Category: Ai Chi

Can we trust “science?”

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My background is in physical therapy, in both clinical practice and leadership positions. In the rehabilitation world, what we do is guided by evidence-based practice. This means that the treatments we provide are based on proven technique and practices. Unsubstantiated treatments are likely to be rejected by third-party payers (insurance payers and government programs), but more importantly, we want to know that what we are doing will make a difference for those we treat.

While “science” is a broad term, research classification is a hierarchy. It is important to scrutinize the level of reliability of the resources we rely upon.

The lowest level of reliability are reports and studies. These are sometimes provided by those with their own interests in mind, such as healthcare manufacturers and organizations that benefit from promotion of their own products and services. There are also reports on hopeful but unreviewed studies by company researchers. These reports will appear in sales materials, institutional reports, magazines and newspapers. Some of these reports are “anecdotal” and are not sufficient as reliable resources. If more solid research is available, you may find it in links within their publications- follow those links to actual published research when available for a more complete picture.

Then there is informed opinion. A year into the COVID pandemic, I provided an informed opinion article about how Ai Chi could be a practical choice for those with long COVID as they transitioned from rehabilitation to wellness programs, noting that further research was needed. (https://pmc.ncbi.nlm.nih.gov/articles/PMC9665893/). As a long-time reviewer for the Journal of Aquatic Physical Therapy, I knew the process to share my ideas would be rigorous. It took a year for my submission to be accepted for publication following several revisions suggested by other industry experts. Reports of this kind can provide information and resources for providers and may be a springboard for more rigorous research.

Next there are case reports, which are based on a single person or a small group of people, and while they can also be regarded as valuable groundwork for guiding expanded studies, they cannot be considered to be applicable to all cases due to their limited population.

Case controlled studies are based on a significant number of participants who share study target criteria (such as patients with hip fractures) and compares them with an equal sized control group. The control group may be a standard population who do not share the targeted study factors, or in a “blind” study the target subjects are randomly placed into groups receiving a real or a placebo intervention. The more participants in the study, the better the data will be.

Randomized controlled trials are structured studies that are based on a significant number of participants, intentionally eliminating factors that could bias outcomes, and rely on statistical tools to reduce the probability of something being “by chance.” A study I did as a master’s degree candidate falls into this category, (https://pubmed.ncbi.nlm.nih.gov/18796886/). The advantage of doing research at a university is having a team of knowledgeable research advisors to provide input on the study aspects and the resources to do the study, including assessment and data collection resources and analysis tools.

The highest level of research is a systemic review, which compares multiple randomized controlled studies and literature about a practice, treatment or intervention. Emily Dunlap et al provide a notable example of this for Ai Chi (https://journals.lww.com/japt/fulltext/2021/01000/ai_chi_for_balance,_pain,_functional_mobility,_and.3.aspx)

Why is solid research important to what we do? Because we want to provide the best possible outcomes for our patients and clients. You can have the most faith in high level research that is reviewed and published in credible sources.

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Ever-evolving Ai Chi

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Jun Konno’s legacy lives on through creative new ways of sharing Ai Chi.

A couple of years ago a young Ai Chi enthusiast half a world away in the Middle East was referred to me with questions about Ai Chi practice. It was not long before she reported that she was sharing Ai Chi with grateful ladies in several towns and was tracking lower body strength, balance, mobility and walking speed with evidence-based tests and measures. Next, I learned that she had published an article about Ai Chi and had developed a version that includes cognitive challenges which she named Braichi, as it relies upon an exercise grid based on the Braille alphabet. She learned about Ai Chi through collaboration, internet research and Jun Konno and Ruth Sova’s book, Ai Chi: Balance, Harmony and Healing. While Ai Chi certification is available through the Aquatic Therapeutic and Rehab Institute and is a great way to learn how to teach Ai Chi, certification is not a requirement. Jun wanted Ai Chi to be available to everyone to use in ways that work for them, and to allow for free growth of the practice.

I love Ai Chi Day, as Ai Chi enthusiasts and practitioners from around the world have the opportunity to share their unique ways of experiencing Ai Chi. This year Ai Chi Day will be held on July 26, 2025. The Zoom program consists of multiple mini-presentations to recognize the work of Jun Konno and Ruth Sova, and in honor of the 45th birthday of Ai Konno, Jun’s daughter who is the inspiration and love behind this life-changing practice. Watch the AEA/ATRI website for registration information as the date draws near. https://aeawave.org

 

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What my dog told me

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I sometimes describe Ai Chi to people as being like T’ai Chi in the water. Both are an integrated series of slow movements based on ancient Asian principles. Both support core strength gains, improve balance, extend mobility, incorporate mindfulness and relieve stress. But they are not the same. Some animals told me that they are different.

