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Improving Balance and Preventing Falls with Tai Chi
Len Kraviz, Ph.D.

Study Reviewed:
Li, F., P. Harmer, K. J. Fisher, and E. Mcauley (2004). Tai Chi: Improving functional balance and predicting subsequent falls in older persons. Medicine & Science in Sports & Exercise, 36(12), 2046-2052.

Introduction
As fitness professionals ‘re-tool’ and ‘re-educate’ in preparation for new fitness opportunities and challenges of the 21st Century, helping older persons prevent falls may be a domain many trainers will pursue. The research has clearly shown that exercise is a successful intervention for fall prevention and quality of life improvement in older persons. But it is not clear what type of exercise delivers the most effective fall prevention benefits. The present study by Li and colleagues (2004) addresses two important questions about the efficacy of Tai Chi (or Tai Chi Chaun) exercise in fall prevention of seniors; 1) Does participation in Tai Chi improve balance as a means to decrease fall risk? 2) Will there be lasting functional balance benefits from Tai Chi exercise, when the structured exercise is no longer provided. The health effects of Tai Chi training in the elderly have been previously published by others (see Side Bar 1).

Methods: Subjects
CA group of 256 participants (males = 77; females = 179) originally volunteered for this study (conducted in Portland, Oregon) with 175 subjects completing the entire one-year investigation. Subjects were all physically inactive adults aged 70 to 92 years of age who were randomly assigned to a Tai Chi or stretching group. It is interesting to note that on a 5-point rating scale (poor=1, fair=2, good=3, very good=4, excellent=5), 84% of the subjects initially rated their health as good or better. The stretching group served as the control group. Physical inactivity was defined as no involvement in regular, moderate, or vigorous physical activity for the immediate 3 months prior to the start of the study. All subjects were fully ambulatory and free of any chronic health problems that may have limited their ability to participate in the 6-month exercise program.

Study Design
Both the stretching group and the Tai Chi group participated in a 50-minute exercise session on 3 days per week for 6 months. Following the _ year exercise phase, subjects were tracked and then tested at a 6-month post-exercise follow-up. No structured exercise interventions were offered during the post-intervention follow-up. As well, subjects were neither encouraged nor discouraged to participate in any follow-up exercise programs during the post-intervention follow-up period.

Tai Chi and Stretching (Control) Interventions
The Tai Chi program was taught by certified Tai Chi instructors who followed a 24-FormYang style of Tai Chi. This is a popular, modern and shorter version of the ancient Chinese health exercise. This style emphasizes weight changes in multiple directions, motor coordination and involvement of all of the major segments of the body (trunk, legs, arms), and focus on body alignment. In addition, the students learn movements and postures with breathing integrated into the program. Each session consisted of a 5-10 minute warm-up, 30 minutes of Tai Chi exercises, and a 5-10 minute cool-down. All exercise sessions were completed with musical accompaniment.

The stretching program involved standing and seated stretches for the trunk and lower body, which was synchronized with deep abdominal breathing and relaxation exercises. In selecting a stretching protocol for the control group, the authors rationalized that this type of program provided a low-intensity, low-impact exercise that contained comparable enjoyment and social interaction to the Tai Chi group. The stretching program, which was formatted similar to the Tai Chi (5-10 minute warm-up, 30 minutes of stretching exercises, and a 5-10 minute cool-down) did not include any of the strength and balance exercises, that were regularly employed in the Tai Chi sessions. Exercise compliance to the Tai Chi and stretching program was favorable; 80% of the Tai Chi participants and 81% of the stretching students attended 50 or more of their 78 total sessions of exercise.

Assessment of Functional Balance and Falls
The three functional balance assessments used to test the subjects were a dynamic gait index, the Berg balance scale, and a functional reach test. The dynamic gait index assessed the subjects ability to alter his/her gait in response to a movement challenge (e.g., stepping over or around obstacles, changing speeds, stepping on uneven surfaces, and pivot turns). The Berg balance scale included 14 distinctive physical tasks that resemble activities of daily living. The functional reach test measured the maximal distance each subject could reach forward beyond arm’s length, while maintaining a fixed base of support in the standing position.

Each subject was given a ‘fall calendar’ for tracking and recording falls. A fall was defined as any accident that resulted in a subject landing on the floor, ground, furniture or stairs. Participants also reported if the fall resulted in their seeking any medical attention.

Results
The Tai Chi group preformed significantly better than the stretching group on the three functional balance assessments (dynamic gait index, the Berg balance scale, and a functional reach test). There was no change in the baseline measurements for the stretching in any of the functional balance assessments. In the 6-month follow-up, where no formalize exercise was offered, the Tai Chi group showed much slower deterioration in functional balance measures as compared to the stretching group. In addition, during the 6-month post-exercise period, there were 28 recorded falls in the Tai Chi Group and 74 reported with the stretching group.

Practical Findings
This study clearly shoes that Tai Chi training can lead to statistically significant improvements in functional balance in older persons. These improvements resulted in a most meaningful reduction in falls during the 6-month period following the formalized Tai Chi intervention. At this time, researchers do not know the precise neural control and biomechanical mechanisms that directly translate to the increase in functional balance and reduction in falls, yet evidence exists supporting this premise (Li et al., 2004). From a practical overview, one could argue that the postural benefits from Tai Chi participation are attributable to the numerous changes from single leg to double leg stances, the different movements that involve various body stabilizers with changing bodily movements, and the constant coordination of the lower extremity with the upper extremity in the different forms.

Bottom Line Message
As professionals, we are all aware of the major health impact and quality of life deterioration that falls present to our elderly citizens. This study, with it large subject population provides highly favorable data and support for implementation of Tai Chi (Yang method used in this investigation) programs as an exceptional alternative exercise program for the elderly for the improvement in functional balance and fall prevention.

Side Bar 1: Study Highlights of the Health Effects of a Tai Chi Training Program in the Elderly

Subjects: 40 men and women aged 58-70 yrs
Design: Tai Chi Chaun Group (9 males, 11 females)
Control Group (9 males, 11 females)
Tai Chi: 20 minute warm-up
24 minute of Tai Chi Chaun (108 postures used)
10 minute cool-down
4 days/week
12 month duration
Control: Self-selected active lifestlye
Results:
Males: 16.1% increase in maximal aerobic capacity
11% increase in thoracic/lumbar flexibility
18.1% increase in muscular strength of knee extensors
15.4% increase in muscular strength of knee flexors
Females: 21.3% increase in maximal aerobic capacity
8.8% increase in thoracic/lumbar flexibility
20.3% increase in muscular strength of knee extensors
15.9% increase in muscular strength of knee flexors
Control: No significant changes observed

Source:
LAN, C., Lai, J-S., Chen, S-Y., & Wong, M-K. (1998). 12-month Tai Chi Training in the elderly: its effect on health fitness. Medicine & Science in Sports & Exercise, 30(3), 345-351.

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