Tai Chi interventions for older adults living in aged care homes in Sri Lanka: a study protocol for a single-arm pretest-posttest feasibility study.

From the May Issue of JAMDA

Tai Chi Exercises Benefit Even Oldest Adults

A growing body of literature substantiates that Tai Chi is a form of exercise that may help older adults increase strength, improve balance, lower fall rates, and experience less fear of falling. Few studies, however, offer controlled experimental design and simultaneously investigate multiple factors known to contribute to fall risk. The purpose of this study was to compare performance on measures relating to fall risk (strength, balance, functional mobility, and fear of falling) in older community-dwelling adults who participated in a community-based Tai Chi program with a control group of their peers who had no Tai Chi training over the same time period. A quasi-experimental comparative pre- and posttest design was used to compare an experimental group of 16 community-dwelling older adults, mean (SD) age = 80.4 (6.8) years, participating in a 16-week Tai Chi training program with a group of 13 adults, mean (SD) age = 71.2 (6.1) years, who had no Tai Chi experience in the areas of knee extension strength (measured by handheld dynamometry), functional strength (by five-time sit to stand), mobility (by Timed Up and Go [TUG] test and Fifty-Foot Walk Test), balance (by Functional Reach and Berg Balance Scale), and fear of falling (by Activity-specific Balance Confidence scale). Within-group and between-groups comparisons were made using 2×2 mixed analysis of variance. Tai Chi participants improved in nearly all measures, whereas controls did not. Tai Chi participants experienced significant improvement in the TUG test during the training period (P = .003), with significant difference when compared with controls (P = .049) and moderate effect size and observed power (ηp = 0.165; observed power = 0.512). Significant knee extension strength improvement occurred (P = .042) with moderate effect size and observed power (ηp = 0.183; observed power = 0.543). While the total balance confidence scale score did not change significantly, responses on many individual items did reach a level of significant change for persons participating in the Tai Chi training. Older adults' participation in a community-based Tai Chi program may lead to improvement in strength, mobility, and confidence in performing functional tasks. Incorporation of elements of Tai Chi into therapy programs for older adults at risk for fall and referral to community-based Tai Chi programs may be viable options in the continuum of health-related care for older adults.

One in four American older adults fall every year, resulting in injuries, death, and significant financial burden. Although fall etiology is multifactorial, the medical problems and aging factors that lead to unsteady gait and imbalance represent one of the major fall risks among older adults. A growing number of research studies support the health benefits of regular Tai Chi (TC) practice including improved physical, cognitive, and psychological function. The purpose of this quality improvement project was to assess the feasibility of establishing a 12-week (45 min per session) Tai Chi (TC) program (Sun Style Tai Chi) in a 75 bed assisted living facility as well as to evaluate the potential of the TC program to improve the fear of falling and functional mobility (as proxy for fall risk) and quality of life (QoL). A nurse who was a certified TC instructor taught the program. Twenty-three participants, 96% female and 96% white, mean (SD) age 83 (±7) years, attended one or more TC classes. Class attendance, self-reported questionnaires (e.g., fear of falling, QoL), and objective measure Timed Up and Go (TUG) were used to collect data. Nine participants (39%) completed 9 out of 12 sessions. Eleven participants (48%) completed both pre- and post-intervention measurements and twelve (52%) provided feedback on a post-intervention satisfaction survey. Participants showed 20% improvement in fear of falling (mean relative change) and 21% decrease (mean relative change) in TUG test (p = 0.001) with no clinically important changes in QoL. This quality improvement project suggested that TC is a feasible exercise that might have the potential to reduce risk of falls in older adults, and the program was well accepted with no serious or other adverse events reported. Further research studies are needed to examine the potential effects of TC programs with an appropriately powered RCT and longer intervention period.

Background. Falls are a common and serious concern among older adults, especially women, leading to reduced independence, balance problems, and increased mortality. Exercise interventions such as the Otago Exercise Programme (OEP) and Tai Chi (TC) have individually shown efficacy in reducing fall risk by improving balance, strength, and mobility. Aim. To evaluate the combined effect of the Otago Exercise Programme and Tai Chi on fall risk, balance, and mobility in senior Indian women. Methods. A pre- and post-experimental study was conducted involving 30 women aged 55–70 years, randomised into three equal groups: Otago Exercise Programme only (OEP, 50 minutes/session, 3 times/week), combined Tai Chi and Otago Exercise Programme (OEP + TC, 50 minutes OEP + 30 minutes Tai Chi, 3 times/week), and a control group (walking 30 minutes, 3 times/week). Outcomes were assessed using the Timed Up and Go (TUG) test for mobility, Berg Balance Scale (BBS) for balance, and Falls Efficacy Scale-International (FES-I) to measure fear of falling. Data analyses included paired t-tests for within-group comparisons and one-way ANOVA for between-group differences. Results. Significant improvements were observed in TUG, BBS, and FES-I scores post-intervention in both OEP and OEP + TC groups (p < 0.001). The combined OEP + TC group demonstrated the greatest gains in balance and mobility compared with OEP alone and control groups. Fear of falling was significantly reduced in intervention groups. ANOVA revealed statistically significant between-group differences favouring the combined exercise protocol for TUG and BBS (p < 0.05). Conclusions. Integrating the Otago Exercise Programme with Tai Chi yields superior improvements in balance, mobility, and reduction of fall risk among senior Indian women compared to Otago exercises alone or walking. This combined exercise approach is recommended for fall prevention in elderly populations. Keywords: fall risk; balance; Otago Exercise Programme; Tai Chi

