Reduce Falls in the Elderly with Exercise and Tai Chi

Reduce Falls in the Elderly with Exercise and Tai Chi

 

By John M. de Castro, Ph.D.

 

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. A great bonus, at the same time, tai chi also improves almost all aspects of health!” – 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, how effective  Tai Chi training is in preventing falls relative to other exercises. The evidence is accumulating. So, it is important to review and summarize what has been learned.

 

In today’s Research News article “Exercise for preventing falls in older people living in the community.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360922/), Sherrington and colleagues review, summarize, and perform a meta-analysis of the relative effectiveness of various exercises, including Tai Chi in improving balance and reducing falls in the elderly. They identified 108 randomized controlled trials including a total of 23,407 participants averaging 77 years of age employing any form of exercise and measuring falls before and after treatment.

 

They report that the published research found that all forms of exercise combined significantly reduced falls by 23% and reduced the number of people experiencing falls by 15% with larger effects when the program was delivered by a health care professional. With respect to specific forms of exercise they found that balance and functional exercises significantly reduced falls by 24% and reduced the number of people experiencing falls by 13% while Tai Chi significantly reduced falls by 19% and reduced the number of people experiencing falls by 20%. There were too few studies with mixed resultsmof other forms of exercise such as walking, dance, strength exercises to evaluate their effectiveness.

 

These findings support the use of exercise to reduce falls in the elderly including the use of Tai Chi. Some advantages of Tai Chi include the facts that it is not strenuous, involves slow gentle movements, and is safe, having no appreciable side effects, it is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion. It can also be practiced without professional supervision and in groups making it inexpensive to deliver and fun to engage in. This makes Tai Chi practice an excellent means to reduce falls in elderly individuals.

 

So, reduce falls in the elderly with exercise and Tai Chi.

 

based on current available evidence, suggest that Tai Chi exercise is an effective intervention to prevent the risk of falls among older adults.” – Yu-Ning Hu

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. The Cochrane database of systematic reviews, 1(1), CD012424. https://doi.org/10.1002/14651858.CD012424.pub2

 

Abstract

Background

At least one‐third of community‐dwelling people over 65 years of age fall each year. Exercises that target balance, gait and muscle strength have been found to prevent falls in these people. An up‐to‐date synthesis of the evidence is important given the major long‐term consequences associated with falls and fall‐related injuries

Objectives

To assess the effects (benefits and harms) of exercise interventions for preventing falls in older people living in the community.

Search methods

We searched CENTRAL, MEDLINE, Embase, three other databases and two trial registers up to 2 May 2018, together with reference checking and contact with study authors to identify additional studies.

Selection criteria

We included randomised controlled trials (RCTs) evaluating the effects of any form of exercise as a single intervention on falls in people aged 60+ years living in the community. We excluded trials focused on particular conditions, such as stroke.

Data collection and analysis

We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls.

Main results

We included 108 RCTs with 23,407 participants living in the community in 25 countries. There were nine cluster‐RCTs. On average, participants were 76 years old and 77% were women. Most trials had unclear or high risk of bias for one or more items. Results from four trials focusing on people who had been recently discharged from hospital and from comparisons of different exercises are not described here.

Exercise (all types) versus control

Eighty‐one trials (19,684 participants) compared exercise (all types) with control intervention (one not thought to reduce falls). Exercise reduces the rate of falls by 23% (rate ratio (RaR) 0.77, 95% confidence interval (CI) 0.71 to 0.83; 12,981 participants, 59 studies; high‐certainty evidence). Based on an illustrative risk of 850 falls in 1000 people followed over one year (data based on control group risk data from the 59 studies), this equates to 195 (95% CI 144 to 246) fewer falls in the exercise group. Exercise also reduces the number of people experiencing one or more falls by 15% (risk ratio (RR) 0.85, 95% CI 0.81 to 0.89; 13,518 participants, 63 studies; high‐certainty evidence). Based on an illustrative risk of 480 fallers in 1000 people followed over one year (data based on control group risk data from the 63 studies), this equates to 72 (95% CI 52 to 91) fewer fallers in the exercise group. Subgroup analyses showed no evidence of a difference in effect on both falls outcomes according to whether trials selected participants at increased risk of falling or not.

The findings for other outcomes are less certain, reflecting in part the relatively low number of studies and participants. Exercise may reduce the number of people experiencing one or more fall‐related fractures (RR 0.73, 95% CI 0.56 to 0.95; 4047 participants, 10 studies; low‐certainty evidence) and the number of people experiencing one or more falls requiring medical attention (RR 0.61, 95% CI 0.47 to 0.79; 1019 participants, 5 studies; low‐certainty evidence). The effect of exercise on the number of people who experience one or more falls requiring hospital admission is unclear (RR 0.78, 95% CI 0.51 to 1.18; 1705 participants, 2 studies, very low‐certainty evidence). Exercise may make little important difference to health‐related quality of life: conversion of the pooled result (standardised mean difference (SMD) ‐0.03, 95% CI ‐0.10 to 0.04; 3172 participants, 15 studies; low‐certainty evidence) to the EQ‐5D and SF‐36 scores showed the respective 95% CIs were much smaller than minimally important differences for both scales.

Adverse events were reported to some degree in 27 trials (6019 participants) but were monitored closely in both exercise and control groups in only one trial. Fourteen trials reported no adverse events. Aside from two serious adverse events (one pelvic stress fracture and one inguinal hernia surgery) reported in one trial, the remainder were non‐serious adverse events, primarily of a musculoskeletal nature. There was a median of three events (range 1 to 26) in the exercise groups.

