Tai chi for fall prevention among the elderly
Effective, low-impact method to reduce falls
By Dónal P. O’Mathúna, PhD
Lecturer in Health Care Ethics
School of Nursing
Dublin City University
Ireland
Falls are the leading cause of injury, death, and disability among the elderly (those older than 65 years).1
Between one-third and one-half of the elderly fall each year.2 Although only about 20% of those falls require medical attention and fewer than 10% result in fractures, less serious falls can be painful and reduce functionality.
In addition, fear of falling can have a significant impact on a person’s quality of life and range of activities. Elderly women particularly are at risk for fall-related injuries, with women being three times more likely than men to be hospitalized after a fall.
For example, in 1996, 80% of those hospitalized with hip fractures were women; only half of those injured were able to return to independent living afterward.1 The economic costs of falls also are significant, leading to $96 million in hospital charges in Wisconsin in 2002.3 With the elderly being the fastest-growing age group in the United States and many developed countries, effective fall-prevention programs are urgently needed.1
Many risk factors are involved with falls, making it difficult to develop and evaluate prevention strategies.
Tai chi, or tai chi chuan, has a reputation of an effective, low-impact method to reduce the incidence of falls, especially in the elderly. People practicing its slow, graceful movements are more commonly seen, since tai chi classes are offered at a variety of public venues.
Through its group classes, tai chi brings social, physical, and psychological benefits.4 Some claim it can reduce blood pressure and cholesterol levels, relieve depression and anxiety, and improve circulation, digestion, and memory.5 Tai chi also is said to bring mental and spiritual clarity.
Background
Tai chi literally means "supreme ultimate power" and is part of traditional Chinese medicine (TCM). It has been described as "an exercise, a dance, a method of achieving mental peace and relaxation, a religious ritual, and a philosophy of life."6
Originally developed to provide general physical fitness for the martial arts, it has been modified to make the movements easy to learn and practice in shorter periods of time.7
Five major styles of tai chi have developed, with the Yang form being the most popular. The Chinese government made tai chi compulsory in many colleges and universities, promoting it as a national cultural activity.8 As a result, millions of Chinese people practice tai chi. In the West, it also has been growing in popularity since the 1980s.
All forms of tai chi involve meditation, breathing exercises, and slow, graceful movements. Many of these represent animal and bird movements, as reflected in their names: "white crane spreads wings," "golden rooster stands on one leg," and "ride the tiger."8
Each session is composed of a series of specific postures combined into one long exercise. The movements all are considered circular with each session being viewed as one continuous, integrated circle.7 Within each session, however, there are many variations. Sessions come in short and long versions, lasting either 10 or 30 minutes.
Mechanism of action
The TCM explanation for how tai chi promotes health is that it restores a balanced flow of chi, which is a nonphysical life energy believed to pervade and animate the universe. Illness is said to arise when the flow of chi is hindered or imbalanced. Tai chi movements are viewed as part of a healthy lifestyle that improves and promotes the flow of chi. Practicing tai chi outdoors is said to be better because it allows chi in the earth to rise up through one’s feet to replenish one’s own chi.
More biological or scientific mechanisms of action have not been established for tai chi, other than viewing it as a gentle form of exercise and "moving meditation."6
Clinical studies
Two systematic reviews of clinical studies conducted on tai chi were published in 2004. One involved a search of Medline, Cinahl, and PsychLit and located studies published in European languages.9 The other review involved a broader search that included the Chinese medical database.5
Both of those reviews identified only one randomized controlled trial (RCT) where the primary outcome measure was incidence of falls among the elderly.10 A number of other studies used secondary outcome measures such as balance and muscle strength, which can be possible predictors of risk of falling.9
The one RCT measuring incidence of falls in the elderly received additional publicity when it was selected by the American Geriatrics Society as the best research paper from the 1990s.11 A total of 200 subjects older than 70 years (average age, 76 years) randomly were assigned to one of three groups: tai chi, computerized balance training, or a discussion group instructed not to change exercise activities.
