Article

The effect of Tai Chi exercise on gait initiation and gait performance in persons with Parkinson's disease

Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA.
Parkinsonism & Related Disorders (Impact Factor: 3.97). 07/2013; 19(11). DOI: 10.1016/j.parkreldis.2013.06.007
Source: PubMed

ABSTRACT

Gait dysfunction and postural instability are two debilitating symptoms in persons with Parkinson's disease (PD). Tai Chi exercise has recently gained attention as an attractive intervention for persons with PD because of its known potential to reduce falls and improve postural control, walking abilities, and safety at a low cost. The purpose of this report is to investigate the effect of Tai Chi exercise on dynamic postural control during gait initiation and gait performance in persons with idiopathic PD, and to determine whether these benefits could be replicated in two different environments, as complementary projects. In these two separate projects, a total of 45 participants with PD were randomly assigned to either a Tai Chi group or a control group. The Tai Chi groups in both projects completed a 16-week Tai Chi exercise session, while the control groups consisted of either a placebo (i.e., Qi-Gong) or non-exercise group. Tai Chi did not significantly improve Unified Parkinson's Disease Rating Scale Part III score, selected gait initiation parameters or gait performance in either project. Combined results from both projects suggest that 16 weeks of class-based Tai Chi were ineffective in improving either gait initiation, gait performance, or reducing parkinsonian disability in this subset of persons with PD. Thus the use of short-term Tai Chi exercise should require further study before being considered a valuable therapeutic intervention for these domains in PD.

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Available from: Joe R Nocera, May 21, 2014
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    • "Additionally, clinical and neurophysiological data indicate that TC may attenuate agerelated cognitive decline, including executive function, which is critical to dynamic postural control (Wei et al., 2013; Hawkes et al., 2014; Wayne et al., 2014b). However, the potential for TC to reduce cognitive–motor interference, and specifically to improve gait performance during a DT activity, has not received much attention (Amano et al., 2013; Manor et al., 2014). "
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    ABSTRACT: Tai Chi (TC) exercise improves balance and reduces falls in older, health-impaired adults. TC's impact on dual task (DT) gait parameters predictive of falls, especially in healthy active older adults, however, is unknown. To compare differences in usual and DT gait between long-term TC-expert practitioners and age-/gender-matched TC-naïve adults, and to determine the effects of short-term TC training on gait in healthy, non-sedentary older adults. A cross-sectional study compared gait in healthy TC-naïve and TC-expert (24.5 ± 12 years experience) older adults. TC-naïve adults then completed a 6-month, two-arm, wait-list randomized clinical trial of TC training. Gait speed and stride time variability (Coefficient of Variation %) were assessed during 90 s trials of undisturbed and cognitive DT (serial subtractions) conditions. During DT, gait speed decreased (p < 0.003) and stride time variability increased (p < 0.004) in all groups. Cross-sectional comparisons indicated that stride time variability was lower in the TC-expert vs. TC-naïve group, significantly so during DT (2.11 vs. 2.55%; p = 0.027); by contrast, gait speed during both undisturbed and DT conditions did not differ between groups. Longitudinal analyses of TC-naïve adults randomized to 6 months of TC training or usual care identified improvement in DT gait speed in both groups. A small improvement in DT stride time variability (effect size = 0.2) was estimated with TC training, but no significant differences between groups were observed. Potentially important improvements after TC training could not be excluded in this small study. In healthy active older adults, positive effects of short- and long-term TC were observed only under cognitively challenging DT conditions and only for stride time variability. DT stride time variability offers a potentially sensitive metric for monitoring TC's impact on fall risk with healthy older adults.
    Full-text · Article · Jun 2015 · Frontiers in Human Neuroscience
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    • "In incomplete outcome, one study was at high risk due to high drop-out rate [17], and others were at low risk [9], [10], [12]–[16]. Most of included studies were unclear in selective reporting due to without the study protocols [10], [12], [14]–[17]. Only two were considered to be low risk in this item [9], [13]. "
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    ABSTRACT: Background Recently, several studies assessed the effectiveness of Tai Chi for Parkinson's disease (PD), but the role of Tai Chi in the management of PD remained controversial. Therefore, the purpose of this systematic review is to evaluate the evidence on the efficacy of Tai Chi for PD. Methods Six English and Chinese electronic databases, up to April 2014, were searched to identify relevant studies. The risk of bias in eligible studies was assessed by Cochrane Collaboration's tools. The primary outcomes were motor function, balance and gait in individuals with PD. Standardized mean difference (SMD) and 95% confidence intervals (CI) of random-effect model were calculated. And heterogeneity was assessed based on the I2statistic. Results 7 randomized controlled trials and 1 non-randomized controlled trial were eligible. The aggregated results suggested that Tai Chi showed beneficial effects in improving motor function (SMD, −0.57; 95% CI −1.11 to −0.04; p = 0.03), balance (SMD, 1.22; 95% CI 0.80 to 1.65; p<0.00001) and functional mobility (SMD, 1.06; 95% CI 0.68 to 1.44; p<0.00001) in patients with PD, but not in improving gait velocity (SMD, −0.02; 95% CI −0.58 to 0.54; p = 0.94), step length (SMD, −0.00; 95% CI −0.57 to 0.56; p = 0.99), or gait endurance (SMD, 0.53; 95% CI −0.07 to 1.12; p = 0.08). Comparing with other active therapies, however, Tai Chi only showed better effects in improving balance (SMD, 0.74; 95% CI 0.38 to 1.10; p<0.0001). Conclusion Tai Chi should be a valid complementary and alternative therapy for PD, especially in improving motor function and balance. However, more studies with long follow-up are warrant to confirm the current finding of Tai Chi for PD.
    Full-text · Article · Jul 2014 · PLoS ONE
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    • "6-minute walking test, stride/step length, gait velocity, cadence, and time up and go were analyzed in eligible studies. The aggregated results suggested that aerobic exercise should show significant effects compared with control therapies in 6-minute walking test (SMD, 0.72; 95% CI 0.08 to 1.36; p = 0.03; Figure 4) [7], [8], [21], [22], [27], stride/step length (SMD, 0.31; 95% CI 0.08 to 0.53; p = 0.008; Figure 4) [7]–[9], [17], [21]–[23], [28], gait velocity (SMD, 0.35; 95% CI 0.10 to 0.60; p = 0.005; Figure 4) [7]–[9], [14], [15], [17], [20]–[24], [28], and time up and go (SMD, 0.42; 95% CI 0.08 to 0.76; p = 0.02; Figure 4) [7], [9], [21], [23], [25]. However, none of the trials indicated the evidence in favor of aerobic exercise for PD in the assessment of the cadence (SMD, −0.18; 95% CI −0.52 to 0.15; p = 0.28; Figure 4) [14], [17], [20], [23], [28]. "
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    ABSTRACT: Background: Although some trials assessed the effectiveness of aerobic exercise for Parkinson's disease (PD), the role of aerobic exercise in the management of PD remained controversial. Objective: The purpose of this systematic review is to evaluate the evidence about whether aerobic exercise is effective for PD. Methods: Seven electronic databases, up to December 2013, were searched to identify relevant studies. Two reviewers independently extracted data and assessed methodological quality based on PEDro scale. Standardised mean difference (SMD) and 95% confidence intervals (CI) of random-effects model were calculated. And heterogeneity was assessed based on the I 2 statistic. Results: 18 randomized controlled trials (RCTs) with 901 patients were eligible. The aggregated results suggested that aerobic exercise should show superior effects in improving motor actions (SMD, -0.57; 95% CI -0.94 to -0.19; p = 0.003), balance (SMD, 2.02; 95% CI 0.45 to 3.59; p = 0.01), and gait (SMD, 0.33; 95% CI 0.17 to 0.49; p<0.0001) in patients with PD, but not in quality of life (SMD, 0.11; 95% CI -0.23 to 0.46; p = 0.52). And there was no valid evidence on follow-up effects of aerobic exercise for PD. Conclusion: Aerobic exercise showed immediate beneficial effects in improving motor action, balance, and gait in patients with PD. However, given no evidence on follow-up effects, large-scale RCTs with long follow-up are warrant to confirm the current findings.
    Full-text · Article · Jul 2014 · PLoS ONE
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Questions & Answers about this publication