 

First my dog told me. When we walk on the beach, she is curious and stands up on two legs to watch pelicans floating on the water. She sniffs cautiously at horseshoe crab exoskeletons. She pulls to greet children and barks at other dogs. But someone quietly doing T’ai Chi on an obscure part of the beach draws her attention like a magnet. Her eyes lock on the deeply immersed exerciser and she lets out a deep growl. That person doing T’ai Chi looks like a threat to her and she immediately moves into full sympathetic nervous system “fight or flight” mode (mostly fight)…

 

On the other hand, my dog watches me with fascination when I do Ai Chi in our pool. In fact, other animals do too. I have been in deep concentration doing Ai Chi and have opened my eyes to see a little blue heron eyeing me with curiosity, circling the pool and finally stopping just a few feet from me for a drink. Normally skittish marsh rabbits have grazed nearby without concern. A mallard duck once hopped right into the pool with me. I don’t know if it was the relaxing music I was playing or the soothing movements of Ai Chi that mesmerized them, but their reactions were clearly different than the effect that T’ai Chi practice had on my dog.

 

T’ai Chi Ch’uan is currently a popular mode of exercise, and those who practice it attest to its many benefits. But its origins are in ancient marshal arts. It has been used in combat in both eastern Asia and in Europe, and means “supreme ultimate fist,” expressing the dichotomy of yin and yang. In fact, “martial” means “arts of mars,” the ancient god of war. No wonder the movements of that poor woman on the beach upset my dog!

 

While Ai Chi relies on a system of movements just as T’ai Chi does, it is based on nurturing inner strength to see the world more clearly. Ai means love in Japanese and Chinese and Chi refers to life energy. The Ai Chi movements have names that draw us to focus within~ to be mindful of how we move, to explore our limits, to accept, flow, reflect, suspend and finally to return to our lives with fresh perspective.

It is wonderful that we have many different exercise options available, some that call on our sympathetic nervous system and some that bring in our parasympathetic nervous system. We need both to function in the world. Thank you Jun Konno for giving us a tool to nurture peace and calm.

 

 

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Finding quiet

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Life can be quite hectic, particularly when changes are in action. Changing seasons bring different demands~ perhaps pulling different clothing out of the back of the closet or scheduling visits from HVAC professionals to assure that our homes are ready for upcoming weather. Holidays may bring added preparations for gatherings of friends and family, putting up decorations, preparing special dishes, making or buying gifts for loved ones, or reaching out to those who need special help. Whether the busyness of these interludes is joyful and exhilarating or is taxing, it is good for our souls to find moments of quiet and centering amid all the action.

My favorite way to find calm is by doing Ai Chi. I take full advantage of swimming pools, rivers, lakes and oceans when I have the opportunity and join local centers with warm water pools for a steady resource. A focus on breathing and gentle excursions of my limbs and joints nurture my body, mind and spirit. However, sometimes I cannot do Ai Chi. Weather permitting, going for a walk in a natural setting can inspire inner peace and calm, as can listening to poetry or music, or even singing. But there are times when I find myself looking for quiet and mindfulness. Just as doing Ai Chi with others enhances my personal experience, I have found that meditating with others multiplies the gains of mindful practice. Jun Konno guided those doing Ai Chi that there is no one right or wrong way to do Ai Chi and that each practice is unique and personal. I learned that the same is true about meditation from my cousin who hosts group sessions by Zoom.

If you are interested in experiencing an effortless guided meditation or simply basking quietly in calming spaciousness alongside others, email [email protected] for information. Bruce and his wife Elly offer Zoom sessions at various times of day to accommodate participants from multiple time zones.

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Something for everyone

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When Jun Konno developed the practice of Ai Chi, one of his primary mantras was, “However it turns out is how it was meant to be.” No two Ai Chi experiences are the same, whether done by two people at the same time or the same person at different times. Sometimes I will be drawn to do extra repetitions of certain postures, and sometimes I will skip a posture that does not feel right at the time. Ai Chi can be done to a variety of genres of music, to poetry, or to meditative mantras and visualization prompts. It is all good.

 

Taking this concept another step, Ai Chi practitioners have offered variations to allow for practice to a wider audience. A focus on breath, range of motion and mindfulness are presented in Ai Chi introductory classes. Katrien Lemahieu has gifted the world with Ai Chi in Three, a faster paced version of Ai Chi that works well in cooler water and establishes calm and stress reduction by finding flow. Nachiko Onuki teaches Power Ai Chi with intensity progressions, rhythmic breathing and strength training based on Ai Chi protocols. Ashley Bishop teaches a land version of Ai Chi that incorporates dance techniques for situations where water practice is not preferable or possible. Donna Lewen has customized an Ai Chi practice for those with post-traumatic stress disorder (PTSD). Clinical Ai Chi allows therapists to customize Ai Chi for the rehabilitation needs of their patients. And I have suggested guidelines for doing Ai Chi with those who are dealing with symptoms experienced with long COVID, chronic fatigue syndrome and myalgic encephalomyelitis.

