Disclosures There are no conflicts of interest or relevant financial

interests that have been disclosed by these presenters or the rest of the planners and presenters that apply to this learning session.

Dr. Yang and Dr. Krieger will not discuss off-label and/or investigational use in this presentation.

2

Traditional taiji & qigong:

a simple but profound path

to daily tranquility, happiness,

vitality and better sleep

Yang Yang, Ph.D.

Center for Taiji and Qigong Studies, New York, NY

Integrative Medicine Service, Memorial Sloan Kettering Cancer Center &

Ana C. Krieger, MD, MPH

Director, Center for Sleep Medicine – Weill Cornell Medical College

NewYork-Presbyterian Hospital, New York, NY

Integrative Healthcare Symposium

February 26, 2016

3

Goals

Science

Tradition

Take home

Sleep: Active or Passive?

Sleep Physiology

REM

Sleep

Functions of Sleep

o Restoration

o Rejuvenation

o Enhances learning

o Memory

o Problem solving

o Reaction time

o Regulates mood

o Immune function

Synchronized to day/night

Self-sustained oscillations

• Connected to the brain – melatonin release

Connected to the body by peripheral oscillators

Sleep Pacemaker Cells

7

Integration of Cycles

Lancet 1997,2007

Effects of Jet Lag

9

Fatigue

Physical

Mental

Irritability

Headaches

Fragmented sleep

Decreased appetite

Gastrointestinal problems

Circadian Rhythm of Sleep

Day 1 Day 2

Time of day (hr)

0 6 12 18 24 6 12 18 24

Sleep

Causes of Sleep Loss

o Schedule

o Worries - ? About sleep

o Leisure – Use of Electronic Devices

o Effect on MELATONIN

Clock Change and Sleep Loss

Average 10% slowing in Reaction Time after DST

Effect lasted for several days

Medina D, Ebben M, Milrad S, Atkinson B, Krieger AC. J Clin Sleep Med 2015; 11:879-44.

Sleep Duration –

Past 50 Years in the U.S.

4

5

6

7

8

9

10

1960 1970 1980 1990 2000 2011

National Sleep Foundation

Home and Office Computers

Handheld Devices

hours

✜

70 million

adults

14 Van Dongen, 2003

PVT lapses

Cognitive Effect of Short Sleep

Consequences of SD

CNS changes in cognitive functions

speech, memory and complex verbal arithmetic (Kim, 2001)

Increased resting BP (Kato, 2000)

Increased IL-6 levels (Vgontas, 2002)

Bacterial translocation (Everson, 2000)

Falleti, 2004

National Sleep Foundation, 2013

Lack of Sleep and

Stress Response

16

“The Ultimate Home Office”

Food and Sleep

Alcohol

Caffeine

Nicotine

Chocolate

Oatmeal

Cherries

Banana

Milk

Behavioral Strategies

Timed light exposure

Regular schedule

Nighttime rituals

Improve Physical and Mental Health

Optimize overall health

Stress/Stimuli reduction

Adequate nutrition

Relaxation/Meditation

Approaches for a Better Sleep

20

Sleep Benefits of TaiJi

Du S, Dong J, Zhang H, Jin S, Xu G, Liu X, Chen L, Yin H and Sun Z. Taichi

exercise for self-rated sleep quality in older people: A systematic review and

meta-analysis. Int J Nurs Studies 2014; 52(1):366-79.

Therapy

a personal story #1

21

Martial Art Champion

in early 80s

22

23

“you are not in the circle yet…”

The Older, The Stronger

24

What Is Taiji/Qigong?

Multidimensional

Multimodal

“Multi”:

Combined benefit of

Meditation & Moderate Exercise

Tranquility and Happiness

A doorman’s story

Nothing is personal

Before/after marriage; Eyes open/close.

Superior/small man focuses on good/bad.

25

26

Meditation Research

Emotional Mind Body

Stress Focus/attention Pain resilience

Depression Information processing Heart disease

Anxiety Decision making Stroke

Mood/depression Memory recall Immunity

Emotional intelligence Creativity Anti-inflammatory

Psychological well-being Increases grey matter Blood pressure

A partial list of positive effects:

27

Exercise Research

Lowered Risk Mind Body

Cardiovascular disease Depression Weight control

Type II diabetes Anxiety Bone/muscle strengthening

Metabolic syndrome Mood Daily tasks

Some cancers Brain plasticity Anti-inflammatory

Premature mortality

“Everybody knows that . . .”

28

Antibody Response

to Flu Vaccine

0 5 10 15 20 25

0.5

1.5

2.5

3.5

4.5

CON

TQ

*

TQ Intervention

*

Time Post-Vaccination (wk)

Geometric Mean Anti-Influenza

Antibody Titer (

+99.2% CI)

Yang, Y., Mariani, R. A., Reed, M., Rosengren, K. S., and Woods, J.A. Effects of

taiji and qigong on the antibody response to influenza vaccine in the elderly. Am J

Chin Med, 2007: 35(4): 597-607.

29

UIUC Research

Strength & Force Control

Lower body (knee extensor) strength &

force control improved concurrently

Christou E. A., Yang Y., & Rosengren K. S. Taiji training improves knee extensor strength and force control in older adults. J Gerontol A Biol Sci Med Sci . 2003: 58: M763–M766.

30

Ability to Utilize

Vestibular Information

Yang, Y., Verkuilen, J., Grubisich, S., et al. Strategic and sensory mechanisms for

improved balance afforded by combined Qigong and Taiji training for older

adults: a randomized controlled trial. Med Sci Monit, 2007: 13(8): CR339–348.

