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Physical Activity Review vol. 7, 2019www.physactiv.euDahn Taekwondo Spondylitis Improvement Program (DTSIP)DTSIP is an amalgamated program of standard Western medicine practices and CAM exercisesbased in Oriental medicine practices, yoga, and taekwondo. The subject performed the DTSIP 5 times aweek for 90 minutes for 28 weeks. He conducted the training once a week with the researchers and 4times a week with assistance from family and acquaintances. The training contents for the DTSIP areshown in Table 1 as well as illustrated and explained in Figures 1-5.Table 1. Contents of the DTSIP trainingLevelProgramWarm upexercises(30 min)TimeDanJeon striking300 reps, 5 minSuByeog (Waterfall) Striking100 reps, 3 minJang-u-dong abdominal exerciseMuHanDae (Infinity) TurningOnmom DuDeuliGi (Whole BodyTapping)Shoulder rotationsHip rotationsTarget areaExpected effectsWholebodyRelaxes whole body,increases bodytemperature,prepares for thetraining200 reps, 5 min4 min3 min5 min5 minRelaxes hip,balances the left andLevel IHip inflexions20 minHipright sides of thebodyRelaxes hip andTrainingShoulderShoulder,shoulder joints,Level II20 mininflexionshipincreases blood(50 min)circulationDischarges coldnessand negative energy,Level IIIWagong position5-10 minBottomimproves immunesystemCool down Rolling20 repsRelieves stress,Wholeexerciserelaxes the wholebodyRelaxation pose5 min(10 min)bodyDTSIP: Dahn Taekwondo Spondylitis Improvement Program; DanJeon: the point in the lower abdomen where Kienergy is stored; Ki: internal energyDTSIP training begins with warm-up exercises. As with any exercise program, a warm-upperiod is needed to prepare the body for exercise and to prevent injury. The purposes of DTSIP warmup exercises includes improvement to improve overall mobility and flexibility in the spine as well asthe flow of Ki along the body’s meridians to prepare the subject for more strenuous exercises (Tables4-5). Within the Oriental medical perspective, this study targeted, but did not measure, threemeridians in order to increase Ki flow to: 1) the lungs, colon, stomach, and spleen (first meridian); 2)the heart, small intestine, bladder, and kidneys (second meridian); and 3) the liver (third meridian).Figure 1 shows and explains the DTSIP warm-up exercises used in this study.Figure 2 shows and explains each Level I DTSIP exercise for hip inflexion. The purpose of theseexercises is to improve overall mobility and flexibility in the spine and Ki flow with each exercisetargeting either a particular region or the entire spine. The subject stands in modified taekwondostances used as preparatory positions for punching. In the DTSIP, the stances allow the subject tomaintain balance. In the majority of the DTSIP exercises, positioning the hands on the hips is intendedto allow the subject to maintain balance (e.g., the knee inflexion and small back knee bend exercises)or, when palms and fingers are outstretched, facilitate the flow of Ki [24] (e.g., the side knee inflexionand the four shoulder pushing exercises).222

Physical Activity Review vol. 7, 2019www.physactiv.euDanJeon Striking: Standing with the feet about oneshoulder-width apart, tap the DanJeon with both hands.This exercise intends to warm the body, loosen theshoulders, and improve digestion.Jang-u-dong Abdominal Exercise: Standing with the feetabout one shoulder-width apart, place both hands aroundthe DanJeon and push them forward and backward onlyusing the hips. This exercise intends to stimulate thesmall intestine; activate colon function; relieveconstipation, diarrhea, tension, and abdominal stiffnesscaused by standing; and relax muscles in the lumbarregion.SuByeog (Waterfall) Striking: Standing with the feet about one shoulder-width apartand the knees bent slightly, clap the hands in front and behind the body at chestheight alternatively. This exercise intends to relax the chest and back and improvethe upper body’s exercise capacity.MuHanDae (Infinity) Turning: Standing with the feet about oneshoulder-width apart and the knees bent slightly, face thepalms outward and make large circles with the hands. The hipsmove in a figure-8 fashion, and the feet remain planted. Thehands, arms, shoulders, and hip joints are relaxed, and themovement is natural. This exercise intends to balance the rightand left sides of the body, stimulate the shoulders and hips, andimprove flexibility and joint mobility.Onmom DuDeuliGi (Whole Body Tapping): Standing with the feet about one shoulder-width apart, strike the bodyin accordance with the path of the meridian as shown. This exercise intends to improve blood and Ki circulationto the skin and around the body.Shoulder Rotations: Standing with the feet about one shoulder-widthapart and the knees bent slightly, place the hands on the shoulders androtate the elbows in an inward-to-outward manner. This exercise intendsto relax stiff shoulders and increase overall range of motion in the upperbody.Hip Rotations: Stand upright and lift the knee forward and then rotate itoutward. Ensure the back stays perpendicular to the ground, and thehands are held at the waist. Reverse the motion and alternate sides. Thisexercise intends to improve lower lumbar and hip mobility, strength, andgeneral lower body flexibility.Figure 1. DTDIP warm-up exercises. DTSIP - Dahn Taekwondo Spondylitis Improvement Program; DanJeon: thepoint in the lower abdomen where Ki energy is stored; Ki: internal energy.223