 

Many of these Ai Chi variations will be highlighted at the AEA International Aquatic Fitness and Therapy Conference (IAFTC) at the Sanibel Harbour Marriott in Fort Myers, FL (USA) May 7-11, 2024. Aquatic fitness practitioners and aquatic rehab professionals will be gathering to collaborate and learn through a wide variety of classes and events. There is still time to register for this enriching biennial event. I hope to see some of you there!

 

Information about IAFTC is available here:

https://aeawave.org/IAFTC

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Mouth Yoga

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Thich Nhat Hanh describes breathing and smiling as “mouth yoga.” Smiling allows us to relax and release our emotions, and to share that joy with others.

Grateful

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Have you ever felt happy and been compelled to share a smile or say hi to a stranger as you passed? Perhaps a song popped into your mind that got you humming. While these moments may be short-lived, the impact of the seeds of warmth and positivity that are sewn carry the potential to grow into something more.

In November we celebrated a special Thanksgiving meal with family and friends from around the world. We had a delightful two days of preparation, shopping, baking and cooking wonderful things to share. We fixed smoked and Cajun versions of turkey, cranberry sauce, Swedish Hasselback potatoes and many kinds of pie. The guests came with food from their homelands of Lithuania, Peru, India, Sri Lanka, Oman, and Dubai. What a feast! We were all grateful to share time and a delicious meal together. Our son and his fiancé then prepared plates of our extra food to hand out to those nearby who were hungry and homeless, as an expression of their gratitude for the love and support of family and friends.

Ai Chi is an expression of love and gratitude extended to us all by Jun Konno. As a father who named his daughter “Love” in his native Japanese, as a dedicated swim coach who searched relentlessly for creative ways to help his swimmers reach new goals, and as an aquatic teacher who developed the practice of Ai Chi to help tense class participants to relax in the water, Jun’s goal was above all to give to others, with grace. When he realized that Ai Chi could benefit a wider audience plagued by stress, he collaborated with renown aquatic educator Ruth Sova to achieve his dream of sharing Ai Chi with the world. Ai Chi certification classes are some of the most popular offerings at aquatic conferences. And the Ai Chi Trainers who come out of those classes help their participants find calm and relaxation in addition to the physical benefits that Ai Chi brings. Expressions of gratitude and kindness inspire sharing with others in ways that multiply exponentially that you may never fully realize.

As a year marked by world strife and stress draws to an end and a new year begins, consider that even small expressions of kindness and positivity can help set a new course.

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SOAP-y Aquatic Programs

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As aquatic exercise experts, we all know that working in the water offers many benefits that are often more difficult to achieve on land. Just being in an aquatic environment provides compression from hydrostatic pressure that reduces swelling and provides resistance to strengthen muscles used in breathing. Turbulence created by others in the water or other sources that cause water movement activates core muscles that are important for stabilizing the trunk and maintaining functional postures. Water buoyancy offloads joints, reducing the effects of gravity and allowing for ease of movement. The water is a safe and effective place to challenge balance without worry of injury from falling.

 

Our clients come to us with particular wants and needs. In a rehab setting, therapists go through a regimented examination process using standardized tests and measures and processes to localize dysfunction from illness or injury. What we learn guides goal setting and determination of appropriate treatment processes. Healthcare workers often look to the SOAP acronym to do this: Gather SUBJECTIVE and OBJECTIVE information, ASSESS that information to determine goals, and make a PLAN. This organized approach links patient needs to a path to improvement.

 

Those who attend aquatic wellness classes to be healthy and stay fit have a wide array of fun and creative options to consider. There are classes that incorporate yoga postures, pilates exercises and artistic synchronized swimming movements. Float fit classes use tethered mats floating on the water to provide a challenging exercise venue. Aqua Zumba incorporates fun dance steps and music. Aqua aerobics provide active movement in multiple planes in the water at varying paces. Ai Chi promotes mindfulness, with a focus on breathing and motion to bring relaxation and calm while stretching, broadening excursion and activating core muscles. The possibilities are almost endless. The key to a successful outcome in an aquatic therapy or a wellness program lies in matching the program with the desired goals. Whether this is therapist or personal trainer led, or initiated by the client, we need to be equipped to guide and provide the right options for successful outcomes for those we teach.

