Sun-style Tai Chi Research Articles

Tai Chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomized controlled trials.

As the population ages, the health of older adults is becoming a public health concern. Falls are a significant threat to their health due to weakened balance. This study aims to investigate the beneficial effects of Tai Chi on fall prevention and balance improvement in older adults. We conducted a systematic review and meta-analysis of randomized controlled trials related to Tai Chi, falls, and balance ability, searching PubMed, Embase, and Cochrane Library databases from their establishment until December 31, 2022. Two independent reviewers performed the search, screening of results, extraction of relevant data, and assessment of study quality. This study followed the PRISMA guidelines for systematic review and meta-analysis. Totally 24 RCTs were included for meta-analysis, and the results showed that Tai Chi can effectively reduce the risk of falls in older adults (RR: 0.76, 95% CI: 0.71 to 0.82) and decrease the number of falls (MD [95% CI]: -0.26 [-0.39, -0.13]). Tai Chi can also improve the balance ability of older adults, such as the timed up and go test (MD [95% CI]: -0.69 [-1.09, -0.29]) and the functional reach test (MD [95% CI]: 2.69 [1.14, 4.24]), as well as other balance tests such as single-leg balance test, Berg balance scale, and gait speed (p < 0.05). Subgroup analysis showed that Tai Chi is effective for both healthy older adults and those at high risk of falls (p < 0.001), and its effectiveness increases with the duration and frequency of exercise. In addition, the effect of Yang-style Tai Chi is better than that of Sun-style Tai Chi. Tai Chi is an effective exercise for preventing falls and improving balance ability in older adults, whether they are healthy or at high risk of falling. The effectiveness of Tai Chi increases with exercise time and frequency. Yang-style Tai Chi is more effective than Sun-style Tai Chi. https://clinicaltrials.gov/, identifier CRD42022354594.

Feasibility of Implementing a Tai Chi Program in an Assisted Living Facility: Reducing Fall Risks and Improving Quality of Life.

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.

A Feasibility Study Assessing the Benefits of Seated Sun-Style Tai Chi Among Individuals with Multiple Sclerosis

A Feasibility Study Assessing the Benefits of Seated Sun-Style Tai Chi Among Individuals with Multiple Sclerosis

Effects of Tai Chi therapy on body mass index and physical index of intellectual disability.

Continuous program development and application are necessary in order to manage the health and address the problems of secondary metabolic disorders for people with intellectual disabilities. This study examines the effects of Tai Chi therapy on body mass index (BMI) and physical index among people with intellectual disabilities. A quasi-experimental study using a pretest-post-test control group, non-synchronized design was employed. Samples were in total 104 people with intellectual disabilities (experimental: n = 67, control: n = 37) in two facilities in South Korea. They were randomly allocated using a coin toss into the two groups. Tai Chi therapy as an experimental intervention was the Sun style Tai Chi exercise, which consists of the warm-up (5 min), main exercise (45 min), and finishing (meditation, 10 min). Tai Chi therapy was conducted twice a week for a total of 40 sessions for 5 months (1 hour each) by one professional instructor. Measures were general characteristics of study participants, BMI as degree of obesity, and physical index. Data were analyzed using the SPSS 21.0 program (descriptive statistics, χ2 test, independent t test). A P value of less than .05 was considered statistically significant. There were statistically significant differences on fasting blood glucose (t = 4.351, P < .001) and high-density lipoprotein (t = -2.052, P = .043) in the physical index between the two groups. Tai Chi therapy was an effective intervention for decreasing fasting blood glucose and for increasing high-density lipoprotein in those with intellectual disabilities. Tai Chi therapy can be implied as a nursing intervention for intellectual disabilities in nursing practice.

