Research Design and Methodology

To evaluate the effects of Tai Ji exercise on bone turn-over in menopausal women, a paired design over an eight months period was utilised (see Figure 4-1). Participants practised 24 movements Tai Ji exercise twice per week.

Twelve of the 40 menopausal women who completed the study (aged 42-55 years) were involved in this trial (see Table 4-1 Subject Characteristics). The participants were divided into two groups (Group A and Group B, six participants respectively) matched according to their Broadband Ultrasonic Attenuation (BUA) scores as well as some consideration of their menopausal status and other related criteria as outlined in Chapter 3. All participants were given information regarding the purpose of this study and the demands of this study design. They were assigned to a group and their relevant treatment regime – Tai Ji exercise was outlined. They were told which group they belonged to, and as a result whether they were initially in a treatment or control group. The subjects were asked to maintain their existing level of physical activity during the eight month period of the study. Each subject filled in a physical activity form so that the researcher could confirm that there were no significant changes in the level of physical activity (see Chapter 3 and Appendix J).

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Figure 4-1 The Research Design

Applicants assigned to the Tai Ji exercise group

12 menopausal women 42-55 years old

(10 administrative staff workers, 2 teachers)

Project 1 Start

A:

Tai Ji exercise 4 months (N=6)

B:

Control 4 months (N=6)

Test 2 Cross Over (4th _Month)

A:

Control (Cease treatment 4 months)(N=6)

B:

Tai Ji exercise 4 months (N=6)

Test 3 Post Test (8th _Month)

Finish

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Table 4-1 Subject Characteristics

N Minimum Maximum Mean St. Deviation

Age (yrs) 12 42 55 50.0 4.0 Height (m) 12 1.52 1.78 1.67 6.84 Weight (kg) 12 54.9 91.8 70.1 10.2 BUA (dB/MHz) 12 61.7 98.4 75.6 12.2 Group A Group B BUA (mean±SD) 74.9±13.2 76.3±12.4

Effectivelysix participants (Group A) practiced Tai Ji exercise (24 movements) for four

months under the researcher’s supervision. During the second four months this group did not exercise. This second four months or control period gave some indication of the residual or long-term effect of Tai Ji exercise on the various parameters considered in this study. Conversely, the other group of six participants served as a control group (Group B) as they did not exercise in the first four months but practised Tai Ji in the second four months. Group B was not studied for residual effect of exercise, as there was no follow up study after they completed their exercise period. During the first four “control months” this group was used to provide some indication of the effects of the passage of time (without treatment) on the parameters considered in this study. This meant that the two groups could be compared using BUA, VOS, OSTN, PYR and D- PYR as well as TCM assessment. After the initial phase of the four month trial the groups traded places from control to treatment respectively for a further four-month

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Subjects in the Tai Ji group completed 32 one hour sessions of Beijing 24-movements Tai Ji over sixteen weeks. The twice a week sessions were undertaken with at least two days between sessions. Each session involved the same sequence of movements, the introductory exercise and the Tai Ji exercise, which were based on the 24 movements.

Consecutive movements were chosen to facilitate the smooth flow of qi in the body.

This harmonizes the body which leads to fewer menopausal and osteoporosis symptoms. Basic instruction was provided in terms of movements, transitions and the breathing techniques for each movement within the sequence. The instructor corrected movements that were not performed correctly and encouraged subjects to learn the sequence so that rhythm and smoothness could be developed with practice.

While performing Tai Ji the participants’ attention must be focused exclusively on the exercises being performed. The muscles must be relaxed and movements must be made slowly and smoothly. All movements should be practiced with the minds attention being totally focussed on the movement being performed. Concentration on, and positioning of different parts of the body were examined by the researcher and adjusted to suit individual needs as required to gain maximum benefit from the exercises.

The Beijing 24-movements Tai Ji (simplified 24-posture Tai Chi Chuan) was employed in this study. It involves twenty-four different kinds of movements (see Appendix K for

full details of each movement). These movements are designed to gather qi, focus the

mind, relax the body, move qi and blood, exercise the muscles, joints and lumbar

region. The set of movements helps the balance function of the body and strengthens the muscles and sinews. According to TCM theory these movements are able to improve the functioning of the five internal organ systems, this is particularly useful for

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The Beijing 24 movements are: 1. Commencement

2. Part wild horse’s mane on both sides –3 times 3. White crane flashes it wings

4. Brush knees on both side – 3 times 5. Strum the lute

6. Curve back arms on both sides – 4 times 7. Grasp the bird’s tail – left style

8. Grasp the bird’s tail – right style 9. Single whip

10. Wave hands like clouds – left style 11. Single whip

12. High pat on horse 13. Kick with right heel

14. Strike opponent’s ears with both fists 15. Turn and kick with left heel

16. Push down and stand on left leg 17. Push down and stand on right leg 18. Work at shuttles on both sides – R. L. 19. Needle at sea bottom

20. Flash arm

21. Turn to deflect downward, parry and punch 22. Apparent close-up

23. Cross hands 24. Closing form

4.3 Statistical Analysis

All of the collected data (BUA, VOS, OSTN, PYR, D-PYR and TCM symptoms) for each participant were recorded at the beginning, the mid-point and the end of the study. Differences were calculated from the results of pre-test, fourth month and eighth month within the groups and between groups. The results were analysed by paired t-tests

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using the SPSS 10.0 and Ridit analysis with results of p<0.05 being accepted as statistically significant.