Join me on Saturday, December 2, 2023 for a class entitled “Integrating Aquatic Gains into ADLs” (activities of daily living). We will explore ways to make successful transitions from aquatic programs to functional gains on land, at the upcoming ATRI/AEA Chicagoland National Aquatic Therapy Conference . Ai Chi certification will also be offered at this conference!

https://aeawave.org/Portals/0/Calendar/CHICAGO_NATC_Brochure_Fall_2023_v2.pdf?ver=gREiA4lwuiU_QjrzmcdH4g%3d%3d&timestamp=1688395517081

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What I learned from Pickleball

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Pickleball has been on my to-do list for several years. It’s a fast moving, engaging sport with welcoming participants who are eager to include new enthusiasts. I enroll in an “Intro to Pickleball” class for a couple of sessions every six months or so. When these classes triggered an old tennis elbow, I invested in a low vibration paddle and never had another bout of tendinitis. But as much as I enjoy these intro classes, I have never felt confident enough in my skills to move into the habit of weekly play with the regulars.

Recently, what I thought was going to be yet another intro class turned out to be a fitness class focusing on specific target areas to improve pickleball play and prevent injury. We stretched, did soft lunges, walked heel to toe along a line, worked on eye/hand coordination with ball bounces on our paddles, made wide springs to each side and got our hearts rate up. Then we practiced playing pickleball together.

Through my Ai Chi practice I have developed good core strength, limberness and balance that were all boons for the Pickleball Fit class, however the ballistic movements and aerobic activities presented unexpected challenges. I realized that this was what was missing from my workouts. In addition to Ai Chi my usual routine includes individual aquatic exercises with buoyant dumb bells and stretch cords, laps with short fins and skateboarding on a kick board, as well as weekly group water aerobics classes, but the next step I needed to take to be an engaged pickleball player had to come on land. After a couple of Pickleball Fit classes, I could already see improvements in my game.

So much of what we do in the water transfers well to our usual activities, but we can’t forget to include activity specific progressions to be better at what we do and have more fun with it.

Who knows? Maybe I’ll even be in a pickleball league one day!

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Sign up for Ai Chi Day 2023!

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Ai Chi Day is nearly here! Join us online on Sunday, July 23. The schedule is chocked full of a great variety of 10 minute Ai Chi presentations, with presenters from around the world.

I will be speaking about adapting your Ai Chi practice for those with persisting COVID issues- much of which pertains to those with other post-viral symptoms, myalgic encephalopathy and chronic fatigue syndrome as well.

Don’t miss this potpourri Ai Chi information! There is something for everyone!

https://aeawave.org/Calendar/ATRI-Education-Events/ArtMID/1942/ArticleID/368/Ai-Chi-Day

Distracted- or embracing…

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I was well into my Ai Chi practice at our local YMCA, when I heard someone clear their throat on the deck nearby. “I’m going to use this lane in 10 minutes,” she said. “I’ve reserved it for a private swimming lesson.” I had signed up for an hour and had felt lucky to nab one of the 2 lanes that were not shared with another swimmer, (a practice established when COVID began). I sighed and moved to another lane to begin my practice again. This time I was next to a lap swimmer who did a lot of splashing. Our carefully devised plans do not always work out, and while both positive and negative life events can raise stress levels, it is the unexpected changes that are the most difficult and stressful~ the changes we didn’t count on.

As I began my practice again next to the splasher, my mind turned to a conversation I had during a Zoom meditation session a few weeks earlier. After sitting in silence with our group for 30 minutes, our leader asked about our experience. I happened to have an “ear worm” during the whole session~ a song stuck in my head that played relentlessly, over and over. I asked if the participants had any advice for getting rid of distractions like that, and the leader asked why I needed to have it gone. My immediate response was that it was too distracting to enjoy the peace of meditation, but I mulled over his reply later. There will always be distractions in our lives and we can choose to allow them to make us feel stressed, or we can accept that they are there and go with the flow. I could have made that song a part of my meditation rather than an annoyance. I could let the sound and feeling of the splashes become a positive part of my Ai Chi practice. We always have a choice.

Ai Chi is practiced all over the world. The most peaceful place that I have done Ai Chi was in an indoor hotel pool in Stockholm. The pool was dimly lit by 2 pots of fire, and only one other person (a silent Swede) was in the pool. It was easy to find calm in this beautiful space. My blog statistics show views from across the globe and I am curious about the Ai Chi experiences of practitioners in other places. Please share a snapshot of your Ai Chi practice (either a picture or a brief written summary) in the comment section.

And if you are interested in sharing your cultural experiences with the larger Ai Chi community, the Ai Chi Newsletter is interested in highlighting Ai Chi from around the world. Please contact Julie at [email protected] to share. Photos need to be in high resolution (original photo files are the best option). They also need a contributor name and email contact, plus a brief description (photo caption) of what/where the photo shares, and permission (technically from anyone recognizable in the photo) to publish.