The tai chi subjects met with an instructor twice a week for about 20 minutes and were encouraged to practice tai chi on their own twice daily for 15 minutes. The primary outcomes were measured at baseline, after 15 weeks of training, and upon follow-up at four months. Those collecting data were blind to the intervention assigned to participants.
Analysis of the outcomes found that the subjects practicing tai chi had reduced fear of falling significantly and saw a substantial reduction in the number of falls.
Subjects receiving computerized balance training and subjects in the discussion group did not reduce their numbers of falls. After adjusting for all fall risk factors, tai chi was found to reduce the risk of falls by 47.5%.
One other RCT measured the effect of tai chi on elderly people.12 Ninety-eight people ages 65 years or older randomly were assigned to tai chi sessions lasting one hour twice a week for six months or to a control group that was asked to continue with usual activities.
Significant improvements were found for the tai chi group in the physical functioning categories of the quality-of-life assessment instrument, SF-20. However, direct assessment of numbers of falls or fall risk factors was not carried out.
A small number of other controlled studies have examined the impact of tai chi on balance and stability in elderly subjects. However, the quality of these studies was problematic, with the review of Chinese and Western studies concluding: "The overall quality score [for studies] varied between 2 and 6 [out of 9 points] with a mean of 3.7, which indicates an overall poor methodological quality."5
Two studies compared balance and flexibility between a group practicing tai chi for eight or 10 weeks and a control group.9 However, subjects were permitted to choose the intervention group they preferred, thus introducing a risk of bias. Both studies found more beneficial effects in the tai chi group.
Another study reported improved balance in 22 subjects who practiced tai chi for one hour per week for eight weeks.5 That study, which did not involve a control group, measured balance before and after the tai chi lessons.
References
1. Stevens JA, Olson S. Reducing falls and resulting hip fractures among older women. MMWR Recomm Rep 2000; 49(RR-2):3-12. Web site: www.cdc.gov/mmwr/preview/mmwrhtml/rr4902a2.htm
2. Gillespie LD, et al. Interventions for preventing falls in elderly people. The Cochrane Database of Systematic Reviews 2003; Issue 4; Article No. CD000340.
3. Mahoney JE, et al. Trends, risk factors, and prevention of falls in older adults in Wisconsin. Wis Med J 2005; 104:22-28.
4. O’Mathúna DP. Tai chi for depression and anxiety. Altern Med Alert; 2005; 8:41-43.
5. Wang C, et al. The effect of tai chi on health outcomes in patients with chronic conditions: A systematic review. Arch Intern Med 2004; 164:493-501.
6. Chen W, Sun W. Tai chi chuan, an alternative form of exercise for health promotion and disease prevention for older adults in the community. Int Q Community Health Edu 1997; 16:333-339.
7. Li JX, et al. Tai chi: Physiological characteristics and beneficial effects on health. Br J Sports Med 2001; 35:148-156.
8. Jacobson BH, et al. The effect of tai chi chuan training on balance, kinesthetic sense, and strength. Percept Mot Skills 1997; 84:27-33.
9. Verhagen AP, et al. The efficacy of tai chi chuan in older adults: A systematic review. Fam Pract 2004; 21:107-113.
10. Wolf SL, et al. Reducing frailty and falls in older persons: An investigation of tai chi and computerized balance training. J Am Geriatr Soc 1996; 44:489-497.
11. Wolf SL, et al. Selected as the best paper in the 1990s: Reducing frailty and falls in older persons: An investigation of tai chi and computerized balance training. J Am Geriatr Soc 2003; 51:1,794-1,803.
12. Li F, et al. An evaluation of the effects of tai chi exercise on physical function among older persons: A randomised controlled trial. Am Behav Med 2001; 23:139-146.
Effective, low-impact method to reduce falls By Dónal P. OMathúna, PhD Lecturer in Health Care Ethics School of Nursing Dublin City University Ireland Falls are the leading cause of injury, death, and disability among the elderly (those older than 65 years).1You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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