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

Discussion

It was found that once weekly tai chi classes for 16 weeks reduced falls in a relatively healthy community-dwelling group of people aged 60 and older in Sydney, Australia. This effect was evident at the conclusion of the tai chi program and was maintained for at least another 8 weeks. The tai chi program had no effect on the proportion of people who had one or more falls during follow-up, but tai chi appeared to reduce the proportion of participants who had two or more falls.

There were multiple tai chi instructors teaching a variety of tai chi styles. Although this reflects the situation as currently found in the community in Sydney, Australia, we acknowledge that this is a limitation of the study, because it makes it impossible for others to replicate this tai chi program. Also reflecting the common situation in the community, tai chi classes were only offered once a week in this study. Despite this, the magnitude of the effect of tai chi in this study is comparable to that of previous studies.[8,17]

A weakness of this study is that good measures of physical activity were not available, so potential confounding by differences in physical activity between the tai chi and the control group could not be adequately controlled for. Another limitation was that nearly 30% of participants did not complete the follow-up balance assessments.

Several studies of older people have suggested that the functional performance benefits of physical activity programs decline in as little as 2 weeks after cessation of exercise.[32,33] In contrast, the current study found that reduction in falls from tai chi was maintained for up to 8 weeks after classes finished. This is consistent with a previous study in which gains from a tai chi program lasted up to 6 months.[8] It may be that tai chi is easier to incorporate into daily life than other forms of exercise, so people continue to practice principles of tai chi after ceasing to attend formal classes. For example, some participants indicated informally that they practiced the tai chi walk (being conscious of foot placement and balance) while going about their daily activities.

Unlike other studies that have reported inconsistent effects of tai chi on balance,[9,34] the tai chi group performed significantly better than the controls on five of the six balance measures. This suggests that the intervention was of sufficient duration, and the exercise stimulus sufficiently intensive, to result in improved balance. The performance of the intervention group on the choice stepping reaction time test may be particularly important, because this test is not unlike the step response required to avoid a fall and provides a useful composite measure of falls risk.[30]

The study population was a fairly robust group of older people, with a mean age of 69. Other trials of tai chi for falls prevention have involved subject groups with mean ages of 76 and older.[8,17,18,19] Most participants rated their health as good, very good, or excellent, and nearly 50% reported that they were able to walk for at least an hour. Two-thirds had no limitations in instrumental activities of daily living. These results should only be generalized to younger groups of relatively healthy older people.

In conclusion, the findings from this study indicate that participation in weekly community-based tai chi classes can reduce falls in relatively healthy, community-dwelling older people. Given that the tai chi program used existing community facilities, the study suggests that tai chi is an effective and sustainable public health intervention for falls prevention for older people living in the community.


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