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The effects of Tai Chi Chuan on physiological function and fear of falling in the less robust elderly: An intervention study for preventing falls
Abstract
The aim of this report is to investigate the effects of 8 weeks of intensive Tai Chi Chuan (TCC) training on physiological function and fear of falling (FOF) in the less-robust elderly. Forty-nine community-dwelling elderly, aged 60 or older, were classified randomly into a TCC training or control group. Physical performance measures (including one-leg stance, trunk flexion, and walking speed) and interviews were conducted before and after the intervention. The TCC group showed significant improvements in balance and flexibility, and a reduced FOF, when compared with the control group after the intervention. However, walking speed did not change significantly. The results suggest that a high-frequency, short-term TCC training program can improve balance, flexibility, and increase the confidence of less-robust elderly. These suggest the effectiveness of TCC for intervention as a means to prevent falling among high-risk elderly populations.
... Univ Sydney (32), Hong Kong Polytech Univ (32), and Shanghai Univ Sport (21) have the highest publication numbers (Figure 4). Univ Sydney (0.19), Curtin Univ (0.11), and Shanghai Univ Sport (0.10) also have the highest centrality. ...
... The analysis of references is also an important way for us to grasp the research hotspots. According to Tables 1 and 2, the research designs of these articles were mainly about randomized controlled trials (RCTs) [10,18,[28][29][30][31]34,36] and reviews (meta-analyses [9,32,35]) [27,33]. Therefore, these two designs are the prioritized choices for scholars writing high-quality articles. ...
... Currently, the focus of research appears to be shifting from a single tai chi intervention [60,61] to a multifactorial intervention (tai chi combined with cognitivebehavioral strategies or usual care) [62,63] as well as the effect of a specific tai chi movement [64,65]. Numerous studies have found strong evidence that tai chi can reduce falls among community-dwelling people [9][10][11]27,28,32]. However, some studies contradict this finding (Tables 1 and 2) [29,30,66]. ...
Recently, substantial studies have increased around the topic of the tai chi fall-prevention field. Few studies, however, have revealed the current progress and hotspots under a bibliometric analysis. Therefore, the present study aimed to conduct Citespace, a significant application for bibliometric analysis, to carry out the situation and trend in this field. This study has identified the core countries are the United States, China, Australia, and England, which are also the origins of the core institutions. Besides this, we also have found two large research groups led by Li and Sherrington. Moreover, the result has revealed that J Aging Phys Act and J Am Geriatr Soc are the primary journals. Geriatrics and gerontology, sport sciences, rehabilitation, and gerontology are the leading categories. Furthermore, one of the more important findings to come out in this study are that “elderly”, “Parkinson’s disease”, “vestibular rehabilitation”, “frail patient”, and “community fall prevention” are the research hotspots. “Women”, “proprioception”, “cognitive impairment”, “dementia”, “osteoarthritis”, and “stroke” are the potential research trend in the future. These findings suggest that the tai chi fall-prevention field has a broad research prospect. Although several questions remain uncertain currently, it is worthy for scholars to do further study.
... Thirteen studies blinded the testing personnel [9,17,22,27,28,[32][33][34][35][36][37]49]. Five studies with a PEDro score between 3 and 7 did not report inclusion and exclusion criteria [19,20,22,38,39]. Training intervention duration ranged from 8 [19,20,22,25,26,29,33,39] to 48 weeks [35], with most interventions lasting 8 or 12 weeks [17, 19-27, 29-33, 36, 38-41, 49] (n = 22). ...
... Five studies with a PEDro score between 3 and 7 did not report inclusion and exclusion criteria [19,20,22,38,39]. Training intervention duration ranged from 8 [19,20,22,25,26,29,33,39] to 48 weeks [35], with most interventions lasting 8 or 12 weeks [17, 19-27, 29-33, 36, 38-41, 49] (n = 22). Training frequencies varied between 2 and 7 times per week. ...
... Roughly, half of the trials conducted a 60-min workout (n = 17). When Tai Chi was indicated, Tai Chi Chuan, Sun style, and Yang style were subsumed under the umbrella term "Tai Chi" [23,26,32,33,38,39,42,49]. ...
