LessonPlan Handouts

Appendix D: Session Handout Packet
Exercises: Hand out #1

National Center for Complimentary and Alternative Medicine at the National Institutes of Health
http://nccam.nih.gov/health/taichi/introduction.htm

Tai Chi: An Introduction
Introduction
Tai chi, which originated in China as a martial art, is a mind-body practice in complementary and alternative medicine (CAM). Tai chi is sometimes referred to as "moving meditation"—practitioners move their bodies slowly, gently, and with awareness, while breathing deeply. This Backgrounder provides a general overview of tai chi and suggests sources for additional information.
Key Points
  • Many people practice tai chi to improve their health and well-being.
  • Scientific research is under way to learn more about how tai chi may work, its possible effects on health, and chronic diseases and conditions for which it may be helpful.
  • Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
Overview
Tai chi developed in ancient China. It started as a martial art and a means of self-defense. Over time, people began to use it for health purposes as well.
Accounts of the history of tai chi vary. A popular legend credits its origins to Chang San-Feng, a Taoist monk, who developed a set of 13 exercises that imitate the movements of animals. He also emphasized meditation and the concept of internal force (in contrast to the external force emphasized in other martial arts, such as kung fu and tae kwon do).
The term "tai chi" (shortened from "tai chi chuan") has been translated in various ways, such as "internal martial art" and "supreme ultimate fist." It is sometimes called "taiji" or "taijiquan."
Tai chi incorporates the Chinese concepts of yin and yang (opposing forces within the body) and qi (a vital energy or life force). Practicing tai chi is said to support a healthy balance of yin and yang, thereby aiding the flow of qi.
People practice tai chi by themselves or in groups. In the Chinese community, people commonly practice tai chi in nearby parks—often in early morning before going to work. There are many different styles, but all involve slow, relaxed, graceful movements, each flowing into the next. The body is in constant motion, and posture is important. The names of some of the movements evoke nature (e.g., "Embrace Tiger, Return to Mountain"). Individuals practicing tai chi must also concentrate, putting aside distracting thoughts; and they must breathe in a deep and relaxed, but focused manner.
Use in the United States
According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, an estimated 2.3 million U.S. adults had used tai chi in the past 12 months.
People practice tai chi for various health-related purposes, such as:
  • For benefits associated with low-impact, weight-bearing, aerobic exercise
  • To improve physical condition, muscle strength, coordination, and flexibility
  • To improve balance and decrease the risk of falls, especially in elderly people
  • To ease pain and stiffness—for example, from osteoarthritis
  • To improve sleep
  • For overall wellness.
The Status of Tai Chi Research
Scientific research on the health benefits of tai chi is ongoing. Several studies have focused on the elderly, including tai chi's potential for preventing falls and improving cardiovascular fitness and overall well-being. A 2007 NCCAM-funded study on the immune response to varicella-zoster virus (the virus that causes shingles) suggested that tai chi may enhance the immune system and improve overall well-being in older adults. Tai chi has also been studied for improving functional capacity in breast cancer patients and quality of life in people with HIV infection. Studies have also looked at tai chi's possible benefits for a variety of other conditions, including cardiovascular disease, hypertension, and osteoarthritis. In 2008, a review of published research, also funded by NCCAM, found that tai chi reduced participants' blood pressure in 22 (of 26) studies.
In general, studies of tai chi have been small, or they have had design limitations that may limit their conclusions. The cumulative evidence suggests that additional research is warranted and needed before tai chi can be widely recommended as an effective therapy.
Side Effects and Risks
Tai chi is a relatively safe practice. However, there are some cautions:
  • As with any exercise regimen, if you overdo practice, you may have sore muscles or sprains.
  • Tai chi instructors often recommend that you do not practice tai chi right after a meal, or when you are very tired, or if you have an active infection. If you are pregnant, or if you have a hernia, joint problems, back pain, fractures, or severe osteoporosis, your health care provider may advise you to modify or avoid certain postures in tai chi.
Training, Licensing, and Certification
Tai chi instructors do not have to be licensed, and the practice is not regulated by the Federal Government or individual states. In traditional tai chi instruction, a student learns from a master teacher. To become an instructor, an experienced student of tai chi must obtain a master teacher's approval. Currently, training programs vary. Some training programs award certificates; some offer weekend workshops. There is no standard training for instructors.
If You Are Thinking About Practicing Tai Chi
  • Do not use tai chi as a replacement for conventional care or to postpone seeing a doctor about a medical problem.
  • If you have a medical condition or have not exercised in a while, consult with your health care provider before starting tai chi.
  • Keep in mind that learning tai chi from a video or book does not ensure that you are doing the movements correctly and safely.
  • If you are considering a tai chi instructor, ask about the individual's training and experience.
  • Look for published research studies on tai chi for the health condition you are interested in.
  • Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about CAM, see NCCAM's Time to Talk campaign.
NCCAM-Funded Research
NCCAM has supported studies of tai chi's effects on:
  • Bone loss in postmenopausal women
  • Cancer survivors
  • Depression in elderly patients
  • Fibromyalgia symptoms, such as muscle pain, fatigue, and insomnia
  • Osteoarthritis of the knee
  • Patients with chronic heart failure
  • Rheumatoid arthritis