Adherence to mind-body therapies for knee osteoarthritis: a systematic review and meta-analysis

Adherence to mind-body therapies for knee osteoarthritis: a systematic review and meta-analysis

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs*

Objective: To identify effective mind-body exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning non-traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with mind-body exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, D-) was used, based on statistical significance (P < 0.5) and clinical importance (⩾15% improvement). Results: The four high-quality studies identified demonstrated that various mind-body exercise programs are promising for improving the management of knee osteoarthritis. Hatha Yoga demonstrated significant improvement for pain relief (Grade B) and physical function (Grade C+). Tai Chi Qigong demonstrated significant improvement for quality of life (Grade B), pain relief (Grade C+) and physical function (Grade C+). Sun style Tai Chi gave significant improvement for pain relief (Grade B) and physical function (Grade B). Conclusion: Mind-body exercises are promising approaches to reduce pain, as well as to improve physical function and quality of life for individuals with knee osteoarthritis.

Systematic review and meta-analysis: Tai Chi for preventing falls in older adults

ObjectiveIt remains unclear whether Tai Chi is effective for preventing falls in older adults. We undertook this systematic review to evaluate the preventive effect of Tai Chi by updating the...

A supplemental report to a randomized cluster trial of a 20-week Sun-style Tai Chi for osteoarthritic knee pain in elders with cognitive impairment

ObjectiveThis was a secondary data analysis of a cluster-randomized clinical trial that tested the efficacy of a 20-week Sun-style Tai Chi (TC) program in reducing pain in community-dwelling elders with cognitive impairment and knee osteoarthritis (OA). The study also examined whether elders’ level of cognitive function was related to the outcomes of the TC program. MethodElders (N=55) were recruited from 8 study sites. Each site was randomly assigned to participate in either a 20-week TC or an education program. Verbal report of pain was measured by a Verbal Descriptor Scale (VDS) at weeks 1, 5, 9, 13, 17 and 21 (designated as times 1–6). Pain behaviors and analgesic intake were also recorded at times 1–6. ResultsAt post-test, scores on the VDS and observed pain behaviors were significantly better in the TC group than in the control group (p=0.008–0.048). The beneficial effects of TC were not associated with cognitive ability. ConclusionThese results suggest that TC can be used as an adjunct to pharmacological intervention to relieve OA pain in elders with cognitive impairment.Trial registration: Clinical Trial.gov NCT01528566.

From the May Issue of JAMDA

From the May Issue of JAMDA

Impact of Tai-Chi on Falls Among Preclinically Disabled Older People. A Randomized Controlled Trial

ObjectiveTo investigate the effectiveness of tai-chi in preventing falls among community-dwelling older people. DesignMultisite parallel group individually randomized controlled trial. SettingMelbourne, Australia. ParticipantsPreclinically disabled community-dwelling people 70 + years (n = 503), without major medical conditions or moderate to severe cognitive impairment. InterventionSixty-minute modified Sun style tai-chi group-based exercise program twice weekly for 48 weeks; control intervention was a seated group-based flexibility exercise program of the same dose. MeasurementsAll falls, self-reported using a monthly calendar, analyzed at 24 weeks and 48 weeks. Injurious falls reported in follow-up telephone interviews for each reported fall. ResultsThe adjusted fall incidence rate ratios at 24 and 48 weeks were 1.08 [(95% confidence interval (CI) 0.64–1.81)], and 1.12 (95% CI 0.75–1.67), respectively. A higher proportion of intervention participants ceased attendance in the first 24 weeks (difference 17.9%, 95% CI 9.6–25.8), and the second 24 weeks (2.7%, 95% CI −5.0 to 10.4). Intervention participants who ceased attendance had lower left quadriceps strength (difference 3.3 kg 95% CI 0.15–6.36) and required longer to complete the timed up and go test (difference 1.7 seconds 95% CI 0.22–3.17) at baseline. ConclusionsThis study does not support modified Sun style tai-chi as a falls prevention measure among relatively well community-dwelling older people with modified mobility and at increased risk of disability. Insufficient intervention intensity, or low exercise class attendance may have contributed to the lack of effect, as may have attrition bias among the intervention group.