  • Pao Yen asked a question in Caffeine:
    Taichi that was developed before and after 1956 are totally different things. Which one was used in your experiment?
    A recent study in 2013 found that taichi developed after 1956 is just low-impact cardiovascular exercises benefitted muscles and muscle control mostly. Whereas taichi created before 1956 had self-healing properties from head to toe because their movements are slow enough to cheat the brain into thinking they are not moving. By using deep breathing and continuous leg movements, oxygenated blood can be squeezed to all capillary beds in the brain (and other internal organs and tissues) by moderate elevation of heart rate and increase of stroke volume. It then allows brain cells to produce new cells with normal DNA in a longer time period. Details can be found in my hypothesis called "Pao's Law of Exercise", which can be applied to a certain extend to other medical treatments, sports and the use of stimulants.
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      [Show abstract] [Hide abstract]
      ABSTRACT: Gait dysfunction and postural instability are two debilitating symptoms in persons with Parkinson's disease (PD). Tai Chi exercise has recently gained attention as an attractive intervention for persons with PD because of its known potential to reduce falls and improve postural control, walking abilities, and safety at a low cost. The purpose of this report is to investigate the effect of Tai Chi exercise on dynamic postural control during gait initiation and gait performance in persons with idiopathic PD, and to determine whether these benefits could be replicated in two different environments, as complementary projects. In these two separate projects, a total of 45 participants with PD were randomly assigned to either a Tai Chi group or a control group. The Tai Chi groups in both projects completed a 16-week Tai Chi exercise session, while the control groups consisted of either a placebo (i.e., Qi-Gong) or non-exercise group. Tai Chi did not significantly improve Unified Parkinson's Disease Rating Scale Part III score, selected gait initiation parameters or gait performance in either project. Combined results from both projects suggest that 16 weeks of class-based Tai Chi were ineffective in improving either gait initiation, gait performance, or reducing parkinsonian disability in this subset of persons with PD. Thus the use of short-term Tai Chi exercise should require further study before being considered a valuable therapeutic intervention for these domains in PD.
      Full-text · Article · Jul 2013 · Parkinsonism & Related Disorders