Physical Activity Review vol. 7, 2019www.physactiv.euKnee Inflexion: Stepping one foot forward, place fistson the pelvis and turn the front foot 45 inward.Keeping it straight, push forward with the back leg andspread the hip joints. Ensure the back staysperpendicular to the ground and the fists are held atthe waist with palms upward. Alternate sides. Thisexercise intends to improve hip flexibility and connectthe meridians in the body.Forward Lunges: Step one foot forward, place fists onthe pelvis, and turn the front foot 45 inward. Lowerthe back knee to about 10 cm off the ground whilebending the forward knee. Ensure the back staysperpendicular to the ground and the fists are held atthe waist with palms upward. Alternate sides. Thisexercise intends to improve knee and hip mobility aswell as strengthens the spleen and liver meridians.Side Knee Inflexion: Spread the feet about twoshoulder-widths apart and bend the knees while keepthe feet pointing straightforward (this forms ataekwondo horse-riding stance). Ensure the back staysperpendicular to the ground and the fists are held atthe waist with palms upward. Then, spread push thehands forward with palms outward while curving thepelvis and thoracic area inward. This exercise intendsto elongate the spine as well as facilitate Ki flow.Half-knee Inflexion: Spread the feet about twoshoulder-widths apart and bend the knees while keepthe feet pointing straightforward (this forms ataekwondo horse-riding stance). Ensure the back staysperpendicular to the ground and the fists are held atthe waist with palms upward. Bend one knee to 90 oruntil the other knee is straightened. Alternate sides.This exercise intends to improve knee strength andflexibility.Small Back Knee Bend: Step one foot forward and placeonly the ball of the foot down while bending the backknee (this forms a taekwondo beom sogi or tigerstance). The thighs should be pushed outward,preventing the knees from turning inward. Ensure theback stays perpendicular to the ground and the fists areheld at the waist with palms upward. Alternate sides.This exercise intends to balance the body and activatethe spleen meridian.Back Knee Bend: Step one foot forward and rotate theback foot so the toes point 90 outward (this forms ataekwondo back stance). Ensure the back staysperpendicular to the ground and the fists are held atthe waist with palms upward. Alternate sides. Thisexercise intends to balance the body and stimulate thethree main meridians.Figure 2. Level I (hip inflexion) DTSIP training. DTSIP - Dahn Taekwondo Spondylitis ImprovementProgram; Ki: internal energy – downhill 224