Experiences and perceptions of the short-form Sun-style Tai Chi training in Caucasians with COPD

IntroductionShort-form Sun-style Tai Chi (SSTC) is an effective form of exercise training for people with COPD. However, the experiences and perceptions of people with COPD about SSTC are unknown. The aim of this study was to investigate the experiences and perceptions of STSS training by people with COPD. MethodsPeople with COPD who participated in a 12-week SSTC program were asked to complete a survey. Each question was associated with a visual analogue scale (VAS) of 100 millimetres (mm) and participants were asked to place a mark on the line at the point which best described the answer to the question. A higher score indicated a better experience. ResultsTwenty-three Caucasians with COPD and no previous Tai Chi experience, mean (SD) FEV1=55 (16)% predicted, completed the survey after SSTC training. Although participants reported moderate difficulty in remembering Tai Chi movements VAS=53 (30)mm, they reported high enjoyment with Tai Chi training (88 (10)mm) and large perceived improvement in physical fitness (77 (20)mm), flexibility (75 (20)mm), balance 78 (10)mm) and relaxation (79 (20)mm). The majority of participants indicated that they would continue Tai Chi as their regular maintenance exercise regimen in the long-term (82 (20)mm). ConclusionsCaucasians with COPD found that SSTC was an enjoyable mode of exercise and that it was an effective way to improve physical fitness, flexibility, balance and relaxation. Participants reported that they would continue Tai Chi as their regular maintenance exercise regimen.

IMPACT OF TAI CHI ON IMPAIRMENT, FUNCTIONAL LIMITATION, AND DISABILITY AMONG PRECLINICALLY DISABLED OLDER PEOPLE: A RANDOMIZED CONTROLLED TRIAL

BackgroundIntegration of falls prevention with promotion of independence for older people will enhance uptake of effective programs.ObjectiveTo test the effect of tai-chi on both progression of disability and falls prevention...

Impact of Tai Chi on impairment, functional limitation, and disability among preclinically disabled older people: a randomized controlled trial

BackgroundIntegration of falls prevention with promotion of independence for older people will enhance uptake of effective programmes.ObjectiveTo test the effect of tai-chi on both progression of disability and falls prevention...

Impact of Tai Chi on Impairment, Functional Limitation, and Disability Among Preclinically Disabled Older People: A Randomized Controlled Trial

Day L, Hill KD, Jolley D, Cicuttini F, Flicker L, Segal L. Impact of tai chi on impairment, functional limitation, and disability among preclinically disabled older people: a randomized controlled trial. ObjectivesTo test the effect of tai chi on the progression of preclinical disability to manifest disability compared with seated flexibility exercise, and to examine whether tai chi mediates delayed disability by reducing impairments in musculoskeletal, cardiovascular, and neurologic systems, and related functional limitations. DesignMultisite parallel group individually randomized controlled trial. SettingGeneral community. ParticipantsPreclinically disabled community-dwelling people older than 70 years (n=503), without major medical conditions or moderate to severe cognitive impairment. InterventionModified Sun style tai chi exercise compared with seated flexibility exercise, both programs delivered in groups for 60 minutes twice weekly for 24 weeks. Main Outcome MeasuresDisability measured with the Late-Life Function and Disability Instrument. Secondary outcomes were impairments and functional limitations of the musculoskeletal, neurologic, and cardiovascular systems. ResultsThere was little change within or between the 2 groups. The mean change in the Disability Frequency Score was 0.3 and 0.1 points (100-point scale) for the intervention and control groups, respectively (adjusted difference −.21; 95% confidence interval [CI] −.99 to .56). The mean change in the Disability Limitation Score was −0.1 and −.04 points for the intervention and control groups, respectively (adjusted difference −0.6; 95% CI −2.31 to 1.11). There was little effect on impairments or functional limitations. A higher proportion of intervention participants ceased attending the exercise program (difference=17.9%, 95% CI 9.6–25.8). Multiple imputation of missing data did not change the results. ConclusionsModified Sun style tai chi did not have an impact on impairment, functional limitations, or disability in preclinically disabled older people when delivered for 24 weeks. Withdrawal from the exercise classes was high but did not explain the null result. Improved compliance, or a longer or more intensive program, may be required.