Selected References
For More Information
NCCAM Clearinghouse
The NCCAM Clearinghouse provides information on NCCAM and complementary health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
Toll-free in the U.S.: 
1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 
1-866-464-3615
Web site: 
nccam.nih.gov
E-mail: 
info@nccam.nih.gov
NIHSeniorHealth
A service of the National Institute on Aging (NIA) and the National Library of Medicine (NLM), NIHSeniorHealth provides health and wellness information, including CAM, for older adults.
Web site: 
nihseniorhealth.gov/cam/toc.html
PubMed®
A service of the National Library of Medicine (NLM), PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals.
Web site: 
www.ncbi.nlm.nih.gov/sites/entrez

The best way to try Tai Chi is through a professional instructor.  They will be able to help with any health impairments while performing the art.
 

Handout #2

Posture Exercises
When a person develops kyphosis, the posture becomes stooped or hunched. The back also becomes stiff and difficult to straighten. Figure 1 shows that bending forward compresses (squeezes) the front of the spine. This makes it more likely to break a bone in the spine. The figure also shows that leaning or bending backward separates the spine and reduces the chance of a broken bone.
Note the area of “strain” (in Figure 1) may cause muscle discomfort. This figure shows that a person with osteoporosis can gently lean back to comfortably stretch out and strengthen the back.
Try the following two exercises to keep your spine more limber and flexible. This will help you to hold your back straight. These exercises can also make your bones stronger.

Head Presses
Purpose:  To reduce tightness in your spine and the muscles of your neck and upper back.  To help get your head lined up over your shoulders rather than stooped forward.

Directions:
Ø  Sit with your middle and lower back well-supported in a chair.
Ø  Move your head straight back as far as possible.
Ø  Keep your chin level with the floor and look straight ahead. Do not tilt your chin or forehead.
Ø  Hold your head back in this position for 3 or 4 seconds.
Ø  Then relax back into your normal posture for a second or two.
Ø  Now repeat 5 times. Do this exercise several times a day.

Standing Back Bends
Purpose: To stretch your spine and muscles for greater flexibility and movement.
Directions:
Ø  Stand with your feet shoulder-width apart and your buttocks against a counter or heavy table that won’t move.
Ø  Place your hands at your waist. Pinch your shoulder blades back as if you are trying to squeeze a pencil between them. Then lean back slightly but stay comfortable.
Ø  Your head should stay in its normal position. The underneath part of the chin should be level with the ground. Your eyes should be looking straight ahead.
Ø  Hold for a slow count of 5.
Ø  Then relax back into your normal posture.
Ø  Now repeat 5 times.
Ø  Repeat several times daily.
NOF thanks Richard Baldwin, P.T., for contributing to this article. Mr. Baldwin is owner and director of Downeast Rehabilitation Associates in Rockport, ME. He is the osteoporosis support group leader of the NOF Coastal Support Group and an NOF health professional member.
http://www.nof.org/articles/16

Hand Out #3 (This handout is not included in the handout packet)

Interactive Summary on Osteoporosis from Medline Plus

National Institute of Arthritis and Musculoskeletal and Skin Diseases [National Institute of Health, NIH]. (2012). X-Plain Osteoporosis Reference Summary. Published by Patient Education Institute.  Retrieved from http://www.nlm.nih.gov/medlineplus/tutorials/osteoporosis/htm/index.htm
Without written permission, the use of this site is for direct use only.  Terms of use state not for distribution to a third party.  An individual may go to this site for their personal use for free. Good source of information so this website is included in this handout packet.
Hand out #4

Two-Minute Moves for Pain Relief

From the Arthritis Foundation (www.ArthritisToday.org)


http://www.arthritistoday.org/fitness/stretching-and-flexibility/2-minute-workout.php

