TAI CHI, BALANCE, AND FALLS

According to the Center for Disease Control (CDC), approximately one third of older adults fall, and falling is the leading cause of fatal and non-fatal injuries for persons age 65 and older. One of the central elements of Tai Chi is the development and control of BALANCE.

Accidents are the fifth leading cause of death in the United States. In the senior population, falls are the number one cause of fatal and non-fatal injuries. One of the key elements of Tai Chi is balance. As mentioned in the page on ESSENTIAL ELEMENTS OF TAI CHI, the weight of the body is balanced almost entirely on one leg, shifting the weight back and forth as a person transitions through the movements. The shifting and balancing of the body’s weight help develops balance and can help to prevent falls.

The development of balance is particular to those styles of Tai Chi that focus on being “single weighted.” If the form does not focus on this element, benefits for balance may be diminished or even eliminated. When the weight of the body is balanced equally between the legs, this results in being “double weighted.” The reason for being single weighted lies in the martial origins of Tai Chi, but the practical effect for health is that by letting the weight of the body shift entirely to one leg (for example the right leg), the rest of the body can be allowed to relax entirely – the left leg, the hips, the torso, shoulders, arms, neck and head. This enhances blood diffusion, and muscular relaxation. As the movement transitions through to the opposite leg (for example, the left leg), the other side relaxes.

An analogy is often made of the idea of imagining one leg being “full” of water, and the water “pouring” into the “empty” leg as one shifts through to the next movement, until the full leg becomes empty, and the empty leg becomes full. This transition of empty and full occurs throughout the entire form. Essentially Tai Chi is the act of balancing on one leg and then the other, while relaxing the opposite leg and the entire body. This is the reason Tai Chi is such a valuable exercise for enhancing balance. The below link will take you to a video demonstrating the “three step” Tai Chi walking exercise demonstrating the above principles.

 

SUPPORTING STUDIES FROM PUBMED

(PUBMED is a free government searchable website for a variety of medical studies. Only those abstracts (a brief paragraph describing the study) that link to the free full text of the article are included, for full access for interested readers. The full article can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed.  As with any study, caution should be used, due to many factors and potential confounders. The below studies present a growing body of evidence regarding the benefits of Tai Chi, but may not be conclusive. Always discuss with your doctor any medical concerns.)

 

Is Tai Chi Chuan effective in improving lower limb response time to prevent backward falls in the elderly?

Age (Dordr). 2009 Jun;31(2):163-70. Epub 2009 May 5.

Wong AM, Pei YC, Lan C, Huang SC, Lin YC, Chou SW.

 

Abstract

To evaluate the training effect of Tai Chi Chuan (TCC) in postural control and backward fall prevention in the elderly, balance assessment and visually guided lower limb response time were analyzed in a case-control study conducted in a community setting. Thirty-one elderly subjects (mean age: 68.2 +/- 6.8 years) participated in the TCC group, 30 community-dwelling elderly subjects with matched age and body composition served as the elderly control group, with 13 young adults (mean age: 27.5 +/- 3.8 years) serving as young controls. The TCC group had practiced TCC regularly five times per week, for over 30 min per day for at least 4 years. Lower limb response time were measured using a computerized dance machine that we developed, which contains two blocks during testing: single and dual feet. The motor planning of the latter is more complex than the former. Postural control was assessed by computerized posturography (Smart Balance Master). Compared to the elderly controls, the TCC group demonstrated significantly better balance performance in sway-referenced support, which is more challenging. Moreover, the TCC group had better dual feet response than the elderly controls in the forward-backward, forward-right and forward-left directions. Practicing TCC may improve motor responses and postural control in the elderly, particularly in more challenging situations. Subjects showed better postural responses to unexpected perturbation in the forward-backward and forward-sideways direction than sideways or backward-sideways directions, which may have clinical relevance.

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Tai Chi improves balance and mobility in people with Parkinson disease.

Gait Posture. 2008 Oct;28(3):456-60. Epub 2008 Apr 18.

Hackney ME, Earhart GM.

 

Abstract

This pilot study examines the effects of Tai Chi on balance, gait and mobility in people with Parkinson disease (PD). Thirty-three people with PD were randomly assigned to either a Tai Chigroup or a control group. The Tai Chi group participated in 20 1-h long training sessions completed within 10-13 weeks; whereas, the control group had two testing sessions between 10 and 13 weeks apart without interposed training. The Tai Chi group improved more than the control group on the Berg Balance Scale, UPDRS, Timed Up and Go, tandem stance test, six-minute walk, and backward walking. Neither group improved in forward walking or the one leg stance test. All Tai Chiparticipants reported satisfaction with the program and improvements in well-being. Tai Chiappears to be an appropriate, safe and effective form of exercise for some individuals with mild-moderately severe PD.

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Tai Chi versus brisk walking in elderly women.

Age Ageing. 2006 Jul;35(4):388-93. Epub 2006 Apr 19.

Audette JF, Jin YS, Newcomer R, Stein L, Duncan G, Frontera WR.

 

Abstract

PURPOSE:

to compare the effects of a short style of Tai Chi versus brisk walking training programme on aerobic capacity, heart rate variability (HRV), strength, flexibility, balance, psychological status and quality of life in elderly women.

METHODS:

nineteen community-dwelling, sedentary women (aged 71.4 +/- 4.5 years) were randomly assigned to Tai Chi Chuan (TCC; n = 11) or brisk walking group (BWG; n = 8). A separate group of elderly women was recruited from the same population to act as a sedentary comparison group (SCG; n = 8). The exercise groups met for 1 h, three days per week for 12 weeks. Outcomes measured before and after training included estimated VO2max, spectral analysis of HRV (high-frequency, low-frequency power as well as high- and low-frequency power in normalised units) as a measure of autonomic control of the heart, isometric knee extension and handgrip muscle strength, single-leg stance time, the State Trait Anxiety Inventory (STAI), Profile of Mood States (POMS) and Short Form-36 (SF-36) questionnaires.