Different exercise types versus control

Different forms of exercise had different impacts on falls (test for subgroup differences, rate of falls: P = 0.004, I² = 71%). Compared with control, balance and functional exercises reduce the rate of falls by 24% (RaR 0.76, 95% CI 0.70 to 0.81; 7920 participants, 39 studies; high‐certainty evidence) and the number of people experiencing one or more falls by 13% (RR 0.87, 95% CI 0.82 to 0.91; 8288 participants, 37 studies; high‐certainty evidence). Multiple types of exercise (most commonly balance and functional exercises plus resistance exercises) probably reduce the rate of falls by 34% (RaR 0.66, 95% CI 0.50 to 0.88; 1374 participants, 11 studies; moderate‐certainty evidence) and the number of people experiencing one or more falls by 22% (RR 0.78, 95% CI 0.64 to 0.96; 1623 participants, 17 studies; moderate‐certainty evidence). Tai Chi may reduce the rate of falls by 19% (RaR 0.81, 95% CI 0.67 to 0.99; 2655 participants, 7 studies; low‐certainty evidence) as well as reducing the number of people who experience falls by 20% (RR 0.80, 95% CI 0.70 to 0.91; 2677 participants, 8 studies; high‐certainty evidence). We are uncertain of the effects of programmes that are primarily resistance training, or dance or walking programmes on the rate of falls and the number of people who experience falls. No trials compared flexibility or endurance exercise versus control.

Authors’ conclusions

Exercise programmes reduce the rate of falls and the number of people experiencing falls in older people living in the community (high‐certainty evidence). The effects of such exercise programmes are uncertain for other non‐falls outcomes. Where reported, adverse events were predominantly non‐serious.

Exercise programmes that reduce falls primarily involve balance and functional exercises, while programmes that probably reduce falls include multiple exercise categories (typically balance and functional exercises plus resistance exercises). Tai Chi may also prevent falls but we are uncertain of the effect of resistance exercise (without balance and functional exercises), dance, or walking on the rate of falls.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360922/

 

Improve Quality of Life and Reduce Falls in Dementia Patients with Tai Chi

Improve Quality of Life and Reduce Falls in Dementia Patients with Tai Chi

 

By John M. de Castro, Ph.D.

 

“The number of people living with Alzheimer’s disease and other dementia-related conditions is exploding in the United States. But while scientists struggle to find a new medical treatment, tai chi, the ancient Chinese martial art, has emerged as a potentially potent way to help stem the tide.” – David-Dorian Ross

 

Dementia is a progressive loss of mental function produced by degenerative diseases of the brain. These are progressive disorders with no cures. Alzheimer’s disease is the most common form of dementia. It is estimated that 5 million Americans have Alzheimer’s disease. It involves an irreversible progressive loss of mental function associated with brain degeneration. The early stages are typified by memory loss but as the disease progresses patients can lose the ability to carry on a conversation or carry on normal life functions, and eventually leads to death.

 

Mindfulness training has been found to help protect aging individuals from physical and cognitive declines. Tai Chi has been practiced for thousands of years with benefits for health and longevityTai Chi training is designed to enhance function and regulate the activities of the body through regulated breathing, mindful concentration, and gentle movements. Tai Chi practice has been found to be effective for an array of physical and psychological issues. Tai Chi has been shown to help the elderly improve attentionbalance, reducing fallsarthritiscognitive functionmemory, and reduce age related deterioration of the brain. So, it makes sense to investigate the effects of Tai Chi practice in patients with dementia.

 

In today’s Research News article “Randomised Controlled Trial Of The Effect Of Tai Chi On Postural Balance Of People With Dementia.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875562/),Nyman and colleagues recruited community dwelling elderly (aged 78 to 97 years) adults with dementia and randomly assigned them to either usual care or usual care plus 20 weeks of once a week for 90 minutes Tai Chi practice and home practice. They were measured before and after training for dynamic balance, functional balance, falls, fall efficacy, fear of falls, quality of life, and cognitive function.

 

They found that in comparison to baseline and the usual care group, the Tai Chi group had a significantly greater quality of life and significantly fewer falls (44% fewer) during the 6-month follow-up period. There were no serious adverse events due to Tai Chi practice recorded.

 

Since Tai Chi is practiced in groups, the fact that it produced an increase in quality of life may have been due to the enhanced social contacts occurring in the course of practice. This can have quite an impact as community dwelling elderly, and particularly those with dementia, are often isolated from social contacts. The reduced falls has been previous documented in the elderly. The present study, though, documents this in dementia patients. This is very important as falls in the elderly are particularly dangerous and can be major contributors to mortality.

 

Tai Chi is not strenuous, involving slow gentle movements, and is safe, having no appreciable side effects, it is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion. It can also be practiced without professional supervision and in groups making it inexpensive to deliver and fun to engage in. This makes Tai Chi practice an excellent means to improve the quality of life and prevent falls in elderly dementia patients.

 

So, improve quality of life and reduce falls in dementia patients with Tai Chi.

 

Researchers have shown that regular practice of Tai Chi increases brain volume, augments memory and thinking skills, and may combat dementia.” – Explore

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Samuel R Nyman, Wendy Ingram, Jeanette Sanders, Peter W Thomas, Sarah Thomas, Michael Vassallo, James Raftery, Iram Bibi, Yolanda Barrado-Martín. Randomised Controlled Trial Of The Effect Of Tai Chi On Postural Balance Of People With Dementia. Clin Interv Aging. 2019; 14: 2017–2029. Published online 2019 Nov 19. doi: 10.2147/CIA.S228931

 

Abstract

Purpose

To investigate the effect of Tai Chi exercise on postural balance among people with dementia (PWD) and the feasibility of a definitive trial on falls prevention.