Two-Minute Moves for Pain Relief

A recent study shows just two minutes of exercise a day can help relieve pain.
By Mary Anne Dunkin
Think you can’t fit exercise into your busy day? Think again. A new study shows that just two minutes of exercise daily is enough to ease pain. In the study of 198 office workers with frequent neck and shoulder pain, those who completed two minutes a day of resistance exercise with elastic tubing experienced relief similar to those who completed 12 minutes of daily exercise.
Although the study did not focus on people with arthritis, Duke University physical therapist, Cynthia Harrell, who specializes in arthritis, says short bouts of exercise can strengthen muscles and relieve pain and stiffness due to arthritis. And even two minutes can be broken up into smaller chunks of different types of exercise that can give your whole body a boost.
Ready for some quick relief? Try these two-minute workouts.
Relax and relieve muscle pain and stiffness:
  • Diaphragmatic breathing, or deep, belly breathing, for 30 to 60 seconds
  • Hamstring stretch for 30 seconds
  • Calf stretch for 30 seconds
Strengthen muscles to support knees:
  • Ball squeeze between knees, 5 second squeezes, for 60 total seconds
  • Seated straight leg raise for 30 seconds for each leg
Strengthen hip and thigh muscles:
  • Marching in place for 30 to 60 seconds
  • Walking forward and backward,10 steps each way
Strengthen and improve upper body range of motion:
  • Arm circles backward for 30 seconds
  • Work arms and back by moving your arms on a table top as if your doing the breast stroke for 60 seconds
  • Wrist circles, wrist bends (up and down), and open and closed fingers for 10 seconds each
Handout # 5

How to Stretch With Osteoporosis

By Thomas King, eHow Contributor


 Instructions

1 Consult with your doctor. You should speak to your doctor before beginning a stretching routine. While stretching prevents and treats osteoporosis in most people, the National Osteoporosis Foundation notes that if you are particularly frail or have recently had a fracture, certain exercises such as high-impact aerobics or bending from the waist can actually be harmful.
2 Standing tall. Improving your posture can help prevent and treat osteoporosis. One way to practice this is to stand with your back against a wall and your heels 2 to 3 inches from the wall. Then, pull in your chin and tighten your abdomen and buttocks. Hold this position for several seconds and repeat.
3 Upper back lift. Lie face down on the floor with a pillow under your abdomen and hips. Tighten your abdominal muscles and raise your head and chest a few inches from the floor. As you do this, be careful not to shrug your shoulders toward your ears. Hold this for five seconds and then repeat 10 times.
4 Chest stretch. Sit in a sturdy chair with your feet flat on the floor and your hands resting on the back of your neck. Inhale and move your elbows backward while keeping your hands against your neck. Hold this position for five seconds and then return to the starting position. Repeat this 10 times.
Read more: How to Stretch With Osteoporosis | eHow.com http://www.ehow.com/how_5673282_stretch-osteoporosis.html#ixzz2AFunjS3m
Handout #6
From Arthritis Today: http://www.arthritistoday.org/fitness/starting-out/tips-for-success/well-rounded-workout.php
Making a Well-Rounded Workout
Aerobic exercise, strength training and flexibility make a good, healthy mix
Your primary care physician recommends you walk to get your weight down. Your physical therapist has you using weights to strengthen the muscles around certain joints. Your rheumatologist recommends stretching to increase your range of motion. Why the conflicts? There is no conflict; in fact, your health-care team is doing you a favor, helping you get a well-rounded workout. A balanced fitness program consisting of aerobic conditioning, strengthening and stretching helps you become fully fit, reduces your chance of injury and broadens your workout options to help minimize boredom.

Aerobic fitness

Aerobic workouts require a high level of endurance. You should be able to exert yourself without becoming winded. The lungs take in more oxygen, the heart pumps more blood to spread that oxygen throughout your body and the body converts the oxygen into energy more efficiently. Getting your heart pumping may make you sweat, but the effort will reward you with improved metabolism, better mood, more energy, increased stamina, and, as studies show, decreased inflammation.

What to do: Aquatic exercise, cycling, swimming, walking

What not to do: High-impact aerobics or running

Muscular fitness

Strength training makes your joints more stable. Strong muscles help keep bones positioned properly, and building muscle through weight-bearing exercise increases bone density, decreasing your risk for osteoporosis and fractures.

What to do: Lift light dumbbells or soup cans, use resistance bands or tubing, stand in a pool and push against water or try Pilates. Do slow, controlled movements, concentrating on proper form.

What not to do: Do not over-train by lifting too much weight or performing too many repetitions or sets of exercises. Do not jerk weighted items quickly.

Flexibility

The “use it or lose it” mantra definitely applies to muscle flexibility. To decrease daily joint stiffness and maintain or improve range of motion in joints, stretch. To minimize muscle soreness after training with weights, squeeze in a few stretches between sets. Stretching muscles while they are warm reduces injury.

What to do: Yoga and tai chi are good flexibility workouts, but be sure to also do basic hamstring, shoulder, neck and back stretches. Simply reaching for the sky and your toes is beneficial.

