Tai Chi Improves Balance, Reduces Falls in Parkinson's

Susan Jeffrey

February 09, 2012

February 9, 2012 — Results of a randomized trial show that training patients with Parkinson's disease in the ancient art of tai chi reduced balance impairments, improving function and reducing falls.

"We found that a program of twice-weekly tai chi for 24 weeks, as compared with a resistance-training program or a stretching program, was effective in improving postural stability and other functional outcomes in patients with mild-to-moderate Parkinson's disease," Fuzhong Li, PhD, from the Oregon Research Institute in Eugene, and colleagues report.

Patients using tai chi also significantly reduced falls without any increase in serious adverse events, and these improvements were maintained 3 months after the intervention.

The authors conclude that, "tai chi appears to be effective as a stand-alone behavioral intervention designed to improve postural stability and functional ability in people with Parkinson's disease."

The trial, supported by the National Institute of Neurological Disorders and Stroke, was published in the February 9 issue of the New England Journal of Medicine.

Exercise Integral to Management

Exercise is an integral part of the management of patients with Parkinson's, as it has been shown to slow deterioration of motor function and prolong functional independence, the researchers write. Benefits also have been shown with resistance-based exercise, but it requires equipment and safety monitoring.

Tai chi has been shown to improve strength, balance, and physical function, as well as prevent falls in older adults, the researchers note. Two pilot trials in patients with Parkinson's disease suggest that this approach could also improve axial symptoms such as postural stability. The current trial aimed to establish whether a tailored tai chi program could provide these benefits in a larger population.

"Because the program emphasized rhythmic weight shifting, symmetric foot stepping, and controlled movements near the limits of stability, we hypothesized that tai chi would be more effective in improving postural stability in limits-of-stability tasks than a resistance-based exercise regimen or low-impact stretching (control)," they write.

A total of 195 patients with Parkinson's who were Hoehn and Yahr scale stages 1 to 4 were assigned to a program of tai chi, resistance training, or stretching. The Hoehn and Yahr scale ranges from 1 to 5, with higher stages indicating more severe disease.

Patients attended two 60-minute exercise sessions per week for 24 weeks. The primary outcomes were changes from baseline in maximum excursion and directional control, both of which are indicators of postural stability, measured using computerized dynamic posturography. Scores on both measures range from 0% to 100%, with higher scores indicating better balance or control. Secondary outcomes included measures of gait and strength, functional reach and timed up-and-go tests, motor scores on the United Parkinson's Disease Rating Scale, and number of falls.

The researchers found that the tai chi group performed significantly better than the other 2 groups on the primary outcomes of maximum excursion and directional control, and that the differences remained significant after adjustment for covariates.

Table. Primary Outcomes: Between-Group Differences in Mean Change From Baseline

Endpoint Tai Chi vs Resistance Training P Tai Chi vs Stretching P
Maximum excursion (%) 5.55 (95% CI, 1.12 - 9.97) .01 11.98 (95% CI, 7.21 - 16.74) < .001
Directional control (%) 10.45 (95% CI, 3.89 - 17.00) .002 11.38 (95% CI, 5.50 - 17.27) < .001

CI, confidence interval.

On all secondary outcomes, tai chi proved superior to stretching. It improved stride length and functional reach compared with resistance training and also reduced falls compared with stretching, but not compared with resistance training.

"No serious adverse events were observed during tai chi training," the researchers conclude, "indicating the safety and usefulness of this intervention for persons with Parkinson's disease."

The trial was supported by the National Institute of Neurological Disorders and Stroke. The authors have disclosed no relevant financial relationships.

N Engl J Med. 2012;366:511-519. Abstract