Neil Osterweil

November 05, 2013

BOSTON — The gentle art of tai chi, as well as strength and flexibility exercises, can help seniors avoid potentially serious falls through conditioning and a gain in self-confidence, according to several new studies.

"Seniors who do tai chi become less dependent on their home healthcare workers and they're able to move around a little better," said Vishal Shah, a third-year medical student at the University of Vermont College of Medicine in Burlington, told Medscape Medical News.

The results of the studies were presented here at the American Public Health Association 141st Annual Meeting.

Shah and his team conducted a pilot study of adults 65 years and older in an integrative healthcare assisted-living facility in Vermont, where falls are the leading cause of injury and death in seniors.

The investigators used the Activities-Specific Balance Confidence Scale to rate confidence in activities such as walking outside, getting in or out of a car, and walking in a crowded place or open expanse, such as a parking lot.

In general, tai chi participants reported higher degrees of confidence than control subjects in most activities requiring balance, and 80% of participants reported having better balance and being more confident in their daily tasks.

The 25% fall rate at the facility is lower than the 33% reported by the US Centers for Disease Control and Prevention, although the sample size was too small to detect a significant benefit, said Shah.

The investigators plan to expand the program to assisted-living facilities throughout Vermont.

In a separate pilot study, investigators from the AltaMed healthcare system in Los Angeles looked at the effects of a tai chi program on 31 older adults with a history of 1 or 2 falls or with no fall history.

Soft Movements in Multiple Directions

The seniors took part in twice-weekly sessions consisting of a 5-minute warm-up, 20 minutes of Pal Dan Gum–style tai chi, which emphasizes soft movements in multiple directions, and a 5-minute cool-down period. The participants were also taught movements and postures that incorporate breathing and meditation techniques.

Participants were rated for fall risk both before and after the intervention on the Berg Balance Test Scale, which categorizes fall risk as low, mild, moderate, or high.

Although only a few participants shifted to a lower fall-risk category after tai chi training, they "demonstrated increased motivation for physical activity and cognitive restructuring" and "a more positive attitude about life, and were less likely to dwell on negative thoughts and emotions," the authors report in their scientific poster.

It was encouraging to see a reduction in the risk of falling, but also that the participants reported feeling better.

"It was encouraging to see a reduction in the risk of falling, but also that the participants reported feeling better, and said they looked forward to the class," coinvestigator Jessica Solares, MPH, MCHES, told Medscape Medical News.

Exercise to improve lower body strength is just one component of a comprehensive approach to reducing falls, say Mary Gallant, PhD, and Kelly Winjum, MPH, from the University at Albany School of Public Health in New York.

Their team from the Health Foundation for Western and Central New York was part of an initiative involving a variety of evidence-based fall-prevention programming. They found that programs that combine exercise, including tai chi and other forms of conditioning, with home evaluations to identify and remove fall hazards were an effective way to implement evidence-based fall-prevention strategies. Education was also important for getting buy-in from healthcare providers to adopt fall-prevention practices.

"For any type of exercise program, we saw positive results," Winjum told Medscape Medical News.

Ironically, the researchers found that "healthcare professionals were the most difficult group to engage" in efforts to reduce falls, highlighting the need for more fall-prevention education and training programs for health workers.

Benefits of Tai Chi

Peter Wayne, MD, research director for the Osher Center for Integrative Medicine in Boston and a tai chi expert, said that the health benefits of mind–body discipline are well documented, and the practice has a range of physiologic and mental health benefits.

"We think of this in terms of a systems biology framework. It's not one active ingredient affecting one physiologic process; rather, tai chi has a portfolio of active ingredients that hit a number of different processes," he explained.

The positive effects of tai chi include lower extremity strength and flexibility, changes in proprioception (particularly plantar proprioception, which has been seen to improve even in patients with peripheral neuropathy), and reductions in anxiety or fear of falling, which itself is a risk factor for falls, said Dr. Wayne.

There is also evidence to suggest that tai chi can lead to positive changes in executive function.

"We know that your ability to shift your attention is very important for balance control and for preventing falls. Tai chi seems to affect executive function independent of balance," he said.

The Vermont study was supported by the Vermont Department of Public Health. The AltaMed study was internally funded. The New York study was supported by the Health Foundation for Western and Central New York. The investigators have disclosed no relevant financial relationships. Dr. Wayne is coauthor of a book on tai chi and health.

American Public Health Association (APHA) 141st Annual Meeting: Abstracts 279776, 282712, 289749. Presented November 3, 2013.


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