RESULTS:

significant improvement was seen in estimated VO(2)max in the TCC group (TCC versus SCG P = 0.003, TCC versus BWG P = 0.08). The mean within-person change of high-frequency power in normalised units (HFnu) increased [8.2 (0.14-16.3)], representing increased parasympathetic activity, and low-frequency power in normalised units (LFnu) decreased [-8.7 (-16.8-0.5)], representing decreased sympathetic activity, in the TCC group only. Significant gains were also seen in the non-dominant knee extensor strength and single-leg stance time (TCC versus BWG P < 0.05).

CONCLUSIONS:

a short style of TCC was found to be an effective way to improve many fitness measures in elderly women over a 3-month period. TCC was also found to be significantly better than brisk walking in enhancing certain measures of fitness including lower extremity strength, balance and flexibility.

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Tai Chi and vestibular rehabilitation improve vestibulopathic gait via different neuromuscular mechanisms: preliminary report.

BMC Neurol. 2005 Feb 18;5(1):3.

McGibbon CA, Krebs DE, Parker SW, Scarborough DM, Wayne PM, Wolf SL.

 

Abstract

BACKGROUND:

Vestibular rehabilitation (VR) is a well-accepted exercise program intended to remedy balance impairment caused by damage to the peripheral vestibular system. Alternative therapies, such as Tai Chi (TC), have recently gained popularity as a treatment for balance impairment. Although VR and TC can benefit people with vestibulopathy, the degree to which gait improvements may be related to neuromuscular adaptations of the lower extremities for the two different therapies are unknown.

METHODS:

We examined the relationship between lower extremity neuromuscular function and trunk control in 36 older adults with vestibulopathy, randomized to 10 weeks of either VR or TC exercise. Time-distance measures (gait speed, step length, stance duration and step width), lower extremity sagittal plane mechanical energy expenditures (MEE), and trunk sagittal and frontal plane kinematics (peak and range of linear and angular velocity), were measured.

RESULTS:

Although gait time-distance measures were improved in both groups following treatment, no significant between-groups differences were observed for the MEE and trunk kinematic measures. Significant within groups changes, however, were observed. The TC group significantly increased ankle MEE contribution and decreased hip MEE contribution to total leg MEE, while no significant changes were found within the VR group. The TC group exhibited a positive relationship between change in leg MEE and change in trunk velocity peak and range, while the VR group exhibited a negative relationship.

CONCLUSION:

Gait function improved in both groups consistent with expectations of the interventions. Differences in each group's response to therapy appear to suggest that improved gait function may be due to different neuromuscular adaptations resulting from the different interventions. The TC group's improvements were associated with reorganized lower extremity neuromuscular patterns, which appear to promote a faster gait and reduced excessive hip compensation. The VR group's improvements, however, were not the result of lower extremity neuromuscular pattern changes. Lower-extremity MEE increases corresponded to attenuated forward trunk linear and angular movement in the VR group, suggesting better control of upper body motion to minimize loss of balance. These data support a growing body of evidence that Tai Chi may be a valuable complementary treatment for vestibular disorders.

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The effect of supervised Tai Chi intervention compared to a physiotherapy program on fall-related clinical outcomes: a randomized clinical trial.

Disabil Rehabil. 2012;34(3):196-201.

Tousignant M, Corriveau H, Roy PM, Desrosiers J, Dubuc N, Hébert R, Tremblay-Boudreault V, Beaudoin AJ.

 

Abstract

Purpose: To assess some fall-related clinical variables (balance, gait, fear of falling, functional autonomy, self-actualization and self-efficacy) that might explain the fact that supervised Tai Chi has a better impact on preventing falls compared to a conventional physiotherapy program. Methods: The participants (152 older adults over 65 who were admitted to a geriatric day hospital program) were randomly assigned to either a supervised Tai Chi group or the usual physiotherapy. The presence of the clinical variables related to falls was evaluated before the intervention (T1), immediately after (T2), and 12 months after the end of the intervention (T3). Results: Both exercise programs significantly improved fall-related outcomes but only the Tai Chi intervention group decreased the incidence of falls. For both groups, most variables followed the same pattern, i.e. showed significant improvement with the intervention between T1 and T2, and followed by a statistically significant decrease at the T3 evaluation. However, self-efficacy was the only variable that improved solely with the Tai Chi intervention (p = 0.001). Conclusions: The impact of supervised Tai Chi on fall preventioncan not be explained by a differential effect on balance, gait and fear of falling. It appeared to be related to an increase of general self-efficacy, a phenomenon which is not seen in the conventional physiotherapy program.

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An economic evaluation of community and residential aged care falls prevention strategies in NSW.

N S W Public Health Bull. 2011 Jun;22(3-4):60-8.

Church J, Goodall S, Norman R, Haas M.

 

Abstract

AIM:

To evaluate the cost-effectiveness of strategies designed to prevent falls amongst people aged 65 years and over living in the community and in residential aged-care facilities.

METHODS:

A systematic review and meta-analysis of the literature was conducted. The pooled fall rate ratio was used in a decision analytic model that combined a Markov model and decision tree to estimate the costs and outcomes of potential interventions and/or strategies. The resulting cost per quality-adjusted life year was estimated.

RESULTS:

The most cost-effective falls prevention strategy in community-dwelling older people was Tai Chi. Expedited cataract surgery and psychotropic medication withdrawal were also found to be cost-effective; however, the effectiveness of these interventions is less certain due to small numbers of trials and participants. The most cost-effective falls prevention strategies in residential aged-care facilities were medication review and vitamin D supplementation.

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