Reduce Injurious Falls in the Elderly with Tai Chi
By John M. de Castro, Ph.D.
“What is fascinating is that the fear of falling often results in more falls; hence, confidence in “not falling” will help to reduce falls. With regular practice, tai chi improves balance by strengthening muscles and co-ordination; at the same time, it strengthens the mind, thereby improving calmness and confidence in not falling. Thus, both physically and mentally, tai chi is an extremely effective exercise for fall prevention.” – Paul Lam
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 discover methods to improve balance and decrease the number of falls 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. Indeed, Tai Chi training has been shown to reduce the frequency of falls in the elderly. It is not known, however, if Tai Chi training is better or worse than other exercises for reducing falls in the elderly.
In today’s Research News article “Effectiveness of Tai Ji Quan vs Multimodal and Stretching Exercise Interventions for Reducing Injurious Falls in Older Adults at High Risk of Falling: Follow-up Analysis of a Randomized Clinical Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484587/), Harmer and colleagues recruited elderly individuals (70 years of age and older) who had impaired mobility and who had experienced falls in the last year. They were randomly assigned to either to twice weekly, 1-hour, sessions, for 24 weeks of Tai Chi practice, multimodal exercise, or stretching exercises. Multimodal exercises consisted of “a mix of aerobic conditioning and strength, balance, and flexibility activities.” They were measured before, after, and 3 and 6 months after the interventions for falls, and the “number of fall-related emergency department visits and hospitalizations.”
They found that at 6 and 12 months, the Tai Chi groups had significantly fewer injurious falls both moderately serious and serious than the stretching group and significantly fewer than the multimodal exercise group at 6 months. The multimodal exercise group also had significantly fewer serious falls than the stretching group at 12 months. At the 12 month point the Tai Chi group had significantly fewer emergency department visits and hospitalizations than the multimodal exercise group and the stretching group. The multimodal exercise group had significantly fewer emergency department visits than the stretching group
The results demonstrate that although multimodal exercise is beneficial for the elderly in reducing injurious falls, practicing Tai Chi was significantly more beneficial; reducing injurious falls, emergency department visits and hospitalizations. Tai Chi is gentle and safe, is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion, is inexpensive to administer, can be performed in groups or alone, at home or in a facility, and can be quickly learned. In addition, it can be practiced in social groups. This can make it fun, improving the likelihood of long-term engagement in the practice. So, Tai Chi practices would appear to be an excellent gentle practice to reduce injurious falls in aging individuals.
“Older adults at high-risk for falls are often physically inactive, thus practical and effective interventions are needed to reduce sedentary time and improve lower-body strength and balance,” – Matthew Smith
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Li, F., Harmer, P., Eckstrom, E., Fitzgerald, K., Chou, L. S., & Liu, Y. (2019). Effectiveness of Tai Ji Quan vs Multimodal and Stretching Exercise Interventions for Reducing Injurious Falls in Older Adults at High Risk of Falling: Follow-up Analysis of a Randomized Clinical Trial. JAMA network open, 2(2), e188280. doi:10.1001/jamanetworkopen.2018.8280
Key Points
Question
Is a therapeutically tailored tai ji quan intervention more effective than stretching exercise or a proven multimodal exercise intervention in decreasing injurious falls among community-dwelling older adults at high risk of falling?
Findings
In this follow-up analysis of a randomized clinical trial that included 670 older adults with a history of falls or impaired mobility, a therapeutic tai ji quan intervention, Tai Ji Quan: Moving for Better Balance, was significantly more effective for lowering the incidence of both moderate injurious falls compared with stretching exercise and serious injurious falls compared with stretching exercise and multimodal exercise.
Meaning
The therapeutically tailored tai ji quan training intervention proved to be more safe and effective than stretching or multimodal exercises in reducing the incidence of injurious falls in older adults at high risk of falling.
Question
Is a therapeutically tailored tai ji quan intervention more effective than stretching exercise or a proven multimodal exercise intervention in decreasing injurious falls among community-dwelling older adults at high risk of falling?
Findings
In this follow-up analysis of a randomized clinical trial that included 670 older adults with a history of falls or impaired mobility, a therapeutic tai ji quan intervention, Tai Ji Quan: Moving for Better Balance, was significantly more effective for lowering the incidence of both moderate injurious falls compared with stretching exercise and serious injurious falls compared with stretching exercise and multimodal exercise.
Meaning
The therapeutically tailored tai ji quan training intervention proved to be more safe and effective than stretching or multimodal exercises in reducing the incidence of injurious falls in older adults at high risk of falling.
Abstract
Importance
Exercise has been shown to reduce injurious falls in older adults. Evidence, however, is lacking regarding the types of intervention that are most effective in preventing injurious falls among older adults at high risk of falling.
Objective
To determine the longer-term effectiveness of therapeutic tai ji quan intervention vs multimodal exercise and stretching exercise in decreasing injurious falls among older adults at high risk of falling.
Design, Setting, and Participants
This trial involves a prespecified analysis with the data analyzed by intent-to-treat. Follow-up analysis of a single-blind randomized trial conducted in community settings of 7 urban and suburban cities in Oregon from February 20, 2015, to September 15, 2018, compared a therapeutic tai ji quan intervention with multimodal exercise and stretching exercise. Eligible participants were community-dwelling adults aged at least 70 years who were considered by a clinician to be at high risk of falling because they had fallen during the preceding year or who had impaired mobility with scores higher than 13.5 seconds on the Timed Up & Go test. Participants were randomized to 1 of the 3 interventions and were assessed monthly after randomization for 12 months, encompassing a 6-month active intervention phase and a 6-month after intervention follow-up phase.
Interventions
The 3 group-based interventions were therapeutic tai ji quan (Tai Ji Quan: Moving for Better Balance [TJQMBB]), multimodal exercise, and stretching exercise, each implemented twice weekly in 60-minute sessions for 24 weeks.
Main Outcomes and Measures
Primary outcomes were the incidence of moderate and serious injurious falls at 12 months, measured as incidence rate ratios (IRRs).
Results
Of the 1147 persons screened, 670 (mean [SD] age, 77.7 [5.6] years; 436 women [65.1%]) were randomly assigned to 1 of 3 intervention groups: 224 persons in TJQMBB, 223 in multimodal exercise, and 223 in stretching exercise. At 12 months, the unadjusted IRR for moderate injurious falls was lower in the TJQMBB (IRR, 0.51; 95% CI, 0.35-0.74; P < .001) and multimodal exercise (IRR, 0.62; 95% CI, 0.42-0.89; P = .01) groups compared with the stretching exercise group. There was no difference between TJQMBB and multimodal exercise groups (IRR, 0.85; 95% CI, 0.58-1.25; P = .42). Both TJQMBB and multimodal exercise significantly reduced serious injurious falls (TJQMBB: IRR, 0.25 [95% CI, 0.13-0.48; P < .001]; multimodal: IRR, 0.56 [95% CI, 0.33-0.94; P = .03]) compared with stretching exercise. Use of TJQMBB was more effective than multimodal exercise (IRR, 0.47; 95% CI, 0.24-0.92; P = .03) in reducing serious injurious falls.
Conclusions and Relevance
For preventing injurious falls, including those that resulted in medical treatment, TJQMBB intervention was found to be superior to multimodal and stretching exercises for older adults at high risk of falling. The findings appear to strengthen the clinical use of TJQMBB as a single exercise intervention to prevent injurious falls in this population.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484587/Importance