As you “retool” and re-educate yourself to prepare for new career opportunities and challenges in the 21st century, you may decide to focus on fitness for older adults. With this clientele, preventing falls is a major issue. Research has clearly shown that exercise is a successful intervention for fall prevention, as well as quality-of-life improvement, in older persons. But what type of exercise delivers the most benefits? A study by Li and colleagues (2004) addresses two important questions about the efficacy of tai chi (or tai chi chuan) exercise in fall prevention for seniors: (1) Does participation in tai chi improve balance and, in turn, decrease the risk of falls? and (2) does a tai chi program provide lasting functional balance benefits when the structured exercise is no longer provided? (Research on the health fitness effects of tai chi training for the elderly has been previously published by others. See, for example, “Health Fitness Effects of Tai Chi Training for the Elderly” on page 23.)
A group of 256 participants (77 males and 179 females) originally volunteered for the Li study, and 175 subjects completed the entire 1-year investigation. Subjects were all physically inactive adults from 70 to 92 years of age who were randomly assigned to a tai chi group or a stretching group, which served as the control. It is interesting to note that on a 5-point rating scale (poor = 1, fair = 2, good = 3, very good = 4, excellent = 5), 84% of the subjects initially rated their health as good or better. Physical inactivity was defined as no involvement in regular, moderate or vigorous physical activity for the immediate 3 months prior to the start of the study. All subjects were fully ambulatory and free of any chronic health problems that may have limited their ability to participate in the 6-month exercise program.
Both the stretching group and the tai chi group participated in exercise sessions 3 days a week for 6 months. No structured exercise interventions were offered during the 6-month postintervention period, and subjects were neither encouraged to participate in any follow-up exercise programs nor discouraged from doing so.
Tai Chi Intervention. The tai chi program was taught by certified tai chi instructors who followed a 24-form yang style of tai chi. A popular, modern and shorter version of the ancient Chinese health exercise, this style emphasizes weight changes in multiple directions, body alignment, motor coordination and involvement of all the major segments of the body (trunk, legs, arms). The subjects learned movements and postures, and synchronized breathing (aligned with the movements) was integrated into the program. Each session consisted of a 5- to 10-minute warm-up, 30 minutes of tai chi and a 5- to 10-minute cooldown. All exercise sessions were accompanied by music.
Stretching (Control) Intervention. The stretching program involved standing and seated stretches for the trunk and upper body, synchronized with deep abdominal breathing and relaxation exercises. In selecting a stretching protocol for the control group, the researchers reasoned that this type of program provided a low-intensity, low-impact exercise that provided enjoyment and social interaction comparable to those offered by the tai chi program. Stretching sessions were formatted similarly to the tai chi sessions (5- to 10-minute warm-up and cooldown, 30 minutes of exercise accompanied by music) but did not include any of the strength and balance exercises employed in the tai chi sessions.
Exercise compliance to both programs was favorable—80% of the tai chi participants and 81% of the stretching participants attended 50 or more of the 78 total sessions.
Three functional balance assessments were used to test the subjects: a dynamic gait index, the Berg balance scale and a functional reach test. The dynamic gait index assessed the subjects’ ability to alter their gait in response to a movement challenge (e.g., stepping over or around obstacles, changing speeds, stepping on uneven surfaces and performing pivot turns). The Berg balance scale included 14 physical tasks that resembled activities of daily living. The functional reach test measured the maximal distance each subject could reach forward beyond arm’s length while maintaining a fixed base of support in the standing position. Subjects were tested at baseline, 3 months and 6 months, and then again 6 months following the exercise phase.
In addition, each subject was given a “fall calendar” for tracking and recording falls. A fall was defined as any accident that resulted in a subject landing on the floor, ground, furniture or stairs. Participants also reported whether the fall resulted in their seeking any medical attention.
During the intervention period, the tai chi group performed significantly better than the stretching group on the three functional balance assessments. In fact, for the stretching group, there was no change in the baseline measurements for any of the assessments. In the 6-month postintervention follow-up, when no formalized exercise was offered, the tai chi group showed much slower deterioration in functional balance measures than did the stretching group. Moreover, during the postexercise period, the tai chi group recorded only 28 falls, in contrast to the stretching group’s 74 falls.
This study clearly demonstrates that tai chi training can lead to statistically significant improvements in functional balance in older persons. The improvements noted in this study resulted in a most meaningful reduction in falls during the 6-month period following the formalized tai chi intervention. At this time, researchers do not know the precise neural control and biomechanical mechanisms that translate to the increase in functional balance and reduction in falls. One could argue that the postural benefits of tai chi participation are attributable to the numerous changes from single-leg to double-leg stances, the movements involving various body stabilizers, and the constant coordination of the lower extremities with the upper extremities in the different forms.
As professionals, we are all aware of the major health impact and quality-of-life deterioration that falls present to elderly citizens. The Li study, with its large subject population, supports implementation of the yang style of tai chi as an exceptional exercise program for improving functional balance and preventing falls in the elderly.