Tai Chi for People With Breast Cancer

Welcome to The Breastcancer.org Podcast, the podcast that brings you the latest information on breast cancer research, treatments, side effects, and survivorship issues through expert interviews, as well as personal stories from people affected by breast cancer. Here's your host, Breastcancer.org Senior Editor, Jamie DePolo. 

Jamie DePolo: Hello, thanks for listening. Today, we’re going to talk about tai chi. What it is, how it can help people diagnosed with breast cancer, and how you can get started if you’d like to try it.

Our guest is Judith Sachs, the founder and director of Anyone Can Move, an adaptive movement program in Philadelphia. Her goal is to get everyone moving whether they’re standing or in a chair. Judith is a 30-year practitioner of taijiquan push hands, a practice that maximizes balance and breath. She teaches a variety of tai chi, qigong, balance, and gait classes. Judith welcome to the podcast.

Judith Sachs: Thank you, Jamie. It’s a pleasure to be here. 

Jamie DePolo: So, I have heard tai chi described as meditation in motion, which is good, but I’m not sure that’s fully enough for everyone to understand, so could you explain to us what tai chi is?

Judith Sachs: Sure, absolutely. I’m going to go back in time. So, tai chi, or in its full description taijiquan, it is a practice that started in China centuries ago and it means grand ultimate fist, because it was conceived as a martial art and that’s why you think of movement, right? When it was developed by the Shaolin monks in Henan Province in the 1st century AD. It’s actually older than yoga. So, there’s one theory, which is kind of interesting, we can’t prove it, but that these fighting monks at the Shaolin Temple met the Indian yogis who were traveling overland. And the yogis were sitting all day with their legs crossed meditating, and the monks were fighting all day and so they exchanged information about the way that they prepared for their practice. 

And the idea was that they would use this kind of breathing that they were now using for fighting as a meditative art, but they would keep moving while they did it. And so, as you probably know, this would extend their longevity because breath is the basis of anything, everything that we do, and then both martial arts and meditation require a clear mind and a strong, flexible body. So, that’s kind of the basis, the background of tai chi. I’m sure you’ve seen the yin-yang symbol. It’s a big circle that’s made up of these two kind of kissing fish or interlocked teardrops. 

Jamie DePolo: Slugs in a circle as we used to call it in college, yes.

Judith Sachs: Right. So, what it actually represents is the whole universe of Chinese medicine and Chinese martial arts and cooking and calligraphy. Everything is based on that symbol. So, the white part, this is the yin-yang symbol, the white part is yang and it represents heaven. The black part is yin, which represents earth. And what’s really interesting about it is within the white part is a little black dot, within heaven is earth, and within earth there is a little white dot that represents heaven. So, the idea is that these two things are always interlocked. 

If you think of, for example, ice, which is water frozen, right? So you can have water that’s a flooding river or you can have it as a still piece of ice. Fire, you can imagine as a raging wildfire in the forest or just that little tiny blue flame on the stove. So, within one there is the other and that’s the purpose of your thought as you are practicing tai chi. You want to be moving, but you want to be still. 

Jamie DePolo: Okay. So, I have to ask, I know in many large cities, Philadelphia where you practice, and countries outside the United States, people who know how to do tai chi, they go to a park, they do it, but if you’re just starting out I can see, like, to somebody like me, that could be very intimidating just trying to go and do something, so a class is probably a good idea for somebody who is just starting out. So, what would somebody perhaps do in a typical class, if there is such thing as a typical class? 

Judith Sachs: Sure, there is, yes. Most of the classes, you know, it’s interesting when you think about yoga I think it’s the thing that people know the best in terms of meditation and movement.

Jamie DePolo: Sure.

Judith Sachs: You think about yoga having an Iyengar or Hatha yoga or hot yoga. Tai chi you’re just basically going to see it’s a tai chi class, but most classes teach what’s called a family form. So, these forms, again, developed centuries ago in different families in China, and in the 1950s a gentleman named Cheng Man-Ch’ing came to America and he started teaching the very, very basics, which is what you would probably learn in a beginner class today. And they teach what’s called Yang form, but most people don’t even bother with the name of it, and it’s kind of the principles of how the yin-yang relates to what’s happening in between. In other words, in between heaven and earth is us, right? 

So, we’re channeling all of this breath and movement through our own body, and you would basically learn a lot of these principles of Chinese medicine. And a teacher would teach very, very simple, the exercises are called forms, and the forms may be as simple as just moving arms when you sit in a chair or learning a foot pattern as you walk along the floor. And then the teacher will, as you become a little bit more advanced, put all these things together and maybe you will do what’s called an eight-step form as opposed to a 108-step form, which would be in a more advanced class.

Jamie DePolo: I gotcha. So, let me ask you this, in tai chi it sounds like the movements or the progression of movements might be called form or forms. Is that sort of parallel to in yoga where you have an asana, which is the pose, is that a correct analogy?