Patients and methods

Dyads, comprising community-dwelling PWD and their informal carer (N=85), were randomised to usual care (n=43) or usual care plus weekly Tai Chi classes and home practice for 20 weeks (n=42). The primary outcome was the timed up and go test. All outcomes for PWD and their carers were assessed six months post-baseline, except for falls, which were collected prospectively over the six-month follow-up period.

Results

For PWD, there was no significant difference at follow-up on the timed up and go test (mean difference [MD] = 0.82, 95% confidence interval [CI] = −2.17, 3.81). At follow-up, PWD in the Tai Chi group had significantly higher quality of life (MD = 0.051, 95% CI = 0.002, 0.100, standardised effect size [ES] = 0.51) and a significantly lower rate of falls (rate ratio = 0.35, 95% CI =0.15, 0.81), which was no longer significant when an outlier was removed. Carers in the Tai Chi group at follow-up were significantly worse on the timed up and go test (MD = 1.83, 95% CI = 0.12, 3.53, ES = 0.61). The remaining secondary outcomes were not significant. No serious adverse events were related to participation in Tai Chi.

Conclusion

With refinement, this Tai Chi intervention has potential to reduce the incidence of falls and improve quality of life among community-dwelling PWD

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875562/

 

Reduce Pain and Falls and Improve Mobility in the Elderly with Tai Chi

Reduce Pain and Falls and Improve Mobility in the Elderly with Tai Chi

 

By John M. de Castro, Ph.D.

 

“Solid research shows that tai chi can benefit people with osteoarthritis, rheumatoid arthritis, fibromyalgia, tension headache, and other ongoing, painful conditions.” – 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. The elderly also frequently suffer from chronic pain.

 

Pain involves both physical and psychological issues. Physically, exercise can be helpful in strengthening the body to prevent or relieve pain. Psychologically, the stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. Indeed, mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back painTai Chi, Qigong, and yoga  are all exercises and mindfulness practices that have been found to be effective for pain.

 

In today’s Research News article “Tai Chi for older adults with chronic multisite pain: a randomized controlled pilot study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6126990/), You and colleagues examine the ability of Tai Chi practice to reduce chronic pain in the elderly. They recruited elderly (>65 years of age) with multisite (2 or more) musculoskeletal pain who either had 1 or more falls in the last year or used a cane or walker. They were randomly assigned to receive 12 weeks, 2 hours, twice a week of either Tai Chi or light physical exercise. They were measured before and after training for acceptability of the exercises, chronic health conditions, pain, attention, executive function, physical function, gait, falls, and fear of falling. 83% of the elderly completed the study.

 

They found that in comparison to baseline the elderly who engaged in Tai Chi had significantly lower pain and pain interference with activities, improvements in gait, including stride and swing time, and decreased gait asymmetry, and decreased fear of falling, and fewer falls over the subsequent 9 months, while the light exercise group did not.

 

These are encouraging pilot results that are similar to other findings with Tai Chi with other types of patients. Unfortunately, because this was a small pilot study there were no statistically significant differences between the Tai Chi group and the light exercise group even though the Tai Chi groups was significantly improved relative to baseline whereas the light exercise group was not. But these results provide justification for performing a future large scale randomized controlled trial.

 

It’s important to note that Tai Chi is a gentle and safe mindfulness practice. It is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion. It 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, reduce pain and falls and improve mobility in the elderly with Tai Chi.

 

“Improved flexibility will reduce stiffness and help keep joints mobile. Stiffness causes pain; increase flexibility will relieve pain.  Tai Chi for Arthritis gently moves all joints, muscles and tendons throughout the body.” – Paul Lam

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

You, T., Ogawa, E. F., Thapa, S., Cai, Y., Zhang, H., Nagae, S., … Leveille, S. G. (2018). Tai Chi for older adults with chronic multisite pain: a randomized controlled pilot study. Aging clinical and experimental research, 30(11), 1335–1343. doi:10.1007/s40520-018-0922-0

 

Abstract

Background

Chronic pain is associated with poorer cognition and mobility, and fall risk in older adults.

Aims

To investigate the feasibility of a randomized trial of mind-body exercise (Tai Chi) versus light physical exercise in older adults with multisite pain.

Methods

Adults aged ≥ 65y with multisite pain who reported falling in the past year or current use of an assistive device were recruited from Boston area communities. Participants were randomized to either a Tai Chi or a light physical exercise program, offered twice weekly for 12 weeks. The primary outcomes were feasibility and acceptability. Secondary outcomes included pain characteristics, cognition, physical function, gait mobility, fear of falling, and fall frequency.

Results

Of 176 adults screened, 85 were eligible, and 54 consented and enrolled (average age 75±8y; 96.30% white; 75.93% female). The dropout rate was 18% for Tai Chi and 12% for light physical exercise. For those completing the study, exercise class attendance was 76% for Tai Chi and 82% for light physical exercise. There were no significant group differences in most secondary outcomes. Tai Chi significantly lowered pain severity (4.58±1.73 to 3.73±1.79, p<0.01) and pain interference (4.20±2.53 to 3.16±2.28, p<0.05), reduced fear of falling (90.82±9.59 to 96.84±10.67, p<0.05), and improved several single-task and dual-task gait variables, while light physical exercise did not change these measures

Discussion and Conclusions

This study demonstrated the feasibility and acceptability of conducting a larger randomized controlled trial in older adults with multisite pain. Study findings and challenges encountered will inform future research.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6126990/

 

Tai Chi Practice is a Cost-Effective Treatment to Reduce Falls in Older Adults

Tai Chi Practice is a Cost-Effective Treatment to Reduce Falls in Older Adults

 

By John M. de Castro, Ph.D.

