A Randomized, Controlled Trial of Tai Chi for the Prevention of Falls: The Central Sydney Tai Chi Trial

Alexander Voukelatos, MA (Psychol); Robert G. Cumming, PhD; Stephen R. Lord, DSc; Chris Rissel, PhD

Disclosures

J Am Geriatr Soc. 2007;55(8):1185-1191. 

In This Article

Abstract and Introduction

Abstract

Objectives: To determine the effectiveness of a 16-week community-based tai chi program in reducing falls and improving balance in people aged 60 and older.
Design: Randomized, controlled trial with waiting list control group.
Setting: Community in Sydney, Australia.
Participants: Seven hundred two relatively healthy community-dwelling people aged 60 and older (mean age 69).
Intervention: Sixteen-week program of community-based tai chi classes of 1 hour duration per week.
Measurements: Falls during 16 and 24 weeks of follow-up were assessed using a calendar method. Balance was measured at baseline and 16-week follow-up using six balance tests.
Results: Falls were less frequent in the tai chi group than in the control group. Using Cox regression and time to first fall, the hazard ratio after 16 weeks was 0.72 (95% confidence interval (CI)=0.51–1.01, P=.06), and after 24 weeks it was 0.67 (95% CI=0.49–0.93, P=.02). There was no difference in the percentage of participants who had one or more falls. There were statistically significant differences in changes in balance favoring the tai chi group on five of six balance tests.
Conclusion: Participation in once per week tai chi classes for 16 weeks can prevent falls in relatively healthy community-dwelling older people.

Introduction

In recent years, preventing falls in older people has become an increasingly important public health issue.[1,2,3] Approximately 30% of people aged 60 and older will fall in any 12-month period.[4,5] Physical activities enhancing balance and strength are among the most promising intervention strategies for preventing falls in older people.[6] An advantage of physical activity as a falls prevention strategy is that physical activity has many health benefits[7] and can form a component of an individual's healthy lifestyle rather than targeting one particular health problem.

Numerous studies have investigated the effect of tai chi on balance.[8,9,10,11,12,13,14,15,16] Some have found that tai chi improves postural sway, single leg stance, tandem stance, lateral stability, and reaching,[9,11,14,16] although other studies have failed to report improvements in these measures or in assessments of sit-to-stand ability and gait.[9,10,13] Two randomized trials have shown tai chi to be an effective way of reducing falls in community-dwelling older people.[8,17] Another randomized trial found that tai chi reduced falls in people transitioning to frailty,[18] but tai chi was not found to be effective for falls prevention in a randomized trial involving people living in long-term care facilities.[19]

Previous trials of tai chi for falls prevention have all involved tai chi classes at least twice per week. This level of commitment might be difficult for many older people to sustain. The quality of tai chi instruction in previous studies was probably higher than might be found in many tai chi classes in the general community. The current study involved just one tai chi class per week and a large number of tai chi instructors, all of whom were currently offering tai chi classes in the study community. Participants in the study tended to be younger than those in previous studies.

The main hypothesis that this study investigated was that a community-based weekly tai chi program of 16 weeks duration would reduce falls in people aged 60 and older. The study also investigated whether any effect on falls was still evident 8 weeks after the end of the tai chi program. Because tai chi is thought to act through improving balance, the effects of the tai chi program on balance were also investigated.

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