Improve Balance in the Elderly with Traditional Tai Chi or Augmented Reality-Assisted Tai-Chi

Improve Balance in the Elderly with Traditional Tai Chi or Augmented Reality-Assisted Tai-Chi


By John M. de Castro, Ph.D.


Tai chi is an ancient Chinese exercise that can help older adults improve their balance and lower their fall risk.” – Harvard Health


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, whether augmented reality can improve the effectiveness of Tai Chi training in improving balance.


In today’s Research News article “Augmented reality-assisted training with selected Tai-Chi movements improves balance control and increases lower limb muscle strength in older adults: A prospective randomized trial.” (See summary below or view the full text of the study at: Chen and colleagues recruited healthy elderly over 65 years of age and randomly assigned them to an 8-week training in either traditional 24 movement Yang Tai Chi or to an Augmented form of Tai Chi. Augmented Tai Chi involved a computerized monitoring of movements and video feedback on the movements and only 8 of the 24 Yang style movements were included. They were measured before and after training for balance, functional reach, timed up-and-go, and lower extremity muscle strength.


They found that both Tai Chi groups had significant improvements in dynamic balance and lower extremity muscle strength. While only static balance was significantly improved in the traditional Tai Chi group, both static and dynamic balance and mobility (timed up-and-go) were significantly improved in the simplified augmented Tai Chi group. The augmented Tai Chi group improved more in all measures that the traditional Tai Chi group, but the differences were not statistically significant.


The results demonstrate that Tai Chi training is effective in improving balance and leg muscle strength in the elderly. This is important to prevent falls. There was evidence that practicing a simplified program with computerized augmentation may produce superior results, but a larger study is needed to have the statistical power to determine if this is in fact a reliable difference. It will also be important to determine if the simplification of the movements (8 rather than 24) or the augmentation, or both are responsible for better performance.


One drawback of the augmented program is that it requires practice in the lab. A strength of traditional Tai Chi practice is that it can be practiced without professional supervision and in groups making it inexpensive to deliver and fun to engage in. So, although the augmented program may produce superior results, there are still considerable advantages to traditional Tai Chi for improving the health and well-being of the elderly..


So, improve balance in the elderly with traditional Tai Chi or augmented reality-assisted Tai-Chi.


When you’re practicing the movements, you’re shifting your weight from one foot to the other to maintain balance. By doing (tai chi), you become more aware of the position of your body in space — which is something we become less aware of as we age.” – Michael Irwin


CMCS – Center for Mindfulness and Contemplative Studies


This and other Contemplative Studies posts are also available on Google+ and on Twitter @MindfulResearch


Study Summary


Chen, P. J., Penn, I. W., Wei, S. H., Chuang, L. R., & Sung, W. H. (2020). Augmented reality-assisted training with selected Tai-Chi movements improves balance control and increases lower limb muscle strength in older adults: A prospective randomized trial. Journal of exercise science and fitness, 18(3), 142–147.




Tai-Chi benefits older adults by enhancing balance control and increasing the muscle strength of the lower limbs. However, a complete set of traditional Tai-Chi exercises is sometimes too difficult for beginners. We investigated whether practicing augmented reality-assisted training with selected Tai-Chi movements tailored to the practitioner’s ability (selected Tai-Chi, or sTC) is as effective as performing a complete set of Tai-Chi sequences (complete traditional Tai-Chi, or tTC).


In this prospective randomized trial carried out in the Beitou District of Taipei City, Taiwan, community-dwelling adults aged ≥65 and without any debilitating diseases (n = 28) were included. Participants were randomly assigned to the sTC group (n = 14) or the tTC group (n = 14). Participants in the sTC group practiced selected Tai-Chi movements using the augmented reality Tai-Chi training system. Participants of the tTC group were asked to complete the 24-form Yang-style Tai-Chi following the instructions of Tai-Chi masters. Each training session lasted 30 min, with 3 sessions per week for 8 weeks. Pre- and post-intervention evaluations included functional balance tests, comprising the Berg Balance Scale (BBS), Timed Up and Go test (TUG), and Functional Reach Test (FRT), as well as muscle strength measurements of the lower extremities.


Pre-intervention evaluations showed significant differences in FRT (p = 0.034) and left hip abductor muscle strength (p = 0.046) between the sTC and tTC groups. After 8 weeks of training, the BBS, TUG, and FRT scores in the sTC group showed significant improvement overall. Although all three functional balance test scores improved in the tTC group, only the improvement in BBS was statistically significant (p = 0.001). After 8 weeks, all muscle strength measurements increased by an average of 3.1 ± 1.0 kgw in the sTC group and 1.6 ± 0.8 kgw in the tTC group.


The augmented reality-assisted training with selected Tai-Chi movements, designed based on objective measurements of the practitioner’s capability, improved balance control and muscle strength of lower limbs at least as effectively as the complete sequence of traditional Tai-Chi exercises.


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