Introduction:
Declines in physical fitness can notably affect healthy aging of older adults. Multimodal exercise training regimen such as mind-body interventions (MBIs) has been reported to mitigate these aging-related declines of physical function. This meta-analytical review aimed at pooling the effects of MBIs on physical fitness indices compared to active control (AC) and inactive control (IC) conditions in healthy older adults.
Methods:
The literature search was conducted in 3 databases using search terms with Boolean conjunctions. Randomized controlled trials applying MBIs focusing on improving physical fitness parameters in healthy seniors over 65 years of age were screened for eligibility. Eligibility and study quality were assessed by 2 researchers using the PEDro scale. Standardized mean differences (SMD) adjusted for small sample sizes (Hedges' g) served as main outcomes for the comparisons of MBIs versus IC and MBIs versus AC.
Results:
Thirty trials with 2,792 healthy community dwellers (mean age: 71.2 ± 4.7 years) were included. Large overall effects were found for strength (p < 0.001, SMD: 0.87 [90% CI: 0.43, 1.30], I2 = 94%), medium effects were observed for functional mobility (p = 0.009, SMD: 0.55 [90% CI: 0.20, 0.89], I2 = 83%), and small overall effects were found for static balance (p = 0.02, SMD: 0.35 [90% CI: 0.10, 0.60], I2 = 77%), endurance (p = 0.0001, SMD: 0.44 [90% CI: 0.25, 0.62], I2 = 0%), and flexibility (p = 0.003, SMD: 0.46 [90% CI: 0.21, 0.72], I2 = 54%) in favor of MBIs compared to IC. Small effects of strength slightly favoring AC (p = 0.08, SMD: -0.22 [90% CI: -0.43, -0.01], I2 = 52%) were found, whereas static balance moderately improved in favor of MBIs (p < 0.001, SMD: 0.46 [90% CI: 0.16, 0.76], I2 = 73%).
Discussion/conclusion:
MBIs induce small to moderate effects in relevant domains of physical fitness in healthy older adults. Strength should be better targeted with traditional resistance training routines, whereas balance seems to sufficiently benefit from MBIs. However, large variability between the studies was observed due to differences in methodology, intervention content, and outcomes that affect conclusive evidence.
... [5] Management of motor symptoms associated with PD includes pharmacological intervention and functional neurosurgery, especially deep brain stimulation. [1] Cholinesterase inhibitors have been used to improve for cognitive functions in 30%-40% of PD. [1] There is an increased interest in using Tai chi and Qigong as an alternative form of treatment to improve mental health, psychological well-being, and stress and sleep in several neurological conditions including PD. [6,7] Tai chi and Qigong are meditative, mind, and body exercise used in China over centuries for health benefits. Both Tai chi and Qigong use a combination of deep breathing and relaxed, controlled, gentle movements. ...
... [12][13][14] The beneficial effects of Tai chi include improvement in quality of life, reduced depression, and increased psychological well-being. [6] The aim of this study was to test the efficacy of four-week Tai chi training program on neuropsychological functions, motor symptoms, anxiety and depression, and quality of life in early-onset PD. ...
... Tai chi and Qigong have been increasingly recognized as an alternative mode of intervention to decrease stress and improve psychological functions in several clinical conditions. [6][7][8] It has been considered as an integrated mind and body program as it requires the synergy of both the mind and body. Its efficacy has been particularly demonstrated in improving mobility and balance in PD. [23] However, there are very few studies, which have explored the benefits on neuropsychological functions comprehensively including executive function, learning and memory, emotions such as anxiety and depression, quality of life, mobility, activity of daily living, cognitive and motor symptoms using UPDRS III in patients with PD. ...
... One such intervention involves motivating the older persons to engage in physical activity through structured instruction and encouragement. Programs that involve aerobic exercise or that improve balance and flexibility can be effective while increasing selfconfidence (5). ...
... These findings are in agreement with those of Loggbe et al., who concluded that TCC had a significant and positive effect on the FOF (7). Our findings are also in agreement with those of another Japanese study, where the experimental group demonstrated reduced FOF following an 8-week TCC program (5). In this study, the FOF was assessed via the MFES. ...