Tai Chi and Its Effects on Dynamic Postural Control in the Initiation of Gait by Older People

[Purpose] This study examined the changes in the translation of the center of pressure (COP) when older adults initiated gait before and after Tai Chi (TC) training. [Subjects] Twenty older adults, ranging in age from 65 to 83 years, participated in a 16-week TC training program. [Methods] Before and after the TC training the subjects were asked to perform gait initiation (GI). The subjects exercised with Sun-style TC, which incorporates elements that emphasize continuous flowing movement, balance control, endurance, strength, concentration and awareness of the environment, three times per week over a 16-week period. The differences in COP excursion in the anteroposterior (A-P) and mediolateral (M-L) directions between preand post-training were analyzed using the data collected from two force plates. [Results] The COP displacement in the A-P and M-L directions after TC training was increased significantly compared to that observed pre-training. [Conclusion] The 16-week practice of TC improved the ability of participants to generate momentum via a greater COP shift in the A-P and M-L directions in the initiation of gait as well as their ability to maintain balance and lateral stability. TC training may be effective for prevention of falls among the healthy elderly.

A randomized controlled trial of a 20 week Tai Chi program for osteoarthritic knee pain in elders with mild dementia

This cluster-randomized controlled trial tested the efficacy of a modified Sun Style Tai Chi (TC) program in reducing knee osteoarthritis (OA) pain in community-dwelling elders with mild cognitive impairment (CI). Fifty-five eligible participants in eight sites were randomly allocated to the TC (N=28) or activity group (N=27) for 20 weeks. There were significant interactions between groups and times (p= 0.0207 - 0.0476), as measured by the generalized estimated equation model on 4 of the 5 pain outcomes, including monthly average scores on Verbal Descriptor Scale (VDS), monthly average acetaminophen equivalence analgesic dosage, 3-day average scores on the Western Ontario and McMaster (WOMAC) pain subscale and number of pain behaviors. The activity group's monthly average VDS score and monthly average analgesic dosage remained constant over the 5-month study period. However, in the TC group, the monthly average VDS score dropped .33 (25% reduction) by Month 5, and the monthly average analgesic dosage dropped 223 mg by Month 5 (17% reduction). The TC group's WOMAC pain scores declined sharply over the 5-month period, by 2.6 or 37%. In contrast, the activity group's WOMAC scores did not start to decline until the very end of the intervention and the decline was less than in the TC group (1.03, 14% reduction). We saw a trend toward an increase in the number of pain behaviors in the activity group (1.63, 33% increase) while the number of pain behaviors in the TC group declined marginally significantly (.96, 21% reduction). These results show that TC can be effectively used as adjunct therapy to reduce OA knee pain in elders with mild CI. This study was supported by the National Institute of Nursing Research (R21NR010003) and Alzheimer's Arkansas.

Teaching Tai Chi to elders with osteoarthritis pain and mild cognitive impairment

This article describes the authors' experience and strategies in teaching Tai Chi, a gentle exercise derived from an ancient Chinese martial art, to mildly cognitively impaired elders to relieve osteoarthritic knee pain. The 12-form Sun-style Tai Chi, a set of Tai Chi forms endorsed by the American Arthritis Foundation, was used in the program. Teaching Tai Chi to elders with mild cognitive impairment requires particular strategies tailored to their physical and cognitive frailty. When effectively taught, Tai Chi can be a unique and cost-effective intervention for elders with knee pain caused by osteoarthritis.

A study design to investigate the effect of short-form Sun-style Tai Chi in improving functional exercise capacity, physical performance, balance and health related quality of life in people with Chronic Obstructive Pulmonary Disease (COPD)

