Preventing Effects of the Korean Martial Art, TaeKwon-Do, in
Mark A. Brudnak, Drew Dundero, and Fred M. Van Hecke
Letter for Doctors & Patients April 2003
Falls are a leading cause
of death in the elderly. Associated with aging is a loss of muscular
strength, flexibility, and coordination.
Regular exercise is widely believed to be of benefit for the
elderly. To this end, various exercise regimes have been employed
to battle the associated problems of aging. One such has been
the Chinese martial art, Tai Chi Chuan (TC). TC as an exercise
system uses slow smooth movements to train the body in balance,
endurance, and strength. For this reason, it is known as a "soft" martial
art in that it is very non-impact oriented. There have been a
variety of studies in the West examining the beneficial effects
of TC. However, to date, there have been no studies with senior
citizens using other martial arts of which, TC is but one. The
present study was designed to examine the appropriateness and
effects of a Korean marital art known as Tae Kwon-Do (TKD), a "hard" martial
art, on an elderly population measuring similar parameters reported
for TC. Results: increases in balance, strength, and flexibility
were all observed. Conclusion: TKD proved effective at increasing
several parameters correlated with fall prevention. The elderly
are capable of participating in a hard marital art and they have
an interest in it as a viable alternative to other forms of exercise.
The present study suggests that TKD as a form of exercise for
an elderly population is both viable and potentially popular
and warrants further study.
Martial arts can be defined as
any of several arts of combat and self-defense (as karate and
judo) that are widely practiced
as sport. While the origins of the martial arts are subject to
controversy, it is generally agreed that they can be traced back
thousands of years. While originally developed as a means of
self-defense, those motivations have given way to the sport and
health-promoting aspects in recent years.
At present, the martial arts
are often divided into two classes or types; hard and soft.
The "soft" martial arts are
named so because their theory of self- defense is based on redirecting
the opponent's energy / attack and using more, but less
powerful punches and kicks. Tai Chi Chuan (TC), a widely practiced
martial art in the East (especially China), is an example of
such an art and has become increasingly popular in the West over
the last decade. The "hard" martial arts, such as Tae
Kwon-Do (TKD), are based on using blocks and punches that can
crush bones or body parts of an enemy. The hard martial arts
try to use fewer strikes and punches, but deliver significantly
more power with each one. There are benefits and drawbacks of
each approach but those are beyond the scope of this paper. However,
both hard and soft martial arts are purported to have great health
TC, as a soft art, has been reasonably well studied over past
two decades by Western science trying to determine the mechanism(s)
responsible for the observed and anecdotal health benefits.3
Such benefits have included the following: movement force variability2,
balance control, flexibility, cardiorespiratory4, fall risk reduction
in the prevention of osteoporosis5,6, to improve muscular strength
and endurance in elderly individuals,7 and even on cardiorespiratory
function in patients with coronary artery bypass surgery.8
The importance of the study and practice of the martial arts
to the health and well-being of the senior population is exemplified
by the fact that for over twenty years, falls have been reported
as the main cause of accidental death in the elderly.9 The present
study is designed to measure the contribution that the Korean
martial art TaeKwon-Do may have on several measurements commonly
used to determine susceptibility of the elderly to falls. Additionally,
the present study examines the feasibility of educating an elderly
population to practice a hard martial art. Further, the appropriateness
of an elderly population practicing a hard martial art is compared
with that of other forms of exercise including soft martial arts.
Twenty seven participants were initially recruited as volunteers
for the study. Ages ranged from 63 to 81 years with a mean of
71. A survey conducted prior to initiation of the study ensured
that all participants were independently ambulatory and had no
severe musculoskeletal or/and neurophysilogoical disorders that
would subject the participants to increased chance of injury
or prevent participation. Informed consent forms were provided
and signed before initiation of the study.1
After the initial screening,
it was determined that twelve of the original volunteers should
continue with the study. Those
final participants (FPs) were assessed by several methods for
several relevant measurements. First, FPs were paired and trunk
flexibility was determined according the standard protocol of
the American College of
Sports Medicine, 6th ed., with the following
modifications. Because not all the FPs were willing to
sit on the ground to for the test, FPs were allowed to
stand, with straight legs, while holding a yard stick and their
distance from the ground to the fingertips was recorded. This
number was normalized to those who were able and willing to sit
on the ground to obtain the measurements according to standard
protocols. One FP recorded the measurements while the other performed
Next, one-leg balance was assessed.