... Because of beneficial effects on the motor coordination, balance, body consciousness, and the overall function of muscles, tendons and joints, especially by increasing the articular function of sub-extremities and body consciousness, TCC may enhance individual perception of safety while performing wideranging activities such as walking, lying down, getting up, and running (12). In the present study, significant improvements in PSDQ sub-scale scores of perceived self-confidence, coordination, and flexibility are consistent with other results reported within the literature (5,13). ...
Introduction: This study was aimed to examine the effects of Tai Chi Chuan on the fear of falling, balance, and physical self-perception in the elderly. Materials and Method: This controlled trial using blocked randomization was stratified by sex, age, and history of falls and conducted with 44 elderly participants, of which 20 underwent Tai Chi Chuan training as experimental group and 24 served as an untrained control group. The experimental group underwent Tai Chi Chuan training for 12 weeks, twice a week, for 35-40 min/day under a research team member. The control group received no intervention. Data were collected from both groups by using a personal information form, the Modified Falls Efficacy Scale, the Physical Self-Perception Questionnaire, and the Tinetti Balance and Gait Assessment. After the exercise practice, each group was re-subjected to the same scales. Results: Student’s t-test and paired sample t-tests were used to analyze the data. The balance and physical self-perception of individuals in the Tai Chi Chuan group significantly improved compared with that in the control group (p<0.001). Additionally, individuals in the Tai Chi Chuan group demonstrated reduced fear of falling (p<0.001). Conclusion: Tai Chi Chuan positively affects balance and physical self-perception, and reduced fear of falling in elderly individuals. As a result, the potential application of Tai Chi Chuan was suggested in various settings where elderly individuals inhabit.
... Fear of falling could be increased with age, can lead to self-imposed activity restrictions (functional decline, decreased mobility, decreased social activity, depression, and low life satisfaction) (Myers, Fletcher, Myers, and Sherk, 1998). Tai Chi is widely used and is one of the best activities recommended to help decrease the effects of muscular rigidity through providing slow stretching movements [2]. The purpose of this study was to examine the evidence of Tai Chi exercises in reducing the amount of fear of falling in older adults. ...
... Zhang et al. [2] which examined the effects of Tai Chi Chuan on physiological function and fear of falling in the less robust elderly was selected as the strongest evidence-based article. Their target population was less robust elderly who are 70-year-old and older, with ambulatory ability, and live in unsupervised environment. ...
... Fear of falling could be increased with age, can lead to self-imposed activity restrictions (functional decline, decreased mobility, decreased social activity, depression, and low life satisfaction) (Myers, Fletcher, Myers, and Sherk, 1998). Tai Chi is widely used and is one of the best activities recommended to help decrease the effects of muscular rigidity through providing slow stretching movements [2]. The purpose of this study was to examine the evidence of Tai Chi exercises in reducing the amount of fear of falling in older adults. ...
... Zhang et al. [2] which examined the effects of Tai Chi Chuan on physiological function and fear of falling in the less robust elderly was selected as the strongest evidence-based article. Their target population was less robust elderly who are 70-year-old and older, with ambulatory ability, and live in unsupervised environment. ...
Objectives: this study was conducted to examine and review the evidence available regarding the effectiveness of Tai Chi exercises in reducing the
fear of falling in older adults.
Results: our review revealed four studies suggesting that in older adults with a fear of falling, the Tai Chi program compared to no or alternative
traditional educational program may produce a greater significant reduction in fear of falling.
Conclusion: Tai Chi exercises are effective and reduce the fear of falling in older adults significantly.
... La revisión bibliográica realizada establece que existe relación directa entre la práctica de Taiji Quan y el equilibrio (11 de las investigaciones así lo recogen). La mejora del equilibrio está asociada a la propiocepción corporal, los mecanismos que intervienen en la estabilidad de la marcha, la respuesta neuromuscular de las piernas, el equilibrio estático, el equilibrio dinámico y la coordinación; en deinitiva, el Taiji Quan puede ser prescrito como un medio adecuado para promocionar la salud en las personas mayores ( Zhang et al., 2006). Por otro lado, según Stenlund, Birgander, Lindahl, Nilsson y Ahlgren (2009), no debe dejarse de lado la mejora del movimiento de los brazos y el control de los mismos, además de la toniicación de hombros que progresa signiicativamente, sobre todo al caminar y al correr. ...