Judith Sachs: I think you might be able to say that, yes. Of course what’s interesting about the difference between them is in yoga we are on a mat, usually not moving from it, either seated cross-legged, on our knees, lying down, standing up, and we hold poses. And the idea is to get deeper into the pose as you breathe and as you stretch a little bit more. In tai chi, it’s all about the flow. You are always moving whether you’re seated in a chair or you’re standing or moving around the room. 

And we think of tai chi as a solo form, but in fact there are partner forms. There are forms where you use a sword, or a staff, or a fan. And the idea, again, is this melding of heaven and earth so that you become very much like this creature who embodies both movement and stillness, but the idea is that we never stop. The whole body is moving almost like a silkworm spinning silk, that’s very often the image that’s used in terms of practice. 

Jamie DePolo: Okay. Okay, that makes sense. How long is a typical tai chi class? 

Judith Sachs: Usually, it’s probably an hour.

Jamie DePolo: An hour, okay. 

Judith Sachs: And then my teacher always used to say, so, you’re going to go home and each day you’ll do one minute of tai chi. And people in the class would say, well, how can you do one minute? She said that’s the point, you just start, and as you start you realize you want to go on. So, the hardest thing is the starting.

Jamie DePolo: I gotcha. So, she really wanted you to do more than one minute. It was just… 

Judith Sachs: Yeah, obviously.

Jamie DePolo: Yeah, telling people that’s what, that was the goal. 

Judith Sachs: Yeah.

Jamie DePolo: I’ve gotcha, okay. So, now I’m wondering about the benefits and some people think because tai chi, or at least the way I’ve seen it practiced, it’s very slow, it’s very gentle, as you said it’s very flowing. They kind of have the no-pain, no-gain mentality and people are thinking, oh, well this can’t possibly, you know, help me get stronger or you know help, be an aerobic exercise, but I believe that’s wrong. So, what are the benefits of tai chi? And especially, you know given our audience, who are people with breast cancer, what benefits might it offer?

Judith Sachs: Research has shown enormous benefits. There are many, many studies, some very long-term, in terms of the benefits of tai chi for people who are well and also people with a variety of different medical conditions, breast cancer being one of them. They have shown that tai chi may help to increase strength, stamina, heart and lung function, feelings of well-being, fatigue, which I think is very important in terms of breast cancer, and again we go back to the, let’s practice for one minute. You kind of trick yourself into, okay, I’m just going to stay here, and kind of move my arms, and take a breath, and then you get started and you keep going. And so, even if you thought you were experiencing a lot of fatigue at the beginning of the session in terms of your breathing and your movement, again, whether seated or standing, you will probably increase a lot of the energy that comes from the dedication to this practice.

I think the other really amazing thing about tai chi, so I usually say taijiquan, but a lot of, most people say tai chi, the other thing it improves is memory. Because these forms, as I said to you, sometimes go on for quite a while. Usually, the teacher is doing it in front of you so that you don’t have to remember it and one of the, one of the great things is that the forms have these very evocative names like grasp the bird’s tail, waving, waving hands like clouds, and my favorite, repulse the monkey.

Jamie DePolo: Oh, repulse the monkey. I like it.

Judith Sachs: Yes. So, as you begin to recall these images of whatever it is you’re doing, your memory can improve by you know what comes after what, because of the flow of tai chi. So, you know that you would grasp the bird’s tail and roll back and then press, withdraw, push, because that is a, something you do in almost every class that you would take this little piece, and again, do it seated or standing, and the more that you practice, of course, the more you want to practice and the more memorization you can do.

Jamie DePolo: True. No, that sounds amazing. And to me, I think, it could be appealing to somebody, especially if somebody is going through treatment for breast cancer, or really any type of cancer, you know, you’re tired, you may feel really bad like on a day that you have chemo or the few days after. And I think just knowing that you could practice tai chi sitting down, it’s just, to me I would think it would be less intimidating than say, like, oh, I have to go out and walk for a half an hour, or I have to make myself try and lift some weights, even if they’re one-pound weights. You know the whole, I think the mental image of that, it could be a little bit easier to get started.

Judith Sachs: I have to say one of the uses of it I remember being at the dentist’s office having a horrible procedure done on my tooth and I went through the form in my head. And using visualization and imagery is another wonderful, evocative piece of what tai chi can do for you, because you don’t even have to be moving. As I said, a lot of this has to do with stillness. In our society today we think we have to hurry up and get there, we have to move really quickly, and I’m always saying to my students just slow down, just stand.

One of the things we do in the beginning classes is learn how to hold a ball, so that you want the ball to feel as though it is touching… like a big beach ball. 