The Effects of Tai Chi on Lung Function, Exercise Capacity and Health Related Quality of Life for Patients With Chronic Obstructive Pulmonary Disease: A Pilot Study

Background: There is increasing evidence that cardiovascular disease (CVD) is linked to a number of psychosocial risk factors and biophysiological risk factors such as metabolic syndrome. The development of effective therapeutic interventions for CVD patients, such as Tai Chi practice, to modify high-risk lifestyles and behaviours and reduce psychosocial and biophysiological risk factors, is a promising primary healthcare approach. This study compared Tai Chi programme CVD participants with CVD patients who did not participate in the Tai Chi programme as the control group in health-related quality of life (HRQoL), including physical health, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. In addition, psychological distress and resilience, body mass index (BMI), systolic blood pressure, and diastolic blood pressure were measured. Methods: In 2012, a case-control study was conducted to compare a group of CVD patients participating in a community based meditation intervention programme with CVD patients who did not participate in the programme. Measures included the Short-Form 12 Health Survey (SF-12), General Health Questionnaire (GHQ30), Resilience Scale, BMI, and blood pressure. Univariate analysis of variance was used to compare the difference between participants with cardiac chronic diseases who had taken part in 2 years regular Tai Chi and cardiac patients who did not participate in the Tai Chi programme. Results: Outcomes differed in significance and magnitude across four HRQoL measures, psychological distress, and resilience. The Tai Chi group also showed fewer incidences of being overweight or suffering from obesity and psychological distress. Conclusions: Regular and more than 2 years meditation exercises had a beneficial effect on HRQoL, reducing psychological distress, promoting resilience, managing and taking an active role in managing health condition, and reducing BMI and blood pressure level in CVD patients.

Community-Based Mind–Body Meditative Tai Chi Program and Its Effects on Improvement of Blood Pressure, Weight, Renal Function, Serum Lipoprotein, and Quality of Life in Chinese Adults With Hypertension

Background: There is increasing evidence that coronary heart disease is linked with a number of psychosocial risk factors and biophysiological risk factors such as metabolic syndrome. This study aimed to compare Tai Chi programme heart-failure participants between the pre-intervention phase and six month after intervention time in health-related quality of life (HRQoL), including physical health, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health. In addition, the difference between pre-intervention and post-intervention time in psychological distress and resilience, body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were compared.Methods: A prospective intervention study was conducted in 2012 to evaluate the effectiveness of a community-based meditation Tai Chi intervention programme to improve heart-failure patients’ health. Measures included the Short-Form 12 Health Survey (SF-12), General Health Questionnaire (GHQ30), resilience scale, BMI, blood pressure and waist circumference. Univariate analysis of variance was used to compare the difference between pre- and post-intervention in Tai Chi participants.Results: Outcomes differed in significance and magnitude across four HRQoL measures, psychological distress and resilience between the pre- and post-intervention time in heart-failure patients who participated in the Tai Chi exercise. The participants in the post-intervention time also reduced BMI, SBP, and waist circumference.Conclusions: Regular and more than six months Tai Chi exercises had a beneficial effect to HRQoL, reducing psychological distress, promoting resilience, and reducing the BMI and blood pressure level in heart-failure patients.

Pilot studies of recruitment and feasibility of remote Tai Chi in racially diverse older adults with multisite pain

Tai Chi, as a traditional Chinese martial art, has received extensive attention in recent years due to its multiple health benefits. Research demonstrates that Tai Chi improves physical health, enhances flexibility and coordination, and alleviates psychological stress. With the increase in research, the health benefits of Tai Chi have been confirmed by many scientific studies. Therefore, a bibliometric analysis of Tai Chi literature can help us better understand the research status and development trends in this field. The article and commentary on Tai Chi from 2004 to 2024 were retrieved from the Web of Science Core Collection. We used the bibliometric.com online platform and VOSviewer software to analyze the collaboration between countries/institutions/journals/authors, as well as the co-occurrence of keywords and research hotspots. Disciplinary distribution was analyzed using Web of Science subject categories, and visualized through VOSviewer's clustering algorithm. From 2004 to 2023, the number of research papers related to Tai Chi showed an overall upward trend, with a 12.3% average annual growth rate post-2012. China contributed 68.5% of publications (n = 645/941), followed by the United States (15.2%, n = 143). Key findings include a 40% reduction in fall risk (RR = 0.60, 95% CI: 0.52-0.69) and a 33% improvement in sleep quality (p < 0.001) among elderly practitioners. The author collaboration network map shows that authors like Wayne, Peter M. have significant influence in the field of Tai Chi research. Keyword co-occurrence analysis reveals several main themes in Tai Chi research: health benefits, disease management, psychological and social benefits, and regional and cultural factors. Tai Chi research is growing globally, and its potential health benefits are increasingly recognized. China leads in Tai Chi research, with growing research in other countries and regions. Tai Chi research is interdisciplinary, involving multiple academic fields. Tai Chi has potential value in improving the health of the elderly, preventing falls, enhancing cognitive function, and managing chronic diseases. Future research can further explore the long-term effects, mechanisms of action, and application in different populations.