... Por otro lado, la puesta en práctica de las sesiones oscila entre los 30, 60 y 90 minutos, incluyendo en estos tiempos tanto el calentamiento como la vuelta a la calma (Carrillo 2013; Du, Dong, Zhang, Jin, Xu et al., 2015). Finalmente, en otros estudios no se observaron mejoras signiicativas entre los grupos de tratamiento y el grupo de control debido a la corta duración de la intervención, de 6 a 8 semanas en vez de las 12 habituales o más, aunque en otros trabajos fueron especialmente signiicativos después de tan solo 8 semanas (Zhang et al., 2006). ...
p>El ejercicio y la actividad física mejoran la salud psicológica y física de los usuarios. Sin embargo, pocas veces se han examinado los efectos cuantitativos del Tai Chi Chuan en los sistemas cardiovascular, locomotor, mental, cognitivo y psicosocial entre otros. Se revisaron sistemáticamente los efectos sobre el estrés, la presión arterial y el riesgo cardiopulmonar, la capacidad respiratoria y su incidencia sobre patologías de este sistema, el equilibrio, la elasticidad muscular sobre el sistema locomotor, la ansiedad, la depresión y trastornos del estado de ánimo en las poblaciones orientales y occidentales. Se han considerado 53 estudios con una muestra de 5.875 sujetos y 13 meta análisis. Hay que resaltar que el Tai Chi parece estar asociado con mejoras en la gran mayoría de los sistemas que analizan los autores pero destaca el bienestar psicológico, incluyendo la reducción del estrés, ansiedad, depresión así como las mejoras a nivel musculo esquelético. Las conclusiones definitivas son limitadas debido a la variación en los diseños, los resultados diversos y los controles incorrectos de calidad. Son necesarios más ensayos aleatorios que garanticen la evidencia.</p
... Growing evidence suggests that "Tai Chi" improves physical function and the quality of life for the elderly. This improved body balance, flexibility, and muscle strength, as well as boosted elderly confidence [102]. More than 500 studies and 120 systematic reviews on Tai Chi have been published. ...
Background
Musculoskeletal disorders are common problems that affect the elderly. They severely restrict mobility and dexterity, resulting in early retirement from work, lower levels of well-being, and reduced ability to participate in society. With the increase in life expectancy, the older populations are dreaming of active, painless, and independent lives in the face of functional limitations that are the result of various comorbidities with age progression.
Main text
The aim of the study is to highlight aging changes in the musculoskeletal system, risk factors that may have a negative impact on musculoskeletal, as well as strategies to optimize musculoskeletal health in the elderly. A narrative review was conducted through a series of literature searches in the database MEDLINE/PubMed focusing on musculoskeletal health. The search terms used were “muscle building,” “bone building,” “osteoporosis,” “osteopenia,” “sarcopenia,” “osteosarcopenia,” “fractures,” “falls,” “functional ability,” “nutrition,” “diet,” “obesity,” “comorbidity,” and “medication.” Data extraction was carried out by the investigators using a standardized data collection form with subsequent discussion among the authors. Peer-reviewed observational controlled and non-controlled studies (case–control and cohort studies) were selected. The data collected in the selected articles were all related to musculoskeletal health.
Conclusion
Many of the changes in the musculoskeletal system result more from disuse than from simple aging. Less than 10% of the Egyptian population participate in regular exercise, and the most sedentary group is older than 50 years of age. Long-term regular exercises may reduce the loss of bone and muscle mass and prevent age-associated increases in body fat.
... This was improved body balance, flexibility, and muscle strength as well as promoted confidence in the elderly less robust. 2 The long-term practice of "TaiChi" was effective to prevent and treatment of diseases ( Table 1). ...