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Ai Chi opportunities

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Will you be near Sanibel Island next week? Join me for a FREE AI CHI AQUATIC POP-UP CLASS at the Sanibel Recreation Center pool on Monday, April 24 at 10:30 am. Ai Chi brings calm and relaxation, which we all need as our islands heal post-hurricane Ian. It also enhances breathing, improves balance, strengthens core muscles, brings centering and extends mobility~ there is something for everyone! All are welcome! https://web1.myvscloud.com/images/flsanibel/wag.pdf

It’s time to pre-order Ruth Sova’s new Ai Chi book! Ai Chi for Health and Healing is a resource for those new to using Ai Chi for themselves as well as the seasoned aquatic therapist. This book details the concepts, benefits, progressions, and evolutions of this slow, breath-centered technique. Its focus is on improving biomechanics as a training program for core, physical alignment, muscle recruitment, balance, and thoracic, lumbar, and pelvic stability. In addition to physical improvements, Ai Chi is excellent for participants’ overall psychology by mitigating stress and calming anxiety. The biochemical benefits are outlined, as Ai Chi assists with blood pH, getting oxygen in and carbon dioxide out of the body. Give Ai Chi a chance to improve your health or speed up your healing.

See a promotional video for the book here: https://vimeo.com/817775472

Ruth is running a limited time pre-publication promotional offer: When you purchase during the pre-publication sale you get:

1. Ai Chi for Health and Healing new book

2. One of Ruth’s videos:

Ai Chi Essentials
Ai Chi Ne
Ai Chi – Range of Motion
Spiraling Ai Chi
Ai Chi Trunk Stability
Ai Chi Upper Extremity

3. One of Jun Konno’s videos:

Ai Chi Japan
Ai Chi Ni
Ai Chi Zen

Free Shipping in the US. Please contact [email protected] for shipping costs outside the US.

To order the book, please click here Ai Chi for Health and Healing | DSL LTD (square.site).

Once you order the book, email [email protected] with which two videos you would like as a bonus. Those will come as vimeo links within 48 hours.

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Focus: Ai Chi+ for feet & ankles

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Ai Chi performance factors can be varied for different outcomes. When strength or balance is a focus, the base of support set for Ai Chi performance can be wider or narrower, to challenge balance at varying levels and to promote strengthening.

Here’s a personal case study: Almost nine years ago, someone accidentally backed an electric wheelchair over my foot. It was a little sore and swollen, but I ignored it for months before finally seeking help from an orthopedist. X-rays showed that I had a metatarsal fracture, which was declared “healed” following a couple of months of stabilization in a “moon boot.”

While my bone had knitted together, other tissues were affected that caused minor lingering issues. Over the years, my left foot has bothered me off and on with mild swelling, an occasional feeling of “giving out” when going down steps, and intermittent aching and discomfort. I’ve done some self-foot mobilization and had reflexology treatments, both of which were helpful. I found great relief through a friend’s instruction in MELT Method foot mobility exercises and by changing to more comfortable and supportive footwear. I’ve used stability discs for home exercise (see the April 11, 2020 post, Sequestered Ai Chi). The improvements I’ve made for this nagging minor malady have opened the door to a focused awareness of the persisting weakness of my left foot muscles. As I now do Ai Chi, I am mindful of how my feet feel in the “core position” as I go through the first six Ai Chi postures. Moving to Gathering and Freeing, I decrease the width between my foot positions to challenge to the muscles in my feet and ankles. In moving from a semi-tandem (one foot behind and slightly off to the side) to tandem positioning (one foot directly behind the other), my left foot and ankle muscles are getting a good workout. When I move into the one-leg stances of Accepting with Grace, Rounding and Balancing, I can adjust the stance time on the supporting leg to give a good challenge without overdoing it.

Here’s the “plus” I’ve added to my current water exercise for my foot issues: I warm up with several repetitions on both sides of slow heel lifts, holding the raised position for several seconds, then slowly lowering. I progress to doing heel lifts on one side at a time with the opposite knee raised, noticing the difference between my left and right sides. I can increase the challenges while standing on “tip toes” on one foot by moving my raised right leg forward, to the side and backwards, or by holding this position when water turbulence is present. I can also try to rely less on arm movements and more on my ankle muscles to maintain my balance. Finally, I’ve added swimming laps with a kick board and short fins to strengthen my ankles.

Every situation is unique, requiring a customized approach, but you can address particular needs by adjusting components of Ai Chi practice. Watch for more ideas about this in upcoming blogs…

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Work, Work, Work… Study, Study, Study

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Early in my career as a physical therapist, while I was still a student, I was lucky to have an amazing mentor. Paul Hughes attended the university and physical therapy program where I was studying, and had built a private practice in central Illinois. He needed some help and I needed a summer job where I could get some hands on physical therapy experience. Paul’s motto was “work, work, work… study, study, study,” which he shared with me from day one as I assisted him in his clinic, based in a small rural hospital. We discussed the proper approach for each patient~ he quizzed me and shared techniques. He had studied with the icons of the day~ Stanley Paris, Ola Grimsby… and had taught in the orthopedic graduate physical therapy program at Northwestern University himself. His motto has stuck with me, and has led me to explore several different paths in depth during the course of my physical therapy career and to share what I have learned with others.

