Evaluating the Exercise Prescription and Instructional Methods of Tai Chi Studies Aimed at Improving Balance

Abstract

Tai Chi is recommended to improve balance among older adults, yet there are no specific guidelines for the exercise prescription (ExRx) or instructional methods of Tai Chi practice. PURPOSE: Our systematic review addressed these gaps. METHODS: Electronic databases identified randomized controlled trials (RCTs) of Tai Chi interventions aimed at improving balance among older adults (≥60yr) without severe debilitating diseases. We developed a 13-item scale to evaluate the ExRx (i.e., time, frequency, intervention length; n=3) and instructional (e.g., style, number of forms, form name; n=10) methods. RESULTS: 26 trials yielded 27 interventions. On average Tai Chi was performed 2.8±1.4 sessions·wk−1 for 56.5±14.4 min·session−1 for 19.7±12.7 wk. Most trials reported all three ExRx methods items with a mean satisfaction rate of 92.6±18.9%. In contrast, the mean satisfaction rate was 41.1±17.7% for the 10 instructional methods items, a significantly lower rate than the ExRx methods (p=0.03). Surprisingly, less than half of the trials reported unsupervised practice (14%), progression (24%), or the use of breathing (31%) and relaxation techniques (17%). Of greater concern, the instructional methods most important for targeting Tai Chi practice to improve balance were routinely not disclosed, with only 48.1% reporting style, 51.9% reporting movement principles, and 14.3% reporting form names. CONCLUSION: Most Tai Chi trials disclosed their ExRx methods, yet routinely failed to report instructional methods. In order to increase the effectiveness of Tai Chi to improve balance among older adults, future RCTs should reveal both their ExRx and instructional methods, especially those methods that target balance.