The effectiveness of exercise training in people with COPD is well established. However, alternative methods of training such as Tai Chi have not been widely evaluated. This paper describes the study design of a clinical trial which aims to determine if short form Sun-style Tai Chi improves exercise capacity and quality of life in people with COPD. Method: This randomised controlled trial will be conducted with concealed allocation and blinded outcome assessment. Participants will be recruited from Concord Repatriation General Hospital, Sydney. After baseline measurement, participants will be randomised into either a Tai Chi Group or a Control Group. Participants in the Tai Chi Group will undergo supervised training twice weekly for twelve weeks. Participants in the Control Group will undergo usual medical care. Measurements will be taken at baseline (week 0) and after the study period (week 12). The primary outcome measurement is endurance walking capacity assessed by the endurance shuttle walk test. Secondary outcomes include measures related to peak walking capacity, physical performance, balance, muscle strength and quality of life. Details of the physiological responses during Tai Chi will be collected in a small cohort to determine the training intensity of Sun-style Tai Chi. Discussion: If short form Sun-style Tai Chi improves exercise capacity, physical performance and quality of life in people with COPD, this would provide an alternate form of exercise training which does not require exercise equipment thus making effective exercise training more accessible for the large numbers of people with COPD.

Hydrotherapy and Tai Chi each provide clinical improvements for older people with osteoarthritis

For people with osteoarthritis of the hip or knee, do hydrotherapy or Tai Chi give worthwhile improvements in pain and physical function? Randomised, 3-arm, parallel, controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Tertiary hospital, Sydney, Australia. Adults aged 59–85 years, with osteoarthritis of the hip or knee meeting American College of Rheumatology criteria, recruited through advertisements, social clubs for older people, and referral from local general practitioners and rheumatologists. 55 participants were randomised to hydrotherapy, 56 to Tai Chi, and 41 to a control group. Participants in either of the two treatments groups were required to attend classes (max 15 participants) for one hour, twice per week for 12 weeks. Hydrotherapy involved lower limb exercise in waist-deep water, including walking, free-standing and bar work, running, and stairs. Tai Chi included a 10-minute warm-up followed by a modification of 24 forms of Sun style Tai Chi. Participants were allowed to purchase, if they desired, a Tai Chi video to assist with home practice. The control group were waitlisted for 12 weeks and then randomly allocated to one of the two treatments. The primary outcomes were pain and physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included the SF-12 general health status questionnaire; the Depression, Anxiety and Stress Scale of psychological well being; the participant's global assessment of treatment effectiveness and current status of the joint that had originally been the most painful; and physical performance measures (50-foot walk test, stair climb test, and Up and Go test). Outcomes were assessed at the end of the 12-week treatment period, and 12 weeks later. At the end of treatment, pain had improved by 6 points (95% CI 0 to 13) more in the hydrotherapy group than the control group. Similarly, physical function had improved by 10 points (95% CI 4 to 14) more in the hydrotherapy group and by 10 points (95%CI 3 to 17) more in the Tai Chi group. The hydrotherapy group also showed significant treatment benefits in the physical component summary of the SF-12 and the three physical performance measures. Twelve weeks later, comparisons with a no-treatment control group were not possible, but the outcomes that had improved significantly during treatment had mostly been maintained. Older people with osteoarthritis of the hip or knee can obtain clinically worthwhile improvements in physical function from hydrotherapy or Tai Chi.

Effects of Tai Chi Exercise in Elderly with Knee Osteoarthritis

This study was to determine whether the Sun-style 24 forms of Tai Chi exercise improve pain, stiffness, disability, knee joint motion, mobility, balance or falling. Forty-six community-dwelling elderly subjects (mean age, 75.46+/-6.28) voluntarily participated in an intervention group of either 24 forms of Sun-style Tai Chi for 60 min, 2 times per week for 12 weeks or a control group. A non-equivalent pretest-posttest design was used. Independent t-test and ANCOVA were used to examine group differences by using SPSS12.0. The experimental group had significantly less pain (F=7.60, p=.008) and stiffness (t=-3.19, p=.003) than the control group. Also there were significant improvements in knee joint motion on the right knee (t=2.44, p=.019), left knee (t=2.30, p=.026), rising time (F=8.03, p=.07), balance on the left single leg test (t=2.20, p=.033), and fear of falling (t=-2.33, p=.024) in the Tai Chi exercise group. No significant group differences were found in disability and falls efficacy. The Sun-style 24 forms Tai Chi exercise is effective in decreasing pain, stiffness, fear of falling and it improves balance, rising time, and knee joint motion. We suggest a continuing long term intervention to decrease disability and increase efficacy concerning falls.