 

“Across multiple studies, Tai chi appears to reduce risk of falling by 20 to 45 percent and is considered one of the best exercises available for ambulatory older adults with balance concerns.” – Peter Wayne

 

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 more or less cost-effective than other exercises for reducing falls in the elderly.

 

In today’s Research News article “Cost-Effectiveness of a Therapeutic Tai Ji Quan Fall Prevention Intervention for Older Adults at High Risk of Falling.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6696718/), Li and colleagues recruited community-based elderly individuals (over 70 years of age) who had experienced at least one fall in the last year and randomly assigned them to one of three conditions; Tai Chi practice, multimodal (mixed) exercises, or stretching. The exercises occurred in twice weekly, 60-minute sessions, for 24 weeks. They were measured before and after training for falls, health related quality of life, health index, quality-adjusted life-years (QALYs), and health-related service utilization expenses.

 

They found that Tai Chi practice resulted in significantly greater reduction in falls and increase in quality-adjusted life-years (QALYs) than either the multimodal or stretching exercises. The costs of implementing the 3 programs were equivalent. The total health-related utilization cost was $1,958 per participant for Tai Chi, compared with $2,583 for multimodal and $2,131 for stretching. Tai Chi produced greater reductions in falls at a lower cost and resulted in lower health care costs results in in incremental costs of $850 per additional fall prevented and $27,614 per additional QALY gained.

 

These results suggest that Tai Chi practice is a safe, effective, and cost-effective means of reducing falls in the elderly. Falls when they occur in the elderly can be quite devastating and can produce major injuries that can even lead to death. So, their prevention is very important not just for reducing health care costs but for the longevity and quality of life of the individual.

 

So, Tai Chi practice is a cost-effective treatment to reduce falls in older adults.

 

Falling in adults age 65 and older is significantly associated with loss of independence, premature mortality and big health care costs.” – Peter Harmer

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Li, F., Harmer, P., Eckstrom, E., Fitzgerald, K., Akers, L., Chou, L. S., … Winters-Stone, K. (2019). Cost-Effectiveness of a Therapeutic Tai Ji Quan Fall Prevention Intervention for Older Adults at High Risk of Falling. The journals of gerontology. Series A, Biological sciences and medical sciences, 74(9), 1504–1510. doi:10.1093/gerona/glz008

 

Abstract

Background

Data on the cost-effectiveness of proven fall prevention exercise interventions are limited. We aimed to establish the cost-effectiveness of Tai Ji Quan: Moving for Better Balance (TJQMBB) compared with a conventional exercise intervention for older adults at high risk of falling.

Methods

We conducted a trial-based cost-effectiveness analysis involving 670 older adults who had a history of falling or impaired mobility. Participants received one of three interventions—TJQMBB, multimodal exercise, or stretching exercise (control)—each of which was implemented twice weekly for 24 weeks. The primary cost-effectiveness measure was the incremental cost per additional fall prevented, comparing TJQMBB and multimodal exercise to Stretching and TJQMBB to multimodal exercise, with a secondary measure of incremental cost per additional quality-adjusted life-year (QALY) gained. The intervention was conducted between February 2015 and January 2018, and cost-effectiveness was estimated from a health care system perspective over a 6-month time horizon.

Results

The total cost to deliver the TJQMBB intervention was $202,949 (an average of $906 per participant); for multimodal exercise, it was $223,849 ($1,004 per participant); and for Stretching, it was $210,468 ($903 per participant). Incremental cost-effectiveness ratios showed that the multimodal exercise was cost-effective ($850 per additional fall prevented; $27,614 per additional QALY gained) relative to Stretching; however, TJQMBB was the most economically dominant strategy (ie, having lower cost and being clinically more efficacious) compared with multimodal and stretching exercises with regard to cost per additional fall prevented and per additional QALY gained. TJQMBB had a 100% probability of being cost-effective, relative to Stretching, at a threshold of $500 per each additional fall prevented and $10,000 per additional QALY gained. Sensitivity analyses showed the robustness of the results when extreme cases, medical costs only, and missing data were considered.

Conclusions

Among community-dwelling older adults at high risk for falls, TJQMBB is a cost-effective means of reducing falls compared with conventional exercise approaches.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6696718/

 

Reduce Injurious Falls in the Elderly with Tai Chi

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

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

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

 

Improve Balance and Mobility and Prevent Falls in Parkinson’s Disease Patients with Tai Chi

Improve Balance and Mobility and Prevent Falls in Parkinson’s Disease Patients with Tai Chi

 

By John M. de Castro, Ph.D.

 

“There is still so much to learn from research about exactly how exercise improves the physical and mental well-being of people with living with Parkinson’s disease, as well as which combinations or activities yield the best outcomes, but there is no doubt whatsoever that exercise remains one of the best therapies for preserving and enhancing quality of life.” – Davis Phinney

 

Parkinson’s Disease (PD) is an incurable progressive degenerative disease of the central nervous system. The condition is caused by the death of nerve cells in the brain that produce the neurotransmitter dopamine. There are around seven million people worldwide and one million people in the U.S. living with PD and about 60,000 people are diagnosed with PD every year. PD is associated with aging as the vast majority of patients are diagnosed after age 50. In fact, it has been speculated that everyone would eventually develop PD if they lived long enough.

 

Its physical symptoms include resting tremor, slow movements, muscle rigidity, problems with posture and balance, loss of automatic movements, and slurring of speech. PD itself is not fatal but is often associated with related complications which can reduce life expectancy, such as falls, choking, and cardiovascular problems. Parkinson’s Disease (PD) also has psychological effects, especially cognitive decline, anxiety, and depression. All of these symptoms result in a marked reduction in the quality of life.