Letter to Editor titled "TaiChi" Exercise for Elderly Care
... The benefits of Tai Chi on physical function and health-related excellence of lifespan for elderly have been documented, such as increased balance, flexibility, and sureness in lessrobust elderly (Zhang et al, 2006), benefits of strengthened hamstrings and active balance (Fong, 2006), a valuable effect on physical functioning (Fisher et al, 2002)and increased perceptions of self-efficacy (Duncan et al, 2001). Furthermore, Tai Chi is a low-intensity workout that has aerobic benefits,is active for improving health fitness (Lin et al, 2006). ...
... When analyzing the large heterogeneity via univariate meta-regression analysis regarding thoracolumbal spine flexibility, 91.4% of the between study heterogeneity could be explained by the existence of a balance impairment (Wehner et al., 2021). This is most apparent in the study of Zhang et al. (2006), who investigated the influence of Tai Chi on balance-impaired participants with a higher risk of falling (defined by a one leg standing time between 5 and 20 s). Significant improvements in both thoracolumbal spine flexibility (+4.5 cm) and the single-leg-stance test with open eyes (+12.3 s) have been reported. ...
The impact of spinal mobility and sagittal spinal shape on the development of
balance impairment supports the hypothesis that enhancing spine flexibility results
in an improvement in postural balance ability. Therefore, the aim of this study was
to investigate whether the range of motion of thoracolumbar rotation during the
movements of the Tai Chi Peking style routine is sufficient to improve thoracolumbar
flexibility. Three-dimensional kinematic and kinetic data were collected from eight
athletes of the German Wushu Federation, while performing all movements of the entire
Peking style routine (1) in a competition version corresponding to national/international
championships and (2) in a health sport version performed with shorter and higher
stances (i.e. a smaller distance between the feet and thus less knee flexion). For each
movement the total mean and standard deviation values for the total range of motion
of thoracolumbar rotation was calculated. Statistical analysis was performed using
the Wilcoxon signed-rank test for paired differences. Eight movements showed major
differences (10.12–19.73◦) between the two versions. For the remainingmovements, only
minor differences (0.7–9.56◦) were observed. All movements performed on both sides
showed no significant lateral differences. Most of the Tai Chi movements, regardless of
the performed version, cover a range of motion of thoracolumbar rotation that has the
potential to lead to an improvement of thoracolumbal spine flexibility with appropriate
training. The most effective single movements (25.97–72.22◦) are Brush Knee and Step
Forward, Step Back and Repulse Monkey, Grasp the Sparrow‘s Tail, Wave Hand in the
Clouds, and Fair Lady Weaves with Shuttle.
... Five studies reported the SLB outcome with eyes opened [22,24,31,32,39]. No significant heterogeneity was found in the studies (P = 0.10, I 2 = 49%). ...
Background
Traditional Chinese medicine (TCM) based exercises have been widely used in the prevention and treatment of balance, cardiopulmonary, and other related diseases in older adults. However, there seems to be no consensus on the improvement and comparison of physical performance, balance, and muscle strength in the elderly population.Objectives
To systematically examine the impact of different TCM-based exercises on physical performance, balance, and muscle strength outcomes in the elderly.Methods
We searched PubMed, EMBASE, Scopus, and Cochrane Center, CNKI and Wan Fang between their date of inception and March 2021. This meta-analysis was performed using RevMan5.3 software. Only randomized controlled trials (RCT) or controlled clinical trials (CCT) were considered in TCM-based exercises (Tai Chi, Ba Duan Jin, Qigong). The overall mean difference (MD) or standardized mean difference (SMD), and its 95% confidence interval (CI) were calculated.Main resultsA total of 27 studies with 2580 older adults met the inclusion criteria. The pooled analysis indicated that Tai Chi could be more effective in Times up and go (TUG) (MD = − 2.62, 95% CI − 4.00 to − 1.24, P = 0.0002), 5 times sit-stand (MD = − 1.89; 95%CI − 3.38 to − 0.40; P = 0.01), and handgrip strength outcomes (SMD = 0.69; 95%CI 0.52–0.86; P < 0.0001) compared to Ba Duan Jin and Qigong. The older adults performing Qigong could have a better benefit in Single-bed balance (SLB) with eyes closed compared to Tai Chi and Ba Duan Jin (MD = 3.42; 95%CI 1.55 to 5.29; P = 0.0003). Tai Chi also had benefits in terms of balance outcomes compared to those in the control group: Berg Balance scale (BBS) (MD = 1.41; 95% CI 0.03–2.85; P = 0.05), Functional reach test (FRT) (MD = 1.57; 95%CI 1.22–1.93; P < 0.0001). The Tai Chi study meta-analysis demonstrated significant effects on lower limb strength: knee extension (SMD = 0.56; 95%CI 0.26–0.86; P = 0.0003), ankle dorsiflexion (SMD = 0.67; 95%CI 0.02–1.31; P = 0.04) compared to the controls.
