by Roger Jahnke, O.M.D.

Tim first came to the clinic as a patient seeking acupuncture and support in his struggle with HIV. He participated in the Circle of Life group we ran for people with chronic illness, which focused on optimizing lifestyle. He also came to our Qigong classes. When Tim dropped out of sight, I assumed we might not see him again. This was in the early years of the AIDS epidemic, and most of the people we saw who had HIV were dying quite young.

Five or six years later, I met Tim again when I was teaching a Qigong class in San Francisco at a conference. Although he looked very familiar, I couldn't place him at first, this tall slender man in the back row. After the class, he introduced himself. Tim was not only surviving HIV; he exuded radiant health. His job required him to travel extensively, yet everywhere he had lived he made it a point to get involved in a support group and a Qigong class. He felt that these two factors had been instrumental in promoting his good health.

You've probably noticed that there's a healing side to exercise: It can chase the blues, help fight stress, and raise your energy. But when is exercise actually therapeutic?

Millennia ago, the people of ancient China and India developed methods of exercise with exceptional healing effects. Although they evolved continents apart, Qigong, t'ai chi, and yoga have certain similarities. They can all be described as meditative exercise and all involve:

• Relaxation and concentration

• A focus on the breath

• Gradual, purposeful movement

We know from modern research that these disciplines have been found to promote the effectiveness of the immune system. They were used purposefully in ancient cultures as a complement to medical treatment.

Qigong is still valued in traditional Chinese medicine and today is practiced throughout China by millions. Each morning, the parks there are filled with people performing Qigong and t'ai chi (a form of Qigong). These exercises are also used in hospitals and sanitariums as part of the therapy for people suffering from conditions such as cancer and tuberculosis.

In Indian Ayurvedic medicine, lifestyle is an integral part of treatment. Specific exercises may be prescribed for individual patients, based on their condition and body type.

The research is clear on two points: that oxygen deficiency leads to decreased immune function and that moderate amounts of mild exercise can increase immune function. Self-healing, self regulation, and self-repair tend to be stimulated and maximized through simple and meditative exercise movement and breathing. Some of these benefits include:

• Increased oxygen. In essence, these practices provide a kind of tune-up to your metabolism. But unlike vigorous exercise, Qigong and yoga actually conserve and generate energy. (Vigorous exercise has its benefits, but for anyone coping with illness, conserving energy is a useful feature.)

• Clearing the body of toxins. The body is protected by the lymphatic system. You've probably noticed the swollen lymph glands in your neck when you have a sore throat. Lymph is a colorless fluid that washes through your system, carrying pollutants, internal toxins, and germs with it. In Qigong, for example, the rhythmic movements, deep breathing, and postures circulate the lymph, enhancing your immune function.

Deepening the breath is the signal that stimulates the lymph system. The second factor that stimulates lymph circulation is movement -- the act of contracting and releasing your muscles -- but the movement does not need to be vigorous to have a beneficial effect on the system. One of the reasons gentle exercise is so spectacularly effective is that it efficiently activates the lymph system.

• Delivering immune cells to their sites of activity. The lymph is an important vehicle for the transport of both immune forces and artillery: T cells and certain antibodies.

• Shifting out of the adrenaline mode. Research has found that Qigong, for example, tends to promote the "relaxation response". This is a phase in which the body relaxes and rebuilds, shifting from adrenal hormone production during exertion or conflict to a rest-and-repair stage. In this mode, the body can produce the chemical messengers that call forth and activate immune cells. This shift is also important, because the presence of high levels of adrenal hormones in the human body can cancel out some of the activity of the immune cells.

• Stimulation of the neurotransmitters that provide a sense of well-being. The relaxation response is initiated through deep, slow breathing, coupled with relaxation.

Research on the link between oxygen deficiency and disease has been active for several decades. Nobel Prize winner Otto Warburg found that oxygen deficiency was often associated with the development of cancer cells. Studies that evaluated lung volume and oxygen capacity noted a parallel between reduced oxygen and disease, with reduced resistance to illness and increased mortality. In studies of older subjects, immune deficiency was found to be one of the consequences of reduced oxygen metabolism.

Oxygen plays a key role in our immune function. It is the source of the ammunition used by killer and natural killer T cells against viruses and tumors. Oxygen is converted into oxidants like peroxide and bleach (hypochlorite). People who are ill or at risk for disease tend to exercise less, so there's less oxygen available to the body. By increasing the intake of oxygen and improving its circulation, therapeutic exercise such as Qigong and yoga can assist our immune function. Since this happens through gradual movement, focused breathing, and relaxation, these practices can be done by most anyone.

Typically, when we think of exercise, we think of aerobics, running, swimming, tennis -- all vigorous activities intended to increase the supply of oxygen to the body (aerobic exercise means exercise "with oxygen"). We also exercise to build muscles, strengthen our heart, or to lose weight by burning up calories. Yet when those activities become more gradual and less intense, they still provide therapeutic benefits.

In meditative exercise, since the metabolic resources promoted by the exercise are not expended as part of the physical activity, it is possible that it is more therapeutic. Done correctly, Qigong and yoga produce and circulate powerful internal resources for health and healing. In fact, aerobics, swimming, and walking can be modified to become more therapeutic by slowing them down and focusing on the breath. At that point, Western exercise and ancient practice merge. Using this approach, walking can also take on a meditative form; in fact many religions include some type of walking meditation such as labyrinth walks or formal walking meditation.

According to the 1996 U.S. Surgeon General's Report on Exercise and Fitness, mild fitness practices are at least as beneficial as vigorous fitness practices. They may even be better, because there's also less risk of injury. Vigorous exercise reuses much of the energy that is created by the movement. Meditative practices such as yoga and Qigong conserve energy, and whenever healing is the goal, conserving energy is an important consideration.

Get a checkup. It's a good idea to get a checkup before you begin to exercise --especially if you have any special health condition or are over forty. Even then, the truth is that nobody is ever going to know as much about your strengths and limitations as you do. So when you exercise, be mindful and monitor yourself carefully. Any kind of pain is an important message from your body that something may not right, like the red warning light on your dashboard. With all forms of exercise, it's important to pay attention to these messages and not to push yourself too far or too fast. Stay in the comfort zone.

Stay mindful. Some people approach exercising as if it's simply a function of the body and don't factor in the role of the mind. It's not uncommon to see people exercising on the StairMaster while reading the paper or riding an Exercyle while watching television. We encourage a different approach.

Mindfulness can add a meaningful dimension to exercise. With relaxation and mindfulness, exercise accelerates the mind-body interaction. Increased awareness of your body and your health can support the healing process in different ways -- it may provide insight that leads to more healthful behaviors or it may bring to mind important symptoms to share with your health-care practitioner.

Mindfulness is an essential component of yoga, Qigong, and t'ai chi. The importance of mindfulness is now acknowledged throughout the world of sports -- in major league football and basketball teams that use meditation; tennis and golf professionals who play practice the Zen of the game; and Olympic athletes who use visualization. Athletes describe this mindfulness as being "in the zone".

Take it easy. No matter what kind of exercise you've typically been doing or that you feel you should be doing, consider lessening the exertion a little and slowing the process down. Next, engage the breath meaningfully, in a deep, slow, relaxed, rhythmic fashion. Finally, adjust the mind toward a deep state of relaxation. By clearing the mind and refusing to engage in list-making and worrying, you curtail the adrenaline-based aspect of your nervous system activity. This activates a whole array of inner healing factors.

Yoga, Qigong, and walking can be done anytime, anywhere. And each of these practices can be introduced very gradually, paced to your situation. None of these activities require equipment of any kind.