FPs were asked to stand on one foot while lifting the other off
the ground just high
enough to keep the foot from touching the floor. Balance time
was indicated as the time until the raised foot was required
to stabilize the FP by placement on the floor. This was done
for each leg and recorded. If an FP wore shoes during the first
round of measurements on the initial day, they were instructed
to wear the same pair on the last day of measurements. If no
shoes were initially worn, then the FP was instructed to again
not wear shoes. Those that could not comply were excluded from
An Exit Poll was conducted
as the conclusion of the study to determine several issues. The
form was handed out along with an addressed and stamped envelope
with the direction to fill
in as completely and honestly as possible and place in mail at
Please fill in as honestly and completely
1. Was the instructor respectful of
2. Was the instructor patient with you?
3. Were directions given clearly and repeated when asked?
4. Did you enjoy the classes?
5. Do you feel the classes were of benefit?
6. Will you continue to practice what you have been taught?
7. Would you continue with classes if a fee was required?
8. Would you continue with classes if NO fee was required?
9. Do you feel any different (in any way, shape or form) from having taken
Please feel free to write any additional comments below.
Results and Discussion
The results of the study
provided interesting. First, the initial drop out rate was 50%.
FPs that dropped out of the
study, did so after the first class. The first class consisted
of taking the necessary measurements and a brief explanation
of what would be covered in the subsequent weeks. After the second
week, the retention rate was over 90%. While not all participants
were able to be tested, it is believed that since the ones that
attended > 85% (according to attendance records) of the time
did get tested, that the numbers obtained are truly reflective
progress that can be expected from senior citizens learning a
hard martial art such as TKD.
1 shows the average increase in the number of pushups the
students were able to do as measured from the beginning of
the study to the end. Participants were directed on the first
day of the study to determine the maximum number of pushup that
each participant could do in 30 sec. For those that could not
bend well enough to do them from the floor, they were done against
a wall at a known distance (toes) from the wall. Subsequently,
on the second analysis at the end of the experiment, participants
were directed to use the exact same distance from the wall for
their pushup counting. As can be, the average increase was 1.8.
This is an interesting number because at no time during the seventeen
weeks of instruction did the participants do pushups of any form.
This suggests that the overall strength and conditioning of a
TKD program, can transcend the exercises that are practiced to
have an effect on other areas that may influence health and well-being.,
such as fall prevention. This will be discussed further below.
Figure 2 represent the average
change of trunk flexion. Study participants were directed to
measure the distance of trunk flexion
as outline according to the ACSM'S
GUIDELINES FOR EXPERCISE TESTING AND PRESECRIPTION. Sixth Ed.1 Briefly, participants sat on the
ground with legs extended directly and fully forward. A yardstick
was placed between the legs with the 15" mark at the sole
of the feet and the 0" towards the trunk. Participants
then bent forward and noted the distance on the yardstick that
the fingertips reached to. This number was recorded and plotted.
The Y-axis show the distance change on average for the participants
from the beginning to the end of the study. The x-axis represents
the cumulative participants as one group who finished the study
(those attending the class > 80% of the time).
The average increase in flexibility
at the trunk, as seen in Figure 2, was just over 3.5 inches.
As with the pushups, at no
time did the students directly practice this. The increase in
flexibility is due to the overall conditioning program. Considering
that the participants only came to class once a week, as opposed
to the two, three, or more classes usually attended by students
of the martial arts, this number is very striking. This will
be discussed in more detail in the Discussion section.
In Figure 3, the balancing time on
each foot was recorded as an average change for the entire class.