Conclusion
This systematic review reveals that TCM-based exercises can effectively improve physical performance outcomes, balance outcomes, and muscle strength in the elderly population. While there is limited evidence on the efficacy of other TCM-based lifestyle interventions, more high-quality clinical trials on this topic are warranted.
... (ii) Targeted therapy: As an exercise prescription, Tai Chi may have targeted and potential therapeutic effects for several diseases. Considering that Tai Chi is a mind-body exercise accompanied by slow and graceful movements, Tai Chi appears to be associated with improvements in motor [53][54][55], behavioral [21,56,57], cardiorespiratory [18,58,59] and cognitive [2,60,61] functions. However, the cross-talk mechanism of these effects is still unclear, besides that, more regulatory factors and circulatory pathways are worthy of investigating to prove the adaptation induced by Tai Chi. ...
While studies on the health benefits of Tai Chi have sprung up over the past four decades, few have engaged in collecting global data, estimating the developing trends, and conducting reviews from the perspective of visualization and bibliometric analysis. This study aimed to provide a summary of the global scientific outputs on Tai Chi research from 1980 to 2020, explore the frontiers, identify cooperation networks, track research trends and highlight emerging hotspots. Relevant publications were downloaded from the Web of Science Core Collection (WoSCC) database between 1980 and 2020. Bibliometric visualization and comparative analysis of authors, cited authors, journals, co-cited journals, institutions, countries, references, and keywords were systematically conducted using CiteSpace software. A total of 1078 publications satisfied the search criteria, and the trend of annual related publications was generally in an upward trend, although with some fluctuations. China (503) and Harvard University (74) were the most prolific country and institution, respectively. Most of the related researches were published in the journals with a focus on sport sciences, alternative medicine, geriatrics gerontology, and rehabilitation. Our results indicated that the current concerns and difficulties of Tai Chi research are “Intervention method”, “Targeted therapy”, “Applicable population”, “Risk factors”, and “Research quality”. The frontiers and promising domains of Tai Chi exercise in the health science field are preventions and rehabilitations of “Fall risk”, “Cardiorespiratory related disease”, “Stroke”, “Parkinson’s disease”, and “Depression”, which should receive more attention in the future.
... e frequency and duration of Tai Chi exercise generally adopted by healthy people were 2-3 times a week for 60 min, respectively. e results of several studies showed that performing simplified 24-form Tai Chi can improve the balance and posture control and reduce the risk of falls of the elderly [109][110][111][112][113][114][115]. e simplified 24-form Tai Chi can also improve self-efficacy [116,117] and quality of life [118] and relieve stress in the elderly [119]. ...