 

There are no cures for Parkinson’s Disease or even treatments to slow its progression. There are only treatments that can produce symptomatic relief. So, there is a need to discover new and different treatments. Mindfulness training has been found to improve the psychological symptoms and the quality of life with PD patients.  In addition, Tai Chi practice has been shown to improve the symptoms of Parkinson’s Disease. Hence, Tai Chi  may be an excellent treatment for the symptoms of Parkinson’s Disease.

 

In today’s Research News article “Effects of Tai Chi Exercise on Reducing Falls and Improving Balance Performance in Parkinson’s Disease: A Meta-Analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6409066/), Liu and colleagues review, summarize, and perform a meta-analysis on the effectiveness of Tai Chi practice to improve balance and mobility and reduce falls in Parkinson’s Disease (PD) patients. They found and reviewed 5 published randomized controlled trials that compared Tai Chi practice to no intervention, stretching/resistance training, and walking control conditions.

 

They report that the trials found that in comparison to baseline and the control conditions Tai Chi  practice significantly improved balance and functional mobility in the Parkinson’s Disease patients and reduced the number who experienced a fall. This is important as the compromised motor ability of patients with Parkinson’s Disease makes them much more vulnerable to falls and the resultant compromised health. By improving balance and mobility in these patients Tai Chi practice produces enhanced health and well-being.

 

The results of the published research strongly suggests that Tai Chi  practice should be routinely prescribed for patients with Parkinson’s Disease. Tai Chi is a gentle and safe mindfulness practice. It is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion. It 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 practice would appear to be an excellent gentle practice to improve the well-being of patients with Parkinson’s Disease.

 

So, improve balance and mobility and prevent falls in Parkinson’s Disease patients with Tai Chi.

 

Daily Tai Chi practice is extremely helpful to those with chronic ailments and illnesses like cancer, heart disease, stroke, Parkinson’s, Alzheimer’s, osteoporosis, peripheral neuropathy, respiratory problems and irritable bowel syndrome to name a few,” – Mwezo

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Liu, H. H., Yeh, N. C., Wu, Y. F., Yang, Y. R., Wang, R. Y., & Cheng, F. Y. (2019). Effects of Tai Chi Exercise on Reducing Falls and Improving Balance Performance in Parkinson’s Disease: A Meta-Analysis. Parkinson’s disease, 2019, 9626934. doi:10.1155/2019/9626934

 

Abstract

Introduction

Parkinson’s disease (PD) is a common neurodegenerative disorder that may increase the risk of falls, functional limitation, and balance deficits. Tai Chi was used as an option for improving balance in people with PD. The aim of this meta-analysis was to evaluate the effects of Tai Chi on falls, balance, and functional mobility in individuals with PD.

Method

The literature search was conducted in PubMed, the Cochrane Library, CINAHL, PEDro, Medline, Embase, sportDISCUS, Trip, and the National Digital Library of Theses and Dissertations in Taiwan. Randomized controlled trials (RCTs) analyzing the effects of Tai Chi, compared to no intervention or to other physical training, on falls, functional mobility, and balance in PD patients were selected. The outcome measurements included fall rates, Berg Balance Scale (BBS), Functional Reach (FR) test, and the Timed Up and Go (TUG) test. Two reviewers independently assessed the methodological quality and extracted data from the studies using the PEDro scale.

Results

Five RCTs that included a total of 355 PD patients were included in this review. The quality of evidence in these studies was rated as moderate to high. Compared to no intervention or other physical training, Tai Chi significantly decreased fall rates (odds ratio = 0.47, 95% confidence interval (CI) 0.30 to 0.74, and p=0.001) and significantly improved balance and functional mobility (BBS mean difference (MD) = 3.47, 95% CI 2.11 to 4.80, and p < 0.001; FR MD = 3.55 cm, 95% CI 1.88 to 5.23, and p < 0.001; TUG MD = −1.06 s, 95% CI −1.61 to −0.51, and p < 0.001) in people with PD.

Conclusion

This meta-analysis provides moderate- to high-quality evidence from five RCTs that Tai Chi could be a good physical training strategy for preventing falls and improving balance and functional mobility in people with PD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6409066/

 

Reduce Falls in the Elderly with Tai Chi Practice

Reduce Falls in the Elderly with Tai Chi Practice

 

By John M. de Castro, Ph.D.

 

Seniors who practice tai chi – a Chinese meditation practice that combines deep breathing and slow, fluid movements – may be less likely to fall than their peers who don’t do this type of exercise.” – Lisa Rapaport

 

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 a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling: A Randomized Clinical Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233748/ ), Harmer and colleagues recruited  health elderly individuals, 70 years of age or older, who had fallen at least once in the last year and randomly assigned them to one of three groups, Tai Chi, stretching exercise, or multimodal exercise including aerobic exercise, balance, flexibility, and strength exercises. All groups practiced twice a week for 1 hour for 24 weeks. The participants were measured before, in the middle, at the end of training, and monthly follow-up telephone calls for falls, fall injuries, physical performance, and cognitive function.

 

They found that during the 12 weeks of training and 6-month follow-up period that the group that practiced Tai Chi had significantly fewer falls and fewer falls that caused moderate or serious injuries than the multimodal exercise group which, in turn, had fewer falls and injuries than the stretching group. In addition, at the end of training the participants in the Tai Chi group and the multimodal exercise group had significantly greater improvements in cognitive and physical performance than the stretching group.