For both feet, the average
change was positive. For the class as a whole, there was a net
increase after the seventeen weeks of instruction. The average
increase in time the participants were able to balance on their
right foot was just over sixteen seconds. The average increase
in time the participants were able to balance on their left foot
was just under sixteen sections. Most of the participants were
right handed and usually the right leg is considered the one
with poorer balance. A greater increase in the balance time for
the right foot vs. the left foot is consistent with what will
be discussed below about the anticipated results from a more
The exit poll (above) was given at
the end of the seventeen week testing period. While subjective,
exit polls that were mailed in, indicated that 90% will probably
continue the exercises, 100% felt their time was well spent,
10% will seek further instruction if a fee is require, and 50%
would seek further instruction if provided pro bono. While the
subjects found no major errors with the instruction, almost 50%
said they would like to try Tai Chi Chuan in the future and had
expected TKD to be more like what they have seen in popular commercials.
The results presented strongly
suggest that a hard martial art has several benefits to an
elderly population. First, Figure
1 demonstrates an increase in the average number of pushups the
class could do. This is especially important because, as stated
in the results, no special instruction or exercises were done
to promote pushup ability. This suggests that TKD conditioning
can have an overall positive effect on the body's health,
as measured by pushup ability. This overall increase in strength
may be translatable to fall prevention. It is known that muscular
strength, coordination, and balance all contribute to falls and
Second, Figure 2 demonstrates and increase
in overall flexibility as indicated by trunk flexion. While the
increase in flexion
is not overly dramatic, it is still significant enough to be
of clinical interest. An increase in flexion correlates with
an increase in muscular control. This may also contribute to
a decrease in fall rate.
Third, Figure 3 indicates a beneficial
effect in balance as measured by the one foot balance test. This
is particularly important
in light of the fact that the leading cause of accidental death
in senior citizens results from falls. This was the only part
of the study where on a weekly basis. Since this is the area
of greatest gains, it is anticipated that if other parameters
were measured that were also practiced as often, similar positive
benefits would be accrued. For instance, punching drills were
a routine portion of each class. It would be of interest for
future studies to measure hand speed.
One of the aims of the present study was to determine the feasibility
of teaching an elderly population to practice a hard martial
art. This question was address by and apparently answered by
the participants progresses being discussed with one of the authors
of the study who is a 5th degree black belt. It was decided that
rather than test after the seventeen weeks of the study, the
students would be offered an opportunity to continue with their
TKD studies at a different time. Of those students, only one
has at present chosen to continue and will go on to receive private
(gratis) instruction from the primary author.
It is of interest that several students expressed a desire to
continue with TKD but did not want to have an evening or weekend
class. This actually turned out to be one of the limiting factors
in this study. The population that was sampled, was from a Senior
Center where senior citizens gather for activities. This population
already has many active things in their lives. It is anticipated
that should a different, more lethargic population be sampled,
even greater gains would be observed in the measured parameters.
This is evidenced by the fact that one of the students that showed
the greatest gain, entered the study with no outside activities
Another goal of the present study
was to determine the appropriateness of an elderly population
practicing a hard marital art vs. a
soft martial art. While this is very subjective, it can nonetheless
be addressed by considering both the dropout rate and the fidelity
during testing as evidenced by retention rate. While the initial
dropout rate after the introductory class was comparatively high,
the dropout rate over the entire course of the study was extremely
low. Of those that originally initiated the study, 20% follow
through to the point of completion (completion being indicated
as having been tested twice). While that may seem low, over 90%
of the class attended more than 85% of the classes. That is a
very good percentage for a class like this. The reason the testing/completion
rate was low is that the testing time was during midsummer when
most American go on vacation. In deed this was the reason
that most of the FPs were not tested. Also, while subjective,
anonymous exit polls that were mailed in, indicated that 90%
will probably continue the exercises, 100% felt their time was
well spent, 10% will seek further instruction if a fee is require,
and 50% would seek further instruction if provided pro bono.
An interesting fact is that those
that completed the study, 100 % attended more than 85% of the
classes. They would typically
be classified as the "serious" students. While these
students did not go on to take part in a formal testing for rank
advancement, they were nonetheless assessed periodically for
their ability to perform various required tasks such as three
step sparing and four direction punching. It was noted that during
the later weeks of the study, the students could progress quickly
into the required physical tasks. That was in sharp contrast
to the early weeks of the study where the participants required
constant verbal and physical assistance to perform an exercise.
