By John M. de Castro, Ph.D.
“Tai Chi is a sophisticated form of whole body Neuromuscular/skeletal movement re-education. With good use, the body moves easily – with balance and coordination; both mental and physical. Initially developed as a martial art, it has now become more widely practiced as an exercise for health and well-being. Its use of natural rotational, as well as linear movements, have placed this well above other falls training methods.” – Mark Peters
The process of aging affects every aspect of the physical and cognitive domains. Every system in the body deteriorates including motor function with a decline in strength, flexibility, and balance. Impaired balance is a particular problem as it can lead to falls. In the U.S. one third of people over 65 fall each year and 2.5 million are treated in emergency rooms for injuries produced by falls. About 1% of falls result in deaths making it the leading cause of death due to injury among the elderly. Falls, with or without injury, also carry a heavy quality of life impact. A growing number of older adults fear falling and, as a result, limit their activities and social engagements. This can result in further physical decline, depression, social isolation, and feelings of helplessness. It is obviously important to investigate methods to improve balance and decrease the number of fall in the elderly.
Tai Chi training is designed to enhance and regulate the functional activities of the body through regulated breathing, mindful concentration, and gentle movements. It includes balance training and has been shown to improve balance and coordination. Because it is not strenuous, involving slow gentle movements, and is safe, having no appreciable side effects, it is appropriate for an elderly population. So, it would seem that tai chi practice would be well suited to improving balance and coordination in seniors and thereby reduce the likelihood of falls.
In today’s Research News article “Implementing an Evidence-Based Fall Prevention Program in an Outpatient Clinical Setting.” See:
or below or view the full text of the study at:
Li and colleagues recruited a large group (379) of seniors (> 65 years of age) who were deemed at risk for falls by their primary care physicians. They delivered a tai chi program that was designed to optimize balance for two one-hour sessions per week for 24 weeks. During the 24 weeks of the program 119 participants reported 261 falls. There was a significant reduction in the number of falls over the 6-month course of the program. For the month prior to the training the participants reported 0.5 falls per month while that number fell to 0.13 during the program. By the end of the program the fall rate declined to 0.05 per month.
Hence, they found clear evidence that tai chi practice reduces the incidence of falls in an at-risk population of elderly. These are excellent and important findings. It should be kept in mind, however, that the study did not include a control comparison condition. So, the results could be due to subject expectancy (placebo) effects. But, with this caveat, the results are very encouraging.
The marked reduction in falls suggests that seniors who practice tai chi will be a substantially less risk of injury from falling. This should not only improve health but also relieve a degree of the fear of falling. This should improve the quality of life and reduce consequent psychological problems. Hence, the practice should be of great benefit to the elderly. In addition, the safe and gentle exercise nature of tai chi practice make it well suited to the elderly. It can also be delivered very inexpensively as it can be taught in large groups and after training practiced at home or in a group without an instructor.
So, reduce falls in the elderly with tai chi.
“problems arise as the elderly become increasing frail, their senses and muscles degrade, and their ability to react to a slip is delayed enough that they can’t stop themselves from falling. Understanding the process helps inform the treatments . . . traditional interventions such as exercise and new glasses are effective. The Chinese martial art of tai chi is considered particularly helpful in improving balance and reducing falls.“ – Thurmon Lockhart
CMCS – Center for Mindfulness and Contemplative Studies
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Li, F., Harmer, P., Stock, R., Fitzgerald, K., Stevens, J., Gladieux, M., … Voit, J. (2013). Implementing an Evidence-Based Fall Prevention Program in an Outpatient Clinical Setting. Journal of the American Geriatrics Society, 61(12), 2142–2149. http://doi.org/10.1111/jgs.12509
Objectives: Few evidence-based fall prevention programs have been evaluated for adoption in clinical settings. This study investigated the dissemination potential of a Tai Ji Quan-based program, previously shown efficacious for reducing risk of falls in older adults, through outpatient clinical settings.
Design: A single-group pre-post design in which participants attended a twice weekly Tai Ji Quan training program for 24 weeks.
Setting: Communities in Lane County, Oregon.
Participants: Referral patients (N = 379) aged 65 and older living independently.
Measurements: Using the RE-AIM framework, the primary outcome was the proportion of participating healthcare providers who made referrals. Secondary outcomes were the proportion of referred patients agreeing to participate and enrolling in the program, and measures of program implementation, maintenance, and effectiveness (on measures of falls, balance, gait, physical performance, and balance efficacy).
Results: Of the 252 providers invited to participate, 157 made referrals (62% adoption rate). Of 564 patients referred, 379 (67% reach) enrolled in the program, which was successfully implemented in senior/community centers with good fidelity. Of the total number of participants, 283 completed the program (75% retention) and 212 of these attended ≥75% of the total (48) sessions. Participants reported a reduction in falls with an incidence rate of 0.13 falls per person-month and showed significant improvement from baseline in all outcome measures. A 3-month post-intervention follow-up indicated encouraging levels of program maintenance among providers, patients, and community centers.
Conclusion: A protocol to refer patients at increased risk of falling to a Tai Ji Quan-based program was successfully implemented among healthcare providers. The evidence-based program appears readily scalable and exportable with potential for substantial clinical and public health impact.