You’re holding it in front of you and it’s touching the inside of your arms, it’s touching your chest and your fingertips. And as you begin to imagine the actual ball, you are really able to sense some kind of energy happening in between your hands and also in your feet. In the diagrams of the old pictures, we see bubbling springs coming up underneath the sole of each foot. The idea is that you are taking from the earth, from the water, all of that energy that pops you up whether you’re in the chair feeling your feet on the floor or whether you are moving forward or sideways or backwards in the class. 

Jamie DePolo: Okay, that’s great. So, now if somebody, well, really somebody diagnosed with breast cancer, or really anyone, wanted to start tai chi, how would you suggest they go about that? And do they need to, I’m thinking specifically for, say, if somebody is being treated for cancer, breast cancer, do they need to tell the teacher, like, there may be some movements I can’t do? Or what’s your advice for all of that?

Judith Sachs: Well, in starting any kind of exercise or movement program you would certainly first talk to your doctor. And if you’re seeing a physical therapist, I work with the Parkinson’s community, you would always speak to the physical therapist about this is what I want to do and this is how I’m going to start doing it and maybe also give little reports along the way. You’d want to make sure your oncologist was onboard with what you were doing. You would, again, start in a class where nobody knew anything. My teacher always talked about having beginner’s mind. In tai chi, as in yoga or mostly kind of anything we do, there’s a lot of repetition and that’s how we learn things. 

And in order not to feel bored the ten-thousandth time you grasp the bird’s tail and roll back, you want to, again, give yourself this kind of impetus to find something new in every gesture. Whether you’re just holding a ball or you’re doing a 108-step form, to begin with, the teacher would probably also ask you to figure out the sense of your body being connected to your mind and your spirit. I would say anybody who’s in breast cancer treatment might have some concerns about holding the arms in space or they are experiencing cellulitis, you would also want to talk to the teacher and say are there some adaptations that I can make? Because you don’t have to be always having your arms in the air, they can certainly be on your belly. 

We talk about the different pieces of the belly being where, where the baby came from. So, in using your breath hold, just putting your hands on what’s called the dantian. It’s an imagery point a little bit below your bellybutton and 3 inches inside, that’s where it’s described in the classic literature, that’s your kernel, your center of energy, so that you’re always using that as you breathe and inhale and exhale. Again, thinking of this motion under the water or this motion-like silk being spun by the silkworm. So, you don’t have to be doing anything extraordinary to be doing tai chi. 

Jamie DePolo: Okay, that’s great. And there are, I believe you said earlier there are classes specifically for beginners, so somebody can check that out. They don’t have to worry about, oh, I’m in a class, and people are doing these 130 forms all together and I don’t know what’s going on.

Judith Sachs: No, there are absolutely beginner classes and you would want to probably start with people who are also about at your level whether they have breast cancer or not. But I have to say, just looking at some of the literature, you know, this has a really positive influence on functional capacity and also quality in life in women of all ages who are being treated for breast cancer. In this one study I looked at there were significant improvements at six and 12 weeks. That’s not really a long period of time.

Jamie DePolo: No.

Judith Sachs: In both aerobic capacity, muscular strength, flexibility, balance, very important that we not fall down as we get older.

Jamie DePolo: Absolutely.

Judith Sachs: And quality of life. The idea that you’re doing something really beneficial for yourself.

Jamie DePolo: Yes, yes, thank you. No, that’s great. Because I’ve, you know when I’ve talked to other people, not obviously tai chi experts such as yourself, but just people who are trying to get anybody diagnosed with cancer moving, they always recommend, think about whatever movement you’re going to do as part of your treatment plan. Like, this is just one other thing you can do to help yourself get healthier, feel better, improve your quality of life, as you said. So, I feel like tai chi could be, that’s, that’s the same way to think about it, like this could be part of your treatment plan.

Judith Sachs: And in the Parkinson’s community we actually are asking neurologists to write prescriptions for any particular exercise whether it’s a balance class or a tai chi class or a boxing class. 

Jamie DePolo: Okay. And one last question, I forgot to ask earlier, how much, you know and I realize you’re in Philadelphia so that’s, you know, you have only that frame of reference, but how expensive is tai chi? Like, how much does it cost to go to a class?

Judith Sachs: It would probably be similar to a yoga class. So, I know here in Philadelphia people charge something like $18 a class, but if you get a package deal I’m sure it’s less money. I think also major teachers around the country and that might be more expensive, but it’s probably good to study with… they talk in terms of lineage. You know I studied with so and so, and my grandmaster, in other words my teacher’s teacher was…

Jamie DePolo: Gotcha.

Judith Sachs: And a lot of people will know that. You know they will say, oh, I studied with so and so. So, that gives them a little bit more credibility and they may be charging more, I really don’t know.

Jamie DePolo: Okay. All right, well, Judith thank you so much. This has been really helpful. I appreciate your time and thank you for sharing all your knowledge with us.

Judith Sachs: You’re very welcome.

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