Physical Activity Review vol. 7, 2019www.physactiv.euTwisting Stance: Step forward and point the toes of theforward foot 90 outward, then bend the back kneeuntil it is approximately 10 cm above the ground, whileensuring the back stays perpendicular to the ground.The fists are held at the waist with palms upward.Alternate sides. This exercise intends to improve Kicirculation in all of the meridians, blood circulation inthe lower body, and knee and hip strength andflexibility. Caution is required: the subject may losebalance during this exercise and thus may need anassistant.Standing Knee Bends: Standing upright with the feettogether, raise one knee straight upward. The fists areheld at the waist with palms upward. Alternate sides.This exercise intends to improve balance and overallleg strength. Caution is required: the subject may losebalance during this exercise and thus may need anassistant.Outward Knee Pushing: Sitting on the ground with theknees bent (ideally with the feet flat on the floor), havean assistant straddle the subject’s outstretched legs.The assistant bends their knees to maintain balancewhile the subject pushes the sides of their kneesoutward and exhales. The assistant provides moderateresistance. This exercise intends to improve core, back,and outer knee strength.Inward Knee Pushing: Sitting on the ground withknees bent (ideally with the feet flat on the floor), havean assistant standing inside the subject’s outstretchedlegs. The assistant bends their knees to maintainbalance while the subject pushes the sides of theirknees inward and exhales. The assistant providesmoderate resistance. This exercise intends to improvecore, back, and inner knee strength.Forward Leg Push: Sitting on the ground with legsshoulder-width apart, knees bent (ideally with the feetflat on the floor), and arms hugging the legs, have anassistant kneel on one knee in front and between thelegs. The subject pushes the body forward, while theassistant pushes both shoulders back, providingmoderate resistance. This exercise intends to improveabdominal, back, and neck strength while improvingbalance.Backward Leg Push: Sitting on the ground with legsshoulder-width apart, knees bent (ideally with the feetflat on the floor), and arms hugging the legs, have anassistant kneel on one knee behind the subject. Thesubject pushes the body forward, while the assistantpushes both shoulders forward, providing moderateresistance. This exercise intends to improveabdominal, back, and neck strength while improvingbalance.Figure 2. Level I (hip inflexion) DTSIP training. DTSIP - Dahn Taekwondo Spondylitis ImprovementProgram; Ki: internal energy225

Physical Activity Review vol. 7, 2019www.physactiv.euFigure 3 shows and explains each Level II DTSIP exercise for shoulder inflexion. Level II DTSIPtraining isolates the upper thoracic area and shoulders.Figure 4 illustrates the wagong position, the sole exercise of the third level of the DTSIP. Froma Western medicine perspective, this position allows blood to drain away from the extremities whereit accumulates during exercise. Oriental medicine, on the other hand, believes that the wagong positionimproves the flow of Ki through the subject’s extremities. To aid with the flow of Ki, the subject isinstructed to concentrate on breathing and be conscious of Ki energy flowing through the extremitiesto the DanJeon.Figure 5 shows the DTSIP’s cool-down exercises, which are based on yoga poses and motions.As with any exercise program, a cool-down period is necessary to return the body to normal levels ofoperation, reduce the heartrate and breathing, lower the body temperature slowly, as well as preventblood from gathering in the lower extremities. Within the Oriental medicine paradigm, cooling downreturns the nature flow of Ki in the case it may have accumulated in the particular body part or areaexercised; in the case of DTSIP, this would usually be the spine. Furthermore, ankylosing spondylitiscauses shoulder joint, hip, and neck hardening, making it difficult for Ki to flow from the DanJeon to theextremities. This cool-down period is thus intended to facilitate the free flow of Ki again.Outward Shoulder Pushing: Standingwith the feet about shoulder-widthapart and the knees bent slightly,straighten the arms forward atshoulder height with palms facinginward. The assistant stands in frontof the subject with their palms on theback of the subject’s hands. Thesubject pushes outward against theassistant’s hands, and the assistant provides moderateresistance. This exercise intends to strengthen theshoulders and upper thoracic area and facilitate Kiflow.Upward Shoulder Pushing: Standingwith the feet about shoulder-widthapart and the knees bent slightly,straighten the arms forward atshoulder height with palms facingdownward. The assistant stands infront of the subject with hands on topof the subject’s forearms. The subjectpushes upward against the assistant’shands, and the assistant provides moderate resistance.This exercise intends to strengthen the shoulders andupper thoracic area and facilitate Ki flow.Inward Shoulder Pushing: Standingwith the feet about shoulder-widthapart and the knees bent slightly,straighten the arms forward atshoulder height with palms facinginward. The assistant stands in frontof the subject with arms outstretchedinside the subject’s arms. The subjectpushes inward against the assistant’shands, and the assistant provides moderate resistance.This exercise intends to strengthen the shoulders andupper thoracic area and facilitate Ki flow.DownwardShoulderPushing:Standing with the feet aboutshoulder-width apart and the kneesbent slightly straighten the armsforward at shoulder height withpalmsfacingdownward.Theassistant stands in front of the subjectwith hands under the subject’sforearms. The subject pushesdownward against the assistant’s hands, and theassistant provides moderate resistance. This exerciseintends to strengthen the shoulders and upperthoracic area and facilitate Ki flow.Figure 3: Level II (shoulder inflexion) DTSIP training. DTSIP - Dahn Taekwondo SpondylitisImprovement Program; Ki: internal energy226