 

The results are interesting and important. They suggest that engaging in Tai Chi exercise reduces falls and improves physical and cognitive performance in the elderly and that Tai Chi exercise is superior to multimodal exercise and stretching in reducing falls. This is important because of the comparisons of types of exercise showed a significant superiority for Tai Chi Exercise. They are also important because of the severity of the consequences of falling for longevity, health, and well-being of the elderly. As an additional bonus Tai Chi exercise appears to reduce the cognitive decline that routinely occurs with aging.

 

It is important to recognize that Tai Chi is a gentle and safe exercise that is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion, such as stroke recovery. Also, Tai Chi 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 practice would appear to be an almost ideal gentle exercise to prevent falls in the elderly and improve their physical and cognitive health and well-being.

 

So, reduce falls in the elderly with Tai Chi practice.

 

Balance training based on the Chinese martial arts discipline tai ji quan — better known as tai chi — reduced falling risks among the elderly more than conventional forms of exercise.” – Ashley Lyles

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Li, F., Harmer, P., Fitzgerald, K., Eckstrom, E., Akers, L., Chou, L. S., Pidgeon, D., Voit, J., … Winters-Stone, K. (2018). Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling: A Randomized Clinical Trial. JAMA internal medicine, 178(10), 1301-1310.

 

Key Points

Question

Is a fall prevention–specific tai ji quan intervention clinically more effective in reducing falls among older adults at high risk of falling than a stretching intervention (control) or a standard multimodal exercise intervention?

Findings

In a randomized clinical trial involving 670 adults 70 years or older with a history of falls or impaired mobility, the therapeutic tai ji quan intervention effectively reduced falls by 58% compared with the stretching exercise (control intervention) and by 31% compared with a multimodal exercise intervention.

Meaning

For older adults at high risk of falling, a therapeutically tailored tai ji quan intervention was more effective than stretching or multimodal exercises in reducing the incidence of falls.

Question

Is a fall prevention–specific tai ji quan intervention clinically more effective in reducing falls among older adults at high risk of falling than a stretching intervention (control) or a standard multimodal exercise intervention?

Findings

In a randomized clinical trial involving 670 adults 70 years or older with a history of falls or impaired mobility, the therapeutic tai ji quan intervention effectively reduced falls by 58% compared with the stretching exercise (control intervention) and by 31% compared with a multimodal exercise intervention.

Meaning

For older adults at high risk of falling, a therapeutically tailored tai ji quan intervention was more effective than stretching or multimodal exercises in reducing the incidence of falls.

Question

Is a fall prevention–specific tai ji quan intervention clinically more effective in reducing falls among older adults at high risk of falling than a stretching intervention (control) or a standard multimodal exercise intervention?

Findings

In a randomized clinical trial involving 670 adults 70 years or older with a history of falls or impaired mobility, the therapeutic tai ji quan intervention effectively reduced falls by 58% compared with the stretching exercise (control intervention) and by 31% compared with a multimodal exercise intervention.

Meaning

For older adults at high risk of falling, a therapeutically tailored tai ji quan intervention was more effective than stretching or multimodal exercises in reducing the incidence of falls.

 

Abstract

Importance

Falls in older adults are a serious public health problem associated with irreversible health consequences and responsible for a substantial economic burden on health care systems. However, identifying optimal choices from among evidence-based fall prevention interventions is challenging as few comparative data for effectiveness are available.

Objective

To determine the effectiveness of a therapeutically tailored tai ji quan intervention, Tai Ji Quan: Moving for Better Balance (TJQMBB), developed on the classic concept of tai ji (also known as tai chi), and a multimodal exercise (MME) program relative to stretching exercise in reducing falls among older adults at high risk of falling.

Design, Setting, and Participants

A single-blind, 3-arm, parallel design, randomized clinical trial (February 20, 2015, to January 30, 2018), in 7 urban and suburban cities in Oregon. From 1147 community-dwelling adults 70 years or older screened for eligibility, 670 who had fallen in the preceding year or had impaired mobility consented and were enrolled. All analyses used intention-to-treat assignment.

Interventions

One of 3 exercise interventions: two 60-minute classes weekly for 24 weeks of TJQMBB, entailing modified forms and therapeutic movement exercises; MME, integrating balance, aerobics, strength, and flexibility activities; or stretching exercises.

Main Outcomes and Measures

The primary measure at 6 months was incidence of falls.

Results

Among 670 participants randomized, mean (SD) age was 77.7 (5.6) years, 436 (65%) were women, 617 (92.1%) were white, 31 (4.6%) were African American. During the trial, there were 152 falls (85 individuals) in the TJQMBB group, 218 (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. At 6 months, the incidence rate ratio (IRR) was significantly lower in the TJQMBB (IRR, 0.42; 95% CI, 0.31-0.56; P < .001) and MME groups (IRR, 0.60; 95% CI, 0.45-0.80; P = .001) compared with the stretching group. Falls were reduced by 31% for the TJQMBB group compared with the MME group (IRR, 0.69; 95% CI, 0.52-0.94; P = .01).

Conclusions and Relevance

Among community-dwelling older adults at high risk for falls, a therapeutically tailored tai ji quan balance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233748/Importance

 

Improve Balance in Stroke Victims with Tai Chi Practice

Improve Balance in Stroke Victims with Tai Chi Practice

 

By John M. de Castro, Ph.D.

 

“Stroke can impair balance, heightening the risk of a debilitating fall. But  . . .  stroke survivors can improve their balance by practicing the Chinese martial art of tai chi.” – ScienceDaily

 

Every year, more than 795,000 people in the United States have a stroke and it is the third leading cause of death, killing around 140,000 Americans each year. A stroke results from an interruption of the blood supply to the brain, depriving it of needed oxygen and nutrients. This can result in the death of brain cells and depending on the extent of the damage produce profound loss of function. Even after recovery from stroke patients can experience residual symptoms. Problems with balance and falling are very common.