Objectives. This systematic review aims to summarize the existing literature on Tai Chi randomized controlled trials (RCTs) and recommend Tai Chi exercise prescriptions for different diseases and populations. Methods. A systematic search for Tai Chi RCTs was conducted in five electronic databases (PubMed, Cochrane Library, EMBASE, EBSCO, and Web of Science) from their inception to December 2019. SPSS 20.0 software and Microsoft Excel 2019 were used to analyze the data, and the risk of bias tool in the RevMan 5.3.5 software was used to evaluate the methodological quality of RCTs. Results. A total of 139 articles were identified, including diseased populations (95, 68.3%) and healthy populations (44, 31.7%). The diseased populations included the following 10 disease types: musculoskeletal system or connective tissue diseases (34.7%), circulatory system diseases (23.2%), mental and behavioral disorders (12.6%), nervous system diseases (11.6%), respiratory system diseases (6.3%), endocrine, nutritional or metabolic diseases (5.3%), neoplasms (3.2%), injury, poisoning and certain other consequences of external causes (1.1%), genitourinary system diseases (1.1%), and diseases of the eye and adnexa (1.1%). Tai Chi exercise prescription was generally classified as moderate intensity. The most commonly applied Tai Chi style was Yang style (92, 66.2%), and the most frequently specified Tai Chi form was simplified 24-form Tai Chi (43, 30.9%). 12 weeks and 24 weeks, 2-3 times a week, and 60 min each time was the most commonly used cycle, frequency, and time of exercise in Tai Chi exercise prescriptions. Conclusions. We recommend the more commonly used Tai Chi exercise prescriptions for different diseases and populations based on clinical evidence of Tai Chi. Further clinical research on Tai Chi should be combined with principles of exercise prescription to conduct large-sample epidemiological studies and long-term prospective follow-up studies to provide more substantive clinical evidence for Tai Chi exercise prescriptions.
1. Introduction
Chronic diseases cause a large burden of disease in the world and affect the quality of life of individuals [1, 2]. Furthermore, almost half of the global population suffers from at least one chronic disease and may be at risk of functional decline and disability [3, 4]. Exercise therapy is a safe way to improve physical function and reduce disability in patients with chronic diseases [5]. In the past few decades, exercise has been widely used in the treatment of chronic diseases, and experts have begun to adopt the terms “exercise prescription” and “exercise therapy” [5]. Exercise prescription mainly includes the type, frequency, duration, and intensity of exercise. It is a scientific, systematic, and individualized exercise intervention program for disease prevention and health promotion.
Tai Chi is a complementary and alternative therapy that has become a widespread exercise worldwide [6]. Over the past two decades, researchers have conducted extensive studies of the health-promoting effects of Tai Chi by focusing on various systems of the human body and their corresponding diseases. Studies have shown that Tai Chi is beneficial for patients with a wide range of diseases [7] and is a safe and effective way to promote balance control, flexibility, and cardiovascular fitness in patients with chronic diseases [8]. Tai Chi has been widely used in the clinical practice of different diseases and people, and their positive effects have been confirmed, but there is no clear guidance on how to incorporate it into exercise prescriptions [9]. A study adopted an evaluation instrument to reveal the characteristics of Tai Chi exercise prescriptions for improving the balance ability of the elderly, but this study has not yet conducted studies on Tai Chi exercise prescriptions for different diseases and populations [10]. In addition, Tai Chi has been shown to be effective in treating diverse diseases, but such treatment effects are not consistent across studies, such as type 2 diabetes. [11–13]. This may be affected by the difference in Tai Chi style and exercise time in Tai Chi exercise prescriptions because a study has confirmed that different Tai Chi styles and exercise time can result in variable effectiveness [14].
A systematic review involves identifying a specific problem, systematically collecting relevant articles, determining which articles meet the predetermined inclusion criteria, evaluating previous reports, implementing rigorous scientific analysis, and forming a reliable comprehensive conclusion for reference in clinical application [15]. A systematic review is the basis of evidence-based medicine and is considered at the highest level of medical evidence [16]. Randomized controlled trials (RCTs) are generally considered to have the highest level of credibility and hence are considered the gold standard for evidence-based clinical practice [17]. Therefore, the purpose of this systematic review was to summarize and analyze the effects of Tai Chi exercise prescriptions in Tai Chi RCTs, in order to recommend common Tai Chi exercise prescriptions for different diseases and individuals and provide a reference for the clinical application and experimental research on Tai Chi exercise prescription.
2. Materials and Methods
2.1. Search Strategy
Five electronic databases (PubMed, Cochrane Library, EMBASE, EBSCO, and Web of Science) were searched for relevant studies published up until December 2019. The search terms used for this systematic review included “Tai Chi,” “Tai Chi Chuan,” “T’ai Chi,” “Tai Ji,” “Taiji,” and “Tai Ji Quan.” The language was restricted to English. Taking a specific strategy as an example, the search terms in the PubMed database were as follows: ((((((Tai Chi [Title/Abstract]) OR (Tai Chi Chuan [Title/Abstract])) OR (T’ai Chi [Title/Abstract])) OR (Tai Ji[Title/Abstract])) OR (Taiji [Title/Abstract])) OR (Tai Ji Quan [Title/Abstract]) AND (humans[Filter])) AND ((randomized controlled trial[Publication Type] OR randomized[Title/Abstract] OR placebo[Title/Abstract]) AND (humans[Filter])).