Physical Activity Review vol. 7, 2019www.physactiv.euWagong Position: Laying on the back with arms outstretched and palms facingupward, bend the knees and ankles at right angles. The legs should be 5-7 cmpart. This exercise intends to drain blood away from the extremities and improveKi flow.Figure 4: Level III (Wagong position) DTSIP training. DTSIP - Dahn Taekwondo SpondylitisImprovement ProgramRolling: Sit down, pull theknees to the chest, hold theknees with both hands,and tuck the chin forward.Then, roll back andforward along the spine.Next, when on the back,roll side to side. Take onebreath for each roll, inhaling when rolling in onedirection and exhaling when rolling in the oppositedirection. This motion intends to stimulate the entirespine as well as improve digestive functions.Relaxation Pose:Laying down, spreadthe arms at 45 fromthe body with palmsand outstretch the legs,allowing the feet torotate outward. Thesubject should examinethe entire body mindfully, starting from the top of thehead and going down to the tips of the toes. Breathingshould be slow and relaxed, and the head should feelcool and the body and extremities warm. This postureintends to allow the subject to normalize their mindand body for regular daily activities.Figure 5: DTSIP cool-down exercises. DTSIP - Dahn Taekwondo Spondylitis Improvement ProgramMeasurements and blood samplingThe subject’s height and weight were measured pre- and post-test of the DTSIP program. Creactive protein (CRP), erythrocyte sedimentation rate (ESR), platelet, white blood cells (WBC), andleukocyte levels were determined. The subject’s spinal and joint ranges of motion were also measured.Body Mass Index (BMI)The height and weight of the subject were measured. From those variables, the subject’s bodymass index (BMI) was calculated.Range of motion of spine and jointsBASMI is an established method consisting of five measurements that verify the range of spinemovement in patients with ankylosing spondylitis [34]. From these measurements, clinical changes inspinal movement are ascertained. A modified BASMI was used for this study.The subject’s tragus to wall (TWD) distance was first determined in accordance with standardBASMI methodology. TWD is an indicator for the development of flexion deformation of the spine andproper posture. The subject stood with his back and heels touching a wall, feet hip-distance apart, andchin tucked to his chest. A standard tape measure was used to determine the distance from the wall tohis tragus in cm. The measurements were then recorded.Second, the lumbar side flexion (LSF) measurement was taken in accordance with standardBASMI methodology. LSF is an index to assess the severity of a subject’s chest and lumbar spineimmobility. The subject stood against a wall with his back and heels touching it, feet hip-distance apart,and arms and fingers straight down his sides. The distance from the tip of his middle fingers to theground was determined with the tape measure perpendicular from the ground to their fingers. Then,he bent as far as possible to each side while maintaining flush contact to the wall with his back and hismiddle finger down the side of his leg. The distance from his middle finger to the ground was takenagain, and the difference of the two measurements was recorded. The measurements were thenrecorded.Third, the modified Schober’s test, sometimes called the lumbar flexion (LF) test, wasconducted to measure the curve of the subject’s waist in accordance with standard BASMI227

Physical Activity Review vol. 7, 2019www.physactiv.eumethodology. The subject stood upright with feet about hip-distance apart. Three successive markswere placed along the subject’s spine: 1) on the posterior superior iliac spine (PSIS) line, 2) 5 cmbelow the PSIS line mark, and 3) 10 cm above the PSIS line mark. The top- and bottommost markswere then 15 cm apart. The subject then bent forward as far as possible t

Dahn Taekwondo is a holistic practice advocated by Dahn Yoga & Health Centers (now called Body & Brain) that combines aspects of traditional Taekwondo and Dahn Yoga practices. Dahn Taekwondo practice is purported to have similar physical and spiritual benefits as those found in yoga