 

There are a number of risk factors for stroke that are unchangeable, such as family history, age, and genes. But there are a very large number of factors that are under our control including high blood pressure, smoking, high cholesterol, poor diet, sedentariness, and obesity. Given this list it is clear that basic physical fitness and exercise would be excellent for stroke prevention. Yoga practice is an exercise that can be adapted to the needs and limitations of stroke victims. The ancient mindful movement technique Tai Chi and Qigong are very safe forms of gentle exercise that appears to be beneficial for stroke victims including improving balance. It is difficult to get stroke survivors to engage in exercise. Perhaps the practice of Tai Chi , since it is adaptable, very gentle, and fun, might be acceptable and effective in the treatment of stroke survivors.

 

In today’s Research News article “Effect of Tai Chi Exercise on Balance Function of Stroke Patients: A Meta-Analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289026/ ), Wu and colleagues review summarize and perform a meta-analysis of the published research literature on the effectiveness of Tai Chi in improving balance and preventing falls in stroke survivors. They identified 6 randomized controlled trials for inclusion in the analysis.

 

They found that the published research reported that after Tai Chi practice the stroke victims demonstrated significantly better balance and walking ability and fewer falls than stroke victims who performed physical therapy or other exercises. Hence, the published research supports the conclusion that Tai Chi practice is a safe and effective exercise for stroke victims to improve balance and decrease the likelihood of falls.

 

Tai Chi is a gentle and safe exercise that is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion, such as stroke recovery. Also, Tai Chi 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 practice would appear to be an almost ideal gentle exercise to improve motor ability and balance and reduce falls in stroke victims.

 

So, improve balance in strike victims with tai chi practice.

 

Stroke survivors are particularly at risk from falls, with evidence suggesting they suffer up to seven times as many falls per year than healthy adults. Tai Chi, an ancient Chinese martial art, could help prevent falls by improving people’s balance, muscle strength and endurance as well as providing psychological benefits.“ – Ruth Taylor-Piliae

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Wu, S., Chen, J., Wang, S., Jiang, M., Wang, X., & Wen, Y. (2018). Effect of Tai Chi Exercise on Balance Function of Stroke Patients: A Meta-Analysis. Medical science monitor basic research, 24, 210-215. doi:10.12659/MSMBR.911951

 

Abstract

Background

Tai Chi is an ancient form of physical activity that has been shown to improve cardiovascular function, but to date there had been no comprehensive systematic review on the effect of Tai Chi exercise on balance function of patients with stroke. This study evaluated the effect of Tai Chi exercise on balance function in stroke patients.

Material/Methods

PubMed, Cochrane library, and China National Knowledge Information databases and the Wan Fang medical network were searched to collect the articles. The random-effects model was used to assess the effect of Tai Chi exercise on balance function of stroke patients.

Results

Six studies were chosen to perform the meta-analysis according to the inclusion and exclusion criteria. There were significant improvements of balance on Berg Balance Scale score (MD=4.823, 95% CI: 2.138–7.508), the standing balance with fall rates (RR=0.300, 95%CI: 0.120–0.770), functional reach test and dynamic gait index in Tai Chi intervention group compared to the control intervention group. However, the short physical performance battery for balance (SPBB) showed Tai Chi did not significantly improve the ability of balance for stroke patients (MD=0.293, 95%CI: −0.099~0.685).

Conclusions

Tai Chi exercise might have a significant impact in improving balance efficiency by increasing BBS score and reducing fall rate.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289026/

 

Reduce Fear of Falling in the Elderly with Yoga

Reduce Fear of Falling in the Elderly with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga makes you have a strong core, so when moving around in your daily life, you are not just flapping around. You are stable, in control.” – Anne Bachner

 

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. Yoga practice helps to develop strength, flexibility, and balance. It would seem likely, then, that practicing yoga would reduce the likelihood of falling by the elderly.

 

In today’s Research News article “A mixed methods evaluation of yoga as a fall prevention strategy for older people in India.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928579/ ), Keay and colleagues recruited elderly participants (> 60 years of age) and provided them with 2 1-hour yoga classes per week for 3 months. The program emphasized standing poses that develop balance. The participants were measured before and after training for overall health, body size, fear of falling, history of falls, physical performance, and blood pressure. At the end of training the participants also attended focus groups with discussion focused on “perceptions of the yoga program, perceived benefits of yoga and understanding fall injury/reporting falls.”

 

They found that there were no adverse events and no falls reported during the program. After the 3-month yoga program the elderly participants were significantly faster in the sit-stand test, had increased stride length while walking, and significantly lower body weight and fear of falling. Hence, participation in a yoga program improved the physical abilities of the elderly. It should be noted that there wasn’t a control or comparison condition so conclusions should be reached cautiously.

 

The results suggest that practicing yoga is beneficial for elderly men and women. These results are sufficiently encouraging to support conducting a large randomized controlled trial. The participants in the present study were quite healthy at the beginning of the trail, so ceiling effects may have prevented the detection of further benefits. Indeed, the participants all successfully passed the most difficult balance test during the baseline test, leaving no room for improvement, In a future trial, it would be good to include participants whose health and physical abilities weren’t quite as good. Regardless, the results suggest that yoga practice is beneficial for the elderly.

 

So, reduce fear of falling in the elderly with yoga.