This month I have the opportunity to share what I have learned about working with long COVID at a virtual conference on Sunday, March 12 through the Aquatic Rehabilitation Exercise Academy, based in England. This conference features British and international presenters speaking on a wide variety of aquatic topics. Information about registration is available on their website:

https://aquaticacademy.co.uk/product/aqua-fitness-and-virtual-conference/

I challenge you to “work, work, work… study, study, study” and be a lifelong learner in order to share with others and help make positive change in the world.

Never stop learning!

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The paradox of the ritual of Ai Chi

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Not long after I was certified as an Ai Chi Trainer, I was excited to share Ai Chi with my friend. As we ended our first session together, my friend asked me, “Am I supposed to feel something?”

Ai Chi is not magic. It is not a cure-all. And while it draws from ancient Asian roots, it is not even a time-honored tradition. It is a ritual, purposely designed to stretch our muscles, our thoughts and our mindfulness, to strengthen our core muscles, our stamina and our perseverance, to broaden breath, awareness and calm and to bring balance and stability to our bodies, our autonomic nervous system and our outlook on life.

Rituals require preparation. Poet Laureate Joy Harjo opens her book POET WARRIOR with a preface appropriately entitled “Prepare” that mirrors aspects of Ai Chi:

Copyright © 2022 by Joy Harjo, from POET WARRIOR by Joy Harjo. W.W. Norton & Company, Inc.

That first earth gift of breathing
Opened your body, these lungs, this heart
Gave birth to the ability to interact
With dreaming
You are a story fed by generations
You carry stories of grief, triumph
Thankfulness and joy
Feel their power as they ascend
Within you
As you walk, run swiftly, even fly
Into infinite possibility

Harjo ponders how different our perspective would be if we learned to listen to the world and the creatures around us with our whole being; listening not just with our ears, but also with our eyes, throat, abdomen, toes… Sometimes I think of seeing with eyes wide open- but it is in stretching all of our senses beyond their normal bounds that we become mindful of our world.

 

My preparation for Ai Chi has evolved to include giving attention to setting the scene for finding calm, as well as including a bit of personal mindfulness practice before participants arrive to put myself in the right mindset. When I share Ai Chi with others, I have grown to realize how important it is to set expectations by providing an explanation of what Ai Chi is and giving an overview of what is to come, while at the same time opening the door for serendipities that Ai Chi practice may bring. I review diaphragmatic breathing and core positioning, then begin time in the water with a mindful walking warm up.

Rituals require regular practice and dedicated attention. The paradox that exists with Ai Chi is that while practicing it in a precise manner over time enhances its benefits, however your Ai Chi practice turns out in the moment for you, is exactly how it was meant to be. We each come to Ai Chi practice with our own constantly updated life stories. You may go through the same motions you have done before, but each time you do Ai Chi is unique, unlike any time you have ever done it before or will ever do it again. And no two people share the same Ai Chi experience, even when doing Ai Chi together. Breathe, dream, listen with your whole being and be open to the infinite possibilities Ai Chi may bring.

 

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Hot off the press…

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Pierce, MN. Ai Chi for Long COVID: Transitioning to a Post-Rehabilitation Community Program. J Aquat Phys Ther. 2022:30(3):60-64. DOI: 10.1097/PXT.0000000000000019

Abstract

Background: 

As the COVID-19 pandemic continues to impact lives around the world, long COVID symptoms plague a significant number of survivors in their daily lives. Guidelines are available for individualized rehabilitation during acute and subacute phases; however, safe community options are needed for those with lingering symptoms who are transitioning away from formal rehabilitation. A lack of access or resistance to COVID-19 vaccination worldwide, and the emergence of more aggressive coronavirus variants, is predicted to result in many more positive COVID-19 cases and consequentially in more long haulers, increasing the need for community resources.

Discussion: 

Ai Chi is a gentle aquatic body-mind practice employed worldwide by aquatic therapists and trainers to reduce stress, enhance breathing, strengthen core muscles, extend joint range of motion, improve balance, stabilize heart rate, and promote focus and centering. It can address some of the common persisting symptoms in medically stable individuals with long COVID including pain, difficulty breathing, muscle weakness, and stress. While Ai Chi is a promising community aquatic intervention, exercise providers need to be aware of special considerations that may impact this population in community programming, such as postexertional malaise, cardiac impairment, oxygen desaturation, and autonomic nervous system dysfunction when providing exercise programs. Research is needed to validate the effectiveness of Ai Chi with post-rehabilitation COVID long haulers in a community setting.

This would be an ideal research area for physical therapy and occupational therapy students as an educational experience, and would help make the world a better place.

