Source: Taggart HM. Effects of Tai Chi exercise on balance, functional mobility, and fear of falling among older women. Appl Nurs Res 2002;15:235-242.
Abstract: The purpose of this study was to determine the effects of tai chi exercise among older women. Multiple regression analysis revealed statistically significant improvements in scores for balance (P < 0.001), functional mobility (P < 0.05), and fear of falling (P < 0.001) and associated demographic factors. Three months of twice weekly, 30-minute tai chi classes was associated with statistically significant improvements in balance and functional mobility and a reduction in the fear of falling in this sample of older women living in retirement communities. Tai chi exercises may be an age-appropriate and acceptable form of exercise for older women.
Source: Qin L, et al. Regular Tai Chi Chuan exercise may retard bone loss in postmenopausal women: A case-control study. Arch Phys Med Rehabil 2002;83:1355-1359.
Abstract: This case-control study was designed to evaluate the potential benefits of regular tai chi chuan exercise on the weight-bearing bones of postmenopausal women. Participants were postmenopausal women (age range 50-59 years), including 17 self-selected regular tai chi chuan exercisers (TCE) with more than four years of regular exercise, and 17 age- and gender-matched non-exercising controls at a university medical school in Hong Kong. Bone mineral density (BMD) in the lumbar spine and proximal femur was measured at baseline and at follow-up 12 months later by using dual-energy X-ray absorptiometry (DXA) and in the distal tibia using multislice peripheral quantitative computed tomography (pQCT). Baseline results showed that the TCE group had significantly higher BMD (10.1%-14.8%, all P < 0.05) than the control group in the lumbar spine, proximal femur, and the ultradistal tibia. The follow-up measurements showed generalized bone loss in both groups. Although both DXA and pQCT measurements revealed decelerated rates of bone loss in the TCE group, only the more sensitive pQCT showed significantly reduced rate of bone loss in trabecular BMD of the ultradistal tibia (TCE vs. control: -1.10% ± 1.26% vs. -2.18% ± 1.60%, P < 0.05) and of cortical BMD of the distal tibial diaphysis (TCE vs. control: -0.90% ± 1.36% vs. -1.86% ± 0.93%, P < 0.05). The authors concluded that regular tai chi chuan exercise may help retard bone loss in the weight-bearing bones of postmenopausal women.
Comments by Mary L. Hardy, MD
Falls in the elderly are a serious public health issue. They are the leading cause of injury death in persons 65 years or older and one-third of older adults fall every year. More than 350,000 seniors were hospitalized in 2000 for injuries related to falls. Falls are more common in nursing homes than in the community, perhaps because of the greater frailty of institutionalized elders. Non-modifiable risk factors for falls include increasing age, female sex, previous falls, and concurrent physical limitations or conditions. Possibly modifiable risk factors include gait or balance problems and lower body weakness. So, interventions that would reduce the risk of falls in elderly women would be of interest—especially if such interventions were safe, relatively low cost, and acceptable to the elderly population at risk.1,2
An increasing body of evidence suggests that an exercise program based on the ancient Chinese martial arts, tai chi, may be very useful in reducing the risk of falling in the elderly. Tai chi (also known as Taiji or Taijiquan) reportedly was invented by a hermit monk living 3,000 years ago in China. He established what has been called the 13 basic postures. By moving in all directions, these postures were thought to represent all of the cardinal directions and the basic elements, ending with the centering of the energy in the earth. Many different types of tai chi have been developed from these basic moves. The most common form practiced in today is the Yang short form. It consists of 24 interconnected movements/postures that are designed to slowly take a person through a series of turns, balance shifts, and changes in distribution of weight from foot to foot while in a slightly crouched stance. These are done in a relaxed, meditative state using slow, controlled breathing. Each person practices as much of the movements as they can at her own pace. In China, it used to be very common for large groups of even very elderly persons to practice these movements each morning in the parks for about 30-45 minutes.3
Given the description of the technique, it should be apparent how such an intervention could aid in fall prevention. The crouched stance increases lower body strength, and the movement from foot to foot while turning slowly addresses balance and stance issues. Patients could be expected to increase their awareness of the position of their body in space and to have a greater sense of self-confidence about their ability to maintain their balance.
A systematic review of clinical studies using tai chi for the improvement of balance and the reduction of falls was performed in 2002.4 Fifteen clinical trials were identified from a search in the Western literature. Subjects were generally older—many older than 70 years and the majority were women. Studies enrolled both healthy patients and those who had fallen previously. Tai chi instruction was the main intervention and the intensity varied from 1-3 times per week for 8-24 weeks. Outcome measures varied widely but they included measures of stability as well as falls incidence and functional status. Results were mixed due in part to this heterogeneity, but were encouraging. In studies that measured the actual rate of falls, the risk of falling was decreased 50%. The study by Taggart was not included in this review, but the results are typical of this literature. It is interesting to note that the most statistically significant result was the reduction in the fear of falling. This was a useful intervention in this group of women in a retirement home, where the risk of falling is perhaps the highest.
Further benefits may accrue to tai chi practice. Since it is a form of weight-bearing exercise, it would be useful to see if it had an effect on osteoporosis and bone loss. Qin et al looked at a group of post-menopausal women who were regular practitioners of tai chi and a group of age-matched controls. These women were younger than the patients featured in the balance studies. The results of this small study were not conclusive, likely due to the small number of patients and the short follow-up time, but they did show the possibility of slowing bone loss in the group that practiced tai chi.
How will elderly patients accept this unusual form of exercise? Subjects in the studies tolerated the procedure well and seemed to continue to practice even after formal instruction ended—at least for a while. Group classes are likely the best forum for patients to learn and continue to practice this type of exercise. For those who have elderly patients or family members at risk, find a class at a local senior center or in a nursing home that is taught by an instructor used to teaching seniors. This low-cost and potentially very helpful intervention could be life-saving.
The patients I have sent for this kind of intervention report enjoying the experience once they figure out "those dance steps," and they are delighted by their new sense of confidence and security.
Dr. Hardy, Medical Director of Cedars-Sinai Integrative Medicine Medical Group in Los Angeles, is on the Editorial Advisory Board of Alternative Therapies in Women's Health.
References
1. Centers for Disease Control. National Center for Injury Prevention and Control. Falls among older adults: A summary of research findings. Available at: www.cdc.gov/ncipc/duip/SummaryOfFalls.htm. Accessed July 12, 2003.
2. Centers for Disease Control. National Center for Injury Prevention and Control. Falls and hip fractures among older adults. Available at: www.cdc.gov/ncipc/factsheets/falls.htm. Accessed July 12, 2003.
3. Novey DW. Clinician’s Complete Reference to Complementary & Alternative Medicine. St. Louis, MO: Mosby; 2000.
4. Wu G. Evaluation of the effectiveness of tai chi for improving balance and preventing falls in the older population—A review. J Am Geriatric Soc 2002;50: 46-54.
Hardy ML. Tai chi: Benefits in older women. Altern Ther Women's Health 2003;5(8):61-62.
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