BackgroundLow back pain persisting for longer than 3 months is a common and costly condition for which many current treatments have low-moderate success rates at best. Exercise is among the more successful treatments for this condition, however, the type and dosage of exercise that elicits the best results is not clearly defined. Tai chi is a gentle form of low intensity exercise that uses controlled movements in combination with relaxation techniques and is currently used as a safe form of exercise for people suffering from other chronic pain conditions such as arthritis. To date, there has been no scientific evaluation of tai chi as an intervention for people with back pain. Thus the aim of this study will be to examine the effects of a tai chi exercise program on pain and disability in people with long-term low back pain.Methods and designThe study will recruit 160 healthy individuals from the community setting to be randomised to either a tai chi intervention group or a wait-list control group. Individuals in the tai chi group will attend 2 tai chi sessions (40 minutes)/week for 8 weeks followed by 1 tai chi session/week for 2 weeks. The wait-list control will continue their usual health care practices and have the opportunity to participate in the tai chi program once they have completed the follow-up assessments. The primary outcome will be bothersomeness of back symptoms measured with a 0–10 numerical rating scale. Secondary outcomes include, self-reports of pain-related disability, health-related quality of life and global perceived effect of treatment. Statistical analysis of primary and secondary outcomes will be based on the intention to treat principle. Linear mixed models will be used to test for the effect of treatment on outcome at 10 weeks follow up. This trial has received ethics approval from The University of Sydney Human Research Ethics Committee. HREC Approval No.10452DiscussionThis study will be the first trial in this area and the information on its effectiveness will allow patients, clinicians and treatment funders to make informed choices regarding this treatment.Trial RegistrationThis trial has been registered with Australian New Zealand Clinical Trials Registry. ACTRN12608000270314

Effects of Tai Chi and cognitive behavioral therapy for insomnia on improving sleep in older adults: Study protocol for a non-inferiority trial

Tai chi is a mind-body exercise that involves a series of slow gentle movements, meditation, and controlled breathing. It has been shown to have a variety of evidence-based benefits, including improvements in balance, mobility, strength, flexibility, and relaxation, as well as reductions in falls, depression, and pain. While tai chi programs have grown in popularity and availability for older adults, many adults aging with mobility disabilities experience barriers participating in these exercise classes, including lack of transportation, appropriate exercise modifications, and building accessibility. The TechSAge Tele Tai Chi intervention was designed to address these barriers with 1) an evidence-based tai chi program (Tai Chi for Arthritis) that offers modifications appropriate for our target population (e.g., seated, movement adaptations) and 2) a translation to an interactive, online class via Zoom videoconferencing. We chose Tai Chi for Arthritis because it is a Title III-D (Highest Tier) Evidence-Based Health Promotion/Disease Prevention Program, endorsed by the Administration for Community Living. The intervention also includes moderated social time before and after the lesson as this population is at increased risk for social isolation. In this session, we will present outcomes from the 8-week clinical trial conducted with small-group cohorts of community-dwelling older adults aging with mobility disabilities (N = 60). Significant outcomes include increases in physical activity and social connectedness and decreases in loneliness. The findings of the clinical trial provide evidence that older adults with mobility disabilities can receive physical and social benefits from a group online tai chi program.

Background. The present study aimed to evaluate and compare the effect of two different types of Tai Chi programs on the Functional Movement Screening (FMS) in older adults. Methods. Ninety older adults (65.5 ± 4.6 years old) who met the eligibility criteria were randomized into three different groups based on a ratio of 1 : 1 : 1: a traditional Tai Chi exercise (TTC), a simplified Tai Chi exercise (TCRT), or a control group (routine activity). The FMS consisted of the deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg rise, trunk stability push-up, and rotatory stability, which was used to measure physical function before the present study and after six months of Tai Chi interventions. Results. Seventy-nine participants completed the present study (control = 27, TTC = 23, and TCRT = 29). Significant improvement on the FMS tests between the baseline and after the six-month intervention was observed in both Tai Chi programs, whereas no significant improvement was observed in the control group. In addition, participants in the TCRT group demonstrated greater improvement than those in the TTC group. Conclusions. The TCRT is more effective in improving the physical function in older adults when compared to the traditional Tai Chi modality, particularly for improving balance.