Physical Qigong, Tai chi chuan Tai chi chuan (literal translation "Supreme Ultimate Fist") is an internal Chinese martial art practiced for both its defense training and its health benefits. It is also typically practiced for a variety of other personal reasons: its hard and soft martial art technique, demonstration competitions, and longevity. As a consequence, a multitude of training forms exist, both traditional and modern, which correspond to those aims. Some of tai chi chuan's training forms are especially known for being practiced at what most people categorize as slow movement. Tai chi training involves five elements, nei gung, tui shou (response drills), sanshou (self defence techniques), Weapons, and solo hand routines, known as forms. While the image of tai chi chuan in popular culture is typified by exceedingly slow movement, many tai chi styles (including the three most popular - Yang, Wu, and Chen) - have secondary forms of a faster pace. Some traditional schools of tai chi teach partner exercises known as "pushing hands", and martial applications of the forms' postures. Health benefits Before tai chi's introduction to Western students, the health benefits of tai chi chuan were largely explained through the lens of traditional Chinese medicine, which is based on a view of the body and healing mechanisms not always studied or supported by modern science. Today, tai chi is in the process of being subjected to rigorous scientific studies in the West.[16] Now that the majority of health studies have displayed a tangible benefit in some areas to the practice of tai chi, health professionals have called for more in-depth studies to determine mitigating factors such as the most beneficial style, suggested duration of practice to show the best results, and whether tai chi is as effective as other forms of exercise. Chronic conditions Researchers have found that intensive tai chi practice shows some favorable effects on the promotion of balance control, flexibility, cardiovascular fitness, and has shown to reduce the risk of falls in both healthy elderly patients, and those recovering from chronic stroke, heart failure, high blood pressure, heart attacks, multiple sclerosis, Parkinson's, Alzheimer's and fibromyalgia. Tai chi's gentle, low impact movements burn more calories than surfing and nearly as many as downhill skiing. Tai chi, along with yoga, has reduced levels of LDLs 20–26 milligrams when practiced for 12–14 weeks. A thorough review of most of these studies showed limitations or biases that made it difficult to draw firm conclusions on the benefits of tai chi. A later study led by the same researchers conducting the review found that tai chi (compared to regular stretching) showed the ability to greatly reduce pain and improve overall physical and mental health in people over 60 with severe osteoarthritis of the knee. In addition, a pilot study, which has not been published in a peer-reviewed medical journal, has found preliminary evidence that tai chi and related qigong may reduce the severity of diabetes. In a randomized trial of 66 patients with fibromyalgia, the tai chi intervention group did significantly better in terms of pain, fatigue, sleeplessness and depression than a comparable group given stretching exercises and wellness education. Stress and mental health There have also been indications that tai chi might have some effect on noradrenaline and cortisol production with an effect on mood and heart rate. However, the effect may be no different than those derived from other types of physical exercise. In one study, tai chi has also been shown to reduce the symptoms of Attention Deficit and Hyperactivity Disorder (ADHD) in 13 adolescents. The improvement in symptoms seem to persist after the tai chi sessions were terminated.