 

“the number of falls in older adults declined 48 percent in the six months after they began attending yoga classes compared to the six months prior.” – Breann Schossow

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Keay, L., Praveen, D., Salam, A., Rajasekhar, K. V., Tiedemann, A., Thomas, V., … Ivers, R. Q. (2018). A mixed methods evaluation of yoga as a fall prevention strategy for older people in India. Pilot and Feasibility Studies, 4, 74. http://doi.org/10.1186/s40814-018-0264-x

 

Abstract

Background

Falls are an emerging public health issue in India, with the impact set to rise as the population ages. We sought to evaluate the acceptability, feasibility and likely impact of a yoga-based program aimed at improving balance and mobility for older residents in urban India.

Methods

Fifty local residents aged 60 years and older were recruited from urban Hyderabad, Andhra Pradesh. They were invited to attend a 1-h yoga class, twice weekly for 3 months. Mixed methods were used to evaluate the acceptability and feasibility (qualitative) and likely impact (quantitative). Two focus groups and eight interviews with participants were conducted to evaluate the acceptability and feasibility of a yoga program. Thematic analysis was conducted in context of perceptions, barriers and benefits of yoga participation and fall ascertainment. Physical performance using the Short Physical Performance Battery, fear of falling, blood pressure and weight loss were measured before and after the program.

Results

The interviews and focus groups provided insights into the preferred format for classes, including session times, level of supervision and location. Improvements were seen in the Short Falls Efficacy Scale-International (Short FES-I (15.9 ± 4.0 vs 13.8 ± 2.1 s, p = 0.002)), the number of steps taken in the timed 4-m walk (T4MW (9.0 ± 1.8 vs 8.6 ± 1.8, p = 0.04)), Short FES-I scores (9.4 ± 2.9 vs 8.6 ± 2.9, p = 0.02) and weight (63.8 ± 12.4 vs 62.1 ± 11.6, p = 0.004) were lower. No changes were seen in standing balance, blood pressure or T4MW time.

Conclusion

Yoga was well accepted and resulted in improved ability to rise from a chair, weight loss, increased step length and reduced fear of falling. These results provide impetus for further research evaluating yoga as a fall prevention strategy in India.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928579/

 

Balance and Fitness in the Elderly and Tai Chi Training

Balance and Fitness in the Elderly and Tai Chi Training

 

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. And by reducing their risk of falls, seniors can lower their odds of suffering a debilitating fracture.” – Harvard Health Letter

 

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 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. These studies, however, employ Tai Chi training over long time frames of 6 months to a year. It is not known if shorter term training would also be effective.

 

In today’s Research News article “Effects of 12 Weeks of Tai Chi Chuan Training on Balance and Functional Fitness in Older Japanese Adults.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968980/ ), Takeshima and colleagues recruited older adults averaging 73 years of age and assigned them to either receive 12 weeks of Tai Chi training for 2 days per week for 60 minutes or to a no-treatment control group. They were measured before and after training for static balance, dynamic balance, and functional fitness, including upper and lower body strength, balance and agility, upper and lower body flexibility, and cardiorespiratory fitness.

 

Contrary to longer-term studies, they did not find any significant differences between the Tai Chi training and no-treatment control groups in static balance, dynamic balance, or functional fitness.  This lack of benefit of Tai Chi training may well be due to the relative shortness of the 12-week program relative to previous studies employing 6-month to one year trainings. Indeed, previous research by Holmes and colleagues also employing a 12 week program could not detect any overall improvement in balance, but could detect a subtle improvement in postural-respiratory coupling. This may be a precursor to improvements in overall balance. So, 12-weeks of training may produce subtle changes that, if continued over a longer period of time, will lead to improvements in balance.

 

Tai Chi movement patterns can be fairly complex and the elderly may have difficulty learning them over a few sessions. Indeed, it has been reported that it takes 8 to 16 sessions before the patterns are mastered. So, there may need for longer periods of training to master the technique and benefit from it. Hence, there is a need for further research on the amount of Tai Chi training needed to improve balance and reduce falls in the elderly.

 

“I’ve always been clumsy, so Tai Chi has offered me the opportunity to be able to think more about what I’m doing, pay attention to what I’m doing, and not fall. I’m able to catch myself if I trip over something because of Tai Chi,” – Velma Chapman

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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Study Summary

 

Takeshima, N., Islam, M. M., Kato, Y., Koizumi, D., Narita, M., Kitabayashi, Y., … Rogers, M. E. (2017). Effects of 12 Weeks of Tai Chi Chuan Training on Balance and Functional Fitness in Older Japanese Adults. Sports, 5(2), 32. http://doi.org/10.3390/sports5020032

 

Abstract

The purpose of this study was to determine the effects of Tai Chi Chuan on static and dynamic balance, and functional fitness in older adults. Forty-nine volunteers were divided into an exercise group (EX: 9 men and 16 women, average age 72 ± 5 years) and control group (13 men and 11 women, average age 73 ± 6 years). The EX participated in a 12-week supervised exercise program (60 min/day, 2 days/week) that consisted of 10-min warm-up and stretching, 40-min Tai Chi Chuan exercise (long-form Yang style with 108 movements), and 10-min cool-down/relaxation exercises. The control group was asked to not change their physical activity habits. Static (sway velocity standing on firm or foam surfaces with eyes open or closed) and dynamic balance (limits of stability (LOS)), as well as functional fitness measures of body mass; upper- and lower-body strength; and flexibility, mobility, and aerobic fitness were taken before and after the intervention. After the 12-week Tai Chi Chuan exercise program, there were no improvements in any functional fitness or balance variable although components of LOS tended to increase (13.1%, p = 0.052). These results indicate that 12 weeks of Tai Chi Chuan exercise has no significant effect on balance and functional fitness parameters in older Japanese adults.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968980/