31

Taiji & Pain:

Fibromyalgia

Wang C, et al. A randomized trial of tai chi for fibromyalgia.

N Engl J Med 2010; 363: 743-754.

32

Exercise Intensity

“No Pain, More Gain . . .”

immunosuppression 1-3

higher mortality (v. moderate) 4-5

injury

High intensity exercise associated with:

33

Spiritual: see reality

Mental: interact w/ reality

Physical: cultivate vitality

Integrative Approach

“Balance” => mind & energy

34

Stronger, Happier

& Wiser

Tranquility

Happiness

Cognition

Cardiovascular

Immune function

Sleep

Balance

Internal power

Vitality

Agility

Posture

Sexual function

Maximizing Human Potential:

35

Training Components

Static

Dynamic

Push-hands (two-person)

36

Static:

Standing Meditation

Sleep

Economy of movement

Posture

Santi Foot Position

37

Left

(front)

~ 30o

~ 3o

Tranquility and Happiness

A physician’s story

Before full, stop eating; before hitting

fatigue, stop working

Fortune/Disaster: Dao De Jing #58

Purpose of life

38

39

Static:

Sitting Meditation

See daily reality

Interact w/ reality

Functional Meditation:

40

Static:

Sitting Meditation

Yin/Yang: difference and transformation

Everyone is seeking their best interest

Nothing is personal

Meaning of life

Awareness of daily reality:

41

Static:

Sitting Meditation

Gratitude

Everyone is my teacher

No expectation

Moderation/Wu Wei

Principles for interacting w/ reality:

Kindness/Golden Rule

Big Heart

Righteousness

Resilience

42

Static:

Lying-Down Meditation

Sleep

Pain prevention

Alignment

43

Dynamic:

Moving Qigong

Grand opening and closing

Washing organs

Golden Rooster Shaking its Wings

44

Dynamic:

Agility

Core strength

Elongation

10 Years Younger

45

Dynamic:

Form

Concentration

Balance

Cognition

46

Holistic

药补不如食补,食补不如气补,气补不如神补o

Yào bŭ bù rú shí bŭ, shí bŭ bù rú qì bŭ, qì bŭ bù rú shén bŭ.

To improve your health,

medicine is not as good as food/nutrition;

food/nutrition is not as good as qi(gong);

qi(gong) is not as good as spiritual nourishment.

47

Suggested Routine

5 -5 -5 -5 -5

anytime

48

Trial Design

Curriculum

Intervention or interventionist?

“One word from a knowledgeable

teacher can save ten years of hard work”

49

TQdos=

[Tc + f(Tcurr, Tm, X) + g(∑iDi, ∑jSj ψ, Ppos, Pmbs, Pphi)

+ h(Ik, Iped) + k(Satt, Smot, Seng, Sund)]

[(Tc + TSP) + m(Cdes, Iapt, Sapt)] =

= Quantity + Quality

Trial Design:

Dosage

50

References

1. Spence L, Brown WJ, Pyne DB, et al. Incidence, etiology, and symptomatology of upper respiratory illness in elite

athletes. Med Sci Sports Exerc. 2007;39(4):577–86.

2. Murphy EA, Davis JM, Carmichael MD, Gangemi JD, Ghaffar A, Mayer EP. Exercise stress increases

susceptibility to influenza infection. Brain Behav Immun. 2008 Nov;22(8):1152-5. doi:

10.1016/j.bbi.2008.06.004. Epub 2008 Jun 21.

3. Martin SA, Brandt DP, Woods JA. Exercise and Respiratory Tract Viral Infections. Exerc Sport Sci Rev. 2009 Oct;

37(4): 157–164. doi: 10.1097/JES.0b013e3181b7b57b

4. Lowder T, Padgett DA, Woods JA. Moderate exercise protects mice from death due to influenza virus. Brain

Behav Immun. 2005;19(5):377–80.

5. Schnohr P, O’Keefe J, Marott J, Lange P, Jensen G. Dose of jogging and long-term mortality: the Copenhagen

city heart study. J Am Coll Cardiol. 2015;65(5):411-419. doi:10.1016/j.jacc.2014.11.023

6. Yang Y, Mariani,RA,, Reed , Rosengren KS, Woods JA. Effects of taiji and qigong on the antibody response to

influenza vaccine in the elderly. Am J Chin Med, 2007: 35(4): 597-607.

7. Christou E A, Yang Y, Rosengren KS. Taiji training improves knee extensor strength and force control in older

adults. J Gerontol A Biol Sci Med Sci . 2003: 58: M763–M766.

8. Yang Y, Verkuilen J, Grubisich S, et al. Strategic and sensory mechanisms for improved balance afforded by

combined Qigong and Taiji training for older adults: a randomized controlled trial. Med Sci Monit, 2007: 13(8):

CR339–348.

9. Wang C, Schmid C, Kalish R. et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med 2010; 363: 743-

754.

51

Take Home

Agility

Moving Qigong

Standing Meditation

Sitting Meditation

Lying Down Meditation

Fun

52

53

54

Contact Information

Center for Taiji and Qigong Studies

New York, NY

phone: 646-717-2838

www.centerfortaiji.com

yang@centerfortaiji.com

Integrative Medicine Service at Memorial Sloan-

Kettering Cancer Center

yyang2@mskcc.org

55

Thank You