In the later weeks of the class, there was a brief "refresher" period
required until they were able to perform the given task at hand.
This was true for each of the exercises. It appeared that this
refresher period was shorter and shorter each week, but no data
were collected to support that empirical observation. Future
studies should include this aspect in the parameters measured.
Taken as a whole, the present study demonstrates several interesting
points. First, an elderly population can learn the martial art
of TaeKwon-Do. Second, there is a desire in an elderly population
to warrant teaching them TKD. TKD may be able to contribute to
overall health of an elderly population. Such contributions may
result from better balance assisting in fall prevention. Better
muscle tone and coordination my also assist in fall prevention.
It is obvious that a large number of further studies are warranted
in this area. These studies should include, but are not limited
to, such things as fall prevention, cardiovascular health, cholesterol
levels, stroke, bone density and breakage, mental health, mental
acuity, and life-span.
Additionally, it should be noted
that a once a week class schedule, meeting for an hour each
time, is insufficient to efficiently
teach TDK. While the students certainly made progress, had they
been taking two or three classes a week, which is usual for the
system the authors are trained in, they would have excelled even
further and been able to test for a higher belt rank at the end
of the study. The time limitation was set by the FPs themselves
as in order to recruit volunteers, a poll was taken as to availability
for the majority. Most fell within a one hour time span on a
Thursday morning. Why that time was vacant, is not understood
but probably involves the schedule of activities at the Senior
Center from which they were recruited.
Along with the periodicity, the
rate of progress may be, at least in part, a function of cognitive
ability. It was noted
by the primary author that the students had problems remembering
not just how to perform certain moves, but also the sequence
of consecutive or combined movements. This would be an extremely
interesting area to explore and should be pursued in future studies.
It is of interest that several of the FPs on the exit
poll had commented that they noticed that TKD had helped them
in their concentration. While subjective, it is anticipated that
should cognitive assays be performed in the future, similar improvements,
to the ones seen in the physical assays, would be observed.
Also, it is of interest that at the beginning of the study,
several other parameters were to be included, such as blood pressure,
heart rate (resting and active) and sit-ups. With an hour long
class and an initial 27 students, that proved impossible due
to time constrains. Also, many of the participants were not physically
capable at the introduction of the class to complete a push-up
or sit-up (most refused to sit on the floor). Along with that,
much for the initial half hour of warm-up/stretching exercises
usually performed by students in the TKD system had to be modified.
There was absolutely no sitting on the floor to stretch out any
portion of the legs or back. Instead, the primary author had
students do very similar exercises by either sitting in a chair
or placing their legs on the chair. Examples include sitting
on the chair and twisting the torso from side to side for 20
seconds each side, repeated several times. Placing one foot on
the opposite knee and bending forward while holding that position
for 30 second, repeated several times. A more detailed list can
be supplied on request but, again, they were all modifications
of the usual exercises done by a standard class in the TKD association
of the authors.
It should be noted that the results reflect a comparatively
active population. It would be interesting to sample two populations
in the future. The first would be a relatively sedentary population.
The second would be a relatively active population. It is hypothesized
that the gains seen, if normalized for attendance, would be greater
for the sedentary population. This is because the is a point
of diminishing returns in any exercise program and the active
population would be closer to that point than the sedentary population.
Taken as a whole, the present
study answered the questions it set out to ask. Can a senior
population be taught a hard martial
art? The answer is yes, with the qualification that progress
may be limited by their schedules, physical abilities, and mental
capacities. Is a hard martial art of benefit to the same population?
The answer is again "yes" as indicated by the increases
in strength, flexion, and balance.
The major weakness of the study was that there was no negative
control group. Initially, a negative control group was recruited
along side of the active group. However, 100% of the negative
control group dropped out of the study after the first day. This
obviously presented a challenge and the decision was made to
continue the study and note any differences in the experimental
group. It is anticipated, armed with the knowledge of this tendency
in the sampled population, different strategies could be devised
to incorporate better control. However, the authors believe that
there is still merit in the study as done and look forward to
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Please feel free to contact
Mark A. Brudnak PhD, ND
957 Lake Shore Road
Grafton, WI 53024
(Wisconsin is in the Central