What not to do: Don’t bounce when you hold a stretch or forget to stretch after finishing a workout.

Set Realistic Goals
Just starting a program? Build your exercise routine slowly in five to 10-minute blocks of time, working up to 30 minutes total. Exercise time is cumulative so you don’t need to worry about doing it all at once. Three 10-minute sessions throughout the day are as effective as one 30-minute session. Already active? If you are regularly getting 30 minutes of physical activity on most days of the week, start adding time to existing workouts gradually. Add anywhere from two to 10 minutes at a time. As you become comfortable with your longer routine, continue to add minutes to build endurance, strength and flexibility.
Handout #7

Carmona, R. H. and Moritsugu, K. P. (2004). See the website for the full document: http://www.surgeongeneral.gov/library/reports/bonehealth/OsteoBrochure1mar05.pdf
Handout #8
Calcium Rich Foods:
Dried Herbs: such as dried savory, celery seed, dried thyme, dried dill, dried, dried rosemary, sage, sisymbrium, oregano, spearmint, parsley, poppy seed, chervil and finally dried basil
Sesame seeds, Brazil nuts & Almonds
Turnip, Mustard, Dandelion Greens, Collards, and Kale
Romaine lettuce, Cabbage, Spinach, Celery
Broccoli, Brussels sprouts, Asparagus, Green beans,
Beans: Black beans, pinto beans, kidney beans, Any white bean (Navy beans), black-eyed peas, and winged beans (Asparagus bean)
Blackstrap Molasses
Oranges                                                          
Salmon and Sardines
Tofu
Summer squash and Crimini mushrooms

Read more at http://www.healthaliciousness.com/articles/foods-high-in-calcium.php#SoYU5mQG2O1KV3Kf.99
And  http://www.helpguide.org/life/healthy_diet_osteoporosis.htm
Handout #9
Stir-Fried Winged Beans (Kacang Botol) with Tomato and Garlic
Vegetarian, vegan, and gluten-free
Serves 4 as a side dish 
  • 1/4 cup vegetable oil
  • 6 cloves garlic, thinly sliced
  • dried red chilies, to taste
  • 1 pound winged beans (kacang botol), cut into bite-sized lengths
  • 1/2 teaspoon Kosher salt
  • 1 large tomato, diced
  • 1 tablespoon soy sauce (gluten-free if needed)
  • 1 teaspoon toasted sesame oil
  1. Heat a wok or your largest skillet over maximum heat. Add the oil, and when it is shimmering, add the garlic and chilies. Stir-fry for ten seconds, without burning, and immediately add the winged beans and salt.
  2. Stir-fry for about 30 seconds, until the beans brighten in color.
  3. Add the tomatoes and stir-fry about 30 more seconds, until the tomatoes just slightly begin to break down and form a sauce. Remove from heat.
  4. Stir in the soy sauce and toasted sesame oil. Taste and adjust seasoning and serve immediately.
 
Handout # 10
Websites for Osteoporosis Education:

The following are some of the many websites that have information about osteoporosis and treatments.

Osteoporosis Defined:

American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/osteoporosis.asp
2004 Surgeon General’s report.
http://www.surgeongeneral.gov/library/reports/bonehealth/OsteoBrochure1mar05.pdf
Medline Plus. http://www.nlm.nih.gov/medlineplus/osteoporosis.html
National Institutes of Health. Osteoporosis Resources Center. http://www.niams.nih.gov/Health_Info/Bone/listPagefamily.asp

Exercises:
National Center for Complimentary and Alternative Medicine at the National Institutes of Health. (Tai Chi exercise) http://nccam.nih.gov/health/taichi/introduction.htm
Mayo Clinic. http://www.mayoclinic.com/health/osteoporosis/HQ00643
National Osteoporosis Foundation. http://www.nof.org/articles/543
National Osteoporosis Foundation. http://www.nof.org/articles/16
King, T. How to Stretch with Osteoporosis http://www.ehow.com/how_5673282_stretch-osteoporosis.html
Arthritis Today: Making a Well-Rounded Workout
http://www.arthritistoday.org/fitness/starting-out/tips-for-success/well-rounded-workout.php
Arthritis Today: Two-Minute Moves for Pain Relief
http://www.arthritistoday.org/fitness/stretching-and-flexibility/2-minute-workout.php

Diet:
WebMD. Living with Osteoporosis. Osteoporosis Diet Dangers: Foods to Avoid. http://www.webmd.com/osteoporosis/living-with-osteoporosis-7/diet-dangers

USDA Foods (calcium rich) http://www.nal.usda.gov/fnic/foodcomp/Data/SR17/wtrank/sr17a301.pdf



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