Some important factors to consider:

  1. Participants must be medically stable COVID long haulers. Recruiting could come from Long COVID clinics, Long COVID support groups, or from social media outreach.
  2. A warm water pool (86-93 degrees F) is needed, where participants can work at shoulder depth with slightly flexed knees. Pools that offer an Arthritis Foundation Exercise Program (AFEP) often meet these parameters.
  3. Teaching is typically done on the pool deck for groups by a provider who has been trained in Ai Chi.
  4. Background and practical understanding of specific issues pertinent to this population is key when providing exercise programming, including post-exertional malaise, orthostatic hypotension, cardiac impairment, oxygen desaturation and autonomic nervous system dysfunction.
  5. Depending on the research focus areas, evidence based examination tools such as the DePaul Symptoms Questionnaire screen for post-exertional malaise (DSQ PEM), the Timed Up and Go test (TUG), the 6-minute walk test (6MWT), the Berg Balance Scale (BBS), functional surveys or cognitive tests could be utilized.

Correspondence: Melinda Nygren Pierce, PT, MS, CEEAA, ATRIC [email protected]

Full article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9665893/

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Dizzy

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You may encounter Ai Chi participants who experience dizziness or lightheadedness while doing Ai Chi. As there are many causes for dizziness, some of which are quite serious, it is important for participants to explore the roots of their symptoms with their medical providers. Participants who are cleared for aquatic exercise but still have some issues with dizziness may need to modify their exercise routines to avoid setting off their symptoms. For example, those with vestibular involvement may experience dizziness with the turning postures of “freeing,” “reflecting” and “suspending.” Slowing down or omitting those postures may be a way to avoid triggering symptoms.

Those with orthostatic hypotension, (also known as postural hypotension) have a condition where blood pressure drops with changing body positions, such as moving from sitting to standing. This condition elicits lightheadedness, dizziness or even fainting when blood is not able to travel efficiently throughout the body’s circulatory system. A broad array of issues may cause orthostatic hypotension, but participants need proper diagnosis, treatment and to be medically stable before proceeding with Ai Chi practice.

Even those with orthostatic hypotension that is well controlled on land may experience blood pressure related symptoms as they leave the water, due to changes in hydrostatic pressure. Hydrostatic pressure is the static force of water exerted on the body. The beneficial effects of hydrostatic pressure include decreasing pain and edema, which promotes joint mobility; it assists in release of air during exhalation to enhance breathing. And importantly, it helps decrease blood pooling in the extremities by providing a compression force to increase venous return. When this extra assistance for circulation is suddenly relieved upon leaving the water, blood may pool in the legs resulting in a blood pressure drop, and causing lightheadedness or other blood pressure related symptoms. A staged exit from the water can help assist in a smooth transition from water to land.

Providing a little extra time and thoughtful attention to transitions can bring a rewarding experience to Ai Chi practice for those with dizziness.

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Nothing is new under the sun

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We’ve seen it before… A brief illness, a seemingly good recovery, then unexpected symptoms that appear later~ sometimes much later. This is the road for those with long COVID, which can be an extension of symptoms after acute illness or unexpectedly appear up to 6 months after apparent recuperation from COVID. In an earlier posting I mentioned the symptoms experienced by patients I worked with in the 1980’s with post-polio syndrome, which surfaces 15 to 40 years post-acute illness. It’s widely recognized that those who have had chicken pox harbor the virus after they recuperate and are susceptible to getting shingles as adults if they have not gotten a shingles vaccine. A recent Nature Medicine review reveals that latent post-acute infection syndromes (PAIS) follow a wide range of illnesses, including Ebola, Dengue, West Nile virus, Epstein-Barr Virus, Giardia, Borrelia and Q fever, among others. Infectious agents may be viruses, bacteria or parasites. While there is often a long and varied list of complex symptoms across many different body systems, many PAIS manifest with functional limitations, exertion intolerance, severe fatigue and unrestful sleep.

So what do you need to know when you encounter aquatic clients who say they have exertion intolerance or fatigue, regardless of the etiology? Before beginning community exercise, your participants need to be medically stable~ body temperature, blood pressure, heart rate, and blood oxygen (SpO2) levels must all be within normal limits. A resting SpO2 level of 90% or better is recommended by the Royal Dutch Society for Physical Therapy before embarking on an exercise program.

For those who identify fatigue or brain fog as an issue, the 10-item DePaul Symptoms Questionnaire for Post-exertional malaise (DSQ-PEM) is a helpful tool. Those with post-exertional malaise (PEM) can track their own SpO2 levels with a splash-proof pool side finger monitor or a smart watch and stop exercise at 85% SpO2 to avoid reaching the tipping point where they “crash” a couple of days later. The Workwell Foundation recommends daily heart rate tracking, and slowing down when an activity results in more than 15 beats per minute of the weekly average. Laminated copies of the linear Borg Scale of Perceived Exertion are a helpful tool to have on hand to estimate heart rate based on perceived exertion while exercising. With this tool, the heart rate is approximately 10x the exertion level. Those with PEM should work at a maximum of the level that correlates with their average weekly heart rate + 15 bpm, but no more than a moderate exertion level on this scale. For a more accurate reading, breaks can be taken for heart rate tracking with digital devices.

