may hesitate to use such practices for a number of reasons. They may assume that mindfulness is not evidence-based and be unaware of the sizable amount of research supporting these practices. They may be reluctant to incorporate new methods that seem obscure, be uncertain of the benefits, or feel they are not qualified because they lack sufficient practice or certification.
Self-care, mindfulness, and meditative movement are now well supported and promoted throughout western institutions. Therapists already possess a strong foundation from which to learn these practices, use them with patients, and even reap the benefits of the practice for themselves. There are many exciting opportunities for therapists who are interested and curious about incorporating mindful movement into patient treatment.
Future installments will explore in depth the benefits of mindful movement; how mindful movement incorporates principles of static and dynamic posture, balance, neural tension, and coordination into fun and dynamic routines; and how therapists even without special certification can be excellent teachers of mindful movement practices.
Karen Danchalski, PT, DPT, has been practicing physical therapy for 24 years. She currently practices in an outpatient orthopedic clinic and provides outpatient services in the home setting. Karen has a special interest in mindful movement, has been a certified Stott Pilates instructor for the past 10 years, and is a member of the National Qigong Institute. She integrates Pilates and qigong exercises into traditional physical therapy treatments whenever it can benefit the patient. She is the author of several articles written for therapists on the topics of exercise for seniors, pain, and personalized healthcare.