It’s not hard to give space for participants to work with post-exertional malaise during Ai Chi sessions. Simply extend the repetitions for soothing or shifting or add a “holding pattern” of the core stance with arms extended to the sides on the water surface, turning palms up and down for the group while participants who need to check their SpO2 or heart rate do so. Being flexible is all a part of Ai Chi. However it turns out is how it was meant to be…

Check out post-exertional malaise resources available through World Physiotherapy: https://world.physio/sites/default/files/2021-06/WPTD2021-InfoSheet3-Fatigue-and-PESE-Final-A4-v1.pdf

What has been will be again,
what has been done will be done again;
there is nothing new under the sun. Ecclesiastes 1:9

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Overcoming COVID stigmas

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In 2020 I started looking for ways to make a difference in the midst of a frightening new pandemic. I read books about the Spanish flu of the last century that took the lives of some in my family tree, and learned that the annual flu shots we have available today stave off the evolving ancestors of that flu, saving the lives of many to this day. There have been historic global illnesses in the distant past, but it is good to remember that we have been through a pandemic just a couple of generations ago and we have learned to build tools to deal with it.

I then took an online contact tracer certification course, but soon sadly found that practicing my new skill would be difficult due to surprising responses on opposite ends of the spectrum. One place where I spend time chose not to provide any opportunities for this job which involves sharing news no one wants to hear, and another only offered full time positions, which was more than I felt I could handle.

Then came the realization that COVID did not end after a couple of weeks of illness for some of the survivors. Part of the population experiences a wild roller coaster ride of a broad array of continuous or intermittent symptoms, impacting their daily lives profoundly. This prompted me to explore the mounting research on the ill-defined phenomena that has been called long COVID, post-acute sequelae of SARS CoV-2 (PASC) or post-COVID syndrome, and I realized that Ai Chi could be helpful in addressing some of the more prominent symptoms. *Look for a manuscript I wrote about this in the December 2022 special COVID edition of the Journal of Aquatic Physical Therapy entitled “Ai Chi for Long COVID: Transitioning to a Post-Rehab Community Program.”

I then proposed a session on community Ai Chi for post-rehab COVID long haulers for an aquatic conference in early 2022, however it did not draw enough interest to hold the class. I then collaborated with an aquatic physical therapist knowledgeable in subacute rehab for long COVID and an aquatic expert in PTSD for a COVID Long Haulers Roundtable discussion at a larger aquatic conference later in the year. We were excited that it brought a high number of attendees from the United States and from around the world for the final class of the conference. They listened attentively and gave positive feedback on our presentations, but there was little discussion on behalf of the participants. Why is there such hesitancy around this topic?

I believe it comes down to a social stigma associated with COVID-19. We all want COVID to just go away, which has resulted in some minimizing its presence and others becoming hyper-vigilant, (a difficult task as best practices for dealing with this brand new virus emerged very slowly over time). The diversity of responses to COVID has made even talking about it a taboo for the majority of people who are tired of a world already filled with conflict. One person in our audience shared with me that she did not want to ask any questions or make comments because she did not want to risk upsetting anyone else.

This stigma is so strong that those who contract COVID worry about others judging them. Will people think they were socially irresponsible, without regard for other people’s health? Will they be villainized or ostracized by acquaintances, friends and family? This can lead to feelings of personal shame and a tendency to hide a positive test or illness from others, or to downplay their experience and not seek help when they need it. And because of this, we can only guess at the true prevalence of COVID or long COVID.

So what can we do in the face of these stigmas, as community aquatic exercise providers? Be aware that these stigmas exist. Set an example by being compassionate, non-judgmental and mindful in your communications with all. Use comforting, inclusive language and avoid terms which could be interpreted as marginalizing. One aquatic provider shared that she feared that her classes would shrink if they were marketed for COVID long haulers. While Long COVID is not a contagious disease that would preclude participation with others, her realization of the impact of this stigma is an important one.

COVID long haulers who want to improve breath, attention and focus, energy levels, strength and balance will find their way to Ai Chi classes, along with those with many other conditions who share these goals. Yes, we need to be aware of and support necessary adaptations for the special needs of each of our clients, but marketing and working from a goal oriented approach rather than a diagnostic one preserves personal privacy and offers protection against stigmatization. And if you find yourself in the midst of a discussion about long COVID, acknowledge the feelings your clients express, listen attentively and feel empowered to correct misconceptions with proven scientific data. Sharing Ai Chi is a gift you can give to everyone.

More information on this important topic is available from The World Health Organization (WHO) in their briefing, “Social Stigma associated with COVID-19.”

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