2.2. Inclusion and Exclusion Criteria
This study strictly followed the PRISMA statement and the principle of PICOS (participants, intervention, control, outcomes, and study design) to formulate the criteria for literature retrieval, inclusion, screening, and exclusion [18].
2.2.1. Inclusion Criteria
Studies included in this review had to meet the following inclusion criteria: (1) the trial was a randomized control trial (RCT), either individual or cluster randomized; (2) any study participants were included, regardless of region, age, gender, and current health condition; (3) Tai Chi was the main intervention, without a limitation based on the type of Tai Chi prescribed; (4) the control group was nonexercise or the exercise was not Tai Chi; (5) outcome indicators were not restricted.
2.2.2. Exclusion Criteria
Studies were excluded if they met any of the following criteria: (1) irrelevant discussion or application of Tai Chi or interventions that lacked Tai Chi; (2) duplicate studies; (3) review, case report, meeting abstract, or monograph; (4) unclear outcome indicators; (5) no data or incomplete data; (6) not RCT.
2.3. Study Selection and Data Extraction
For this systematic review, two researchers independently read the titles, abstracts, and full text of research studies and conducted literature screening and data extraction according to the above inclusion and exclusion criteria. Disagreements were resolved either by consensus between the two researchers or by asking a third researcher to make a final decision. The following data were extracted: first author, publication year, study design, participants, intervention characteristics (i.e., type, duration, time, frequency), and outcome measures.
2.4. Quality Assessment
Based on the bias risk assessment tool recommended by the Cochrane Systematic Review Handbook (2011) [19], two researchers independently assessed the methodological quality and the bias risk of each included literature. The assessed items included the presence of random sequence generation, allocation concealment, blinding, outcome assessors, incomplete outcome data, selective reporting, and the presence of other biases. Based on these criteria, the literature included was divided into the high risk of bias, low risk of bias, and unclear risk of bias categories. Disagreements between the two researchers were resolved by discussion with a third researcher.
2.5. Data Analysis
Due to the heterogeneity of the included studies, a meta-analysis was not conducted. We performed descriptive data analysis using SPSS 20.0 and Microsoft Excel 2019. Data were presented in terms of counts, percentage, and frequency.
3. Results
3.1. Selection of Studies
A total of 8529 articles were obtained according to the search strategy. These articles were imported into EndNote X9, and duplicates were eliminated. The remaining 6714 articles were then subject to the screening on the basis of the title and abstract, resulting in the exclusion of 5951 studies. The remaining 763 articles were further screened by reading the full-text article and 624 articles were excluded. Finally, this review included 139 qualitative studies (see Figure 1).
... 22 The thoracolumbar spine flexibility was assessed by five studies, using either the sit-and-reach 19 36 45 47 or standand-reach test. 46 ...
Objective
To investigate the impact of Tai Chi training on muscle strength, physical endurance, postural balance and flexibility, as measured by tests commonly used in health-related fitness or competitive sports contexts.
Design
Systematic review and meta-analysis.
Data sources
The following databases were searched up to 31 July 2020: CINAHL, Cochrane Library, MEDLINE via PubMed and SPORTDiscus.
Eligibility criteria for studies
Inclusion: (1) Randomised controlled trials published in German or English; (2) Tai Chi used as an intervention to improve physical performance; (3) Test methods commonly used in health-related fitness or competitive sports and (4) Participants aged ≥16 years (irrespective of health status). Exclusion: (1) Studies not focusing on Tai Chi or including Tai Chi mixed with other interventions and (2) Modified or less than eight Tai Chi movements.
Results
Out of 3817 records, 31 studies were included in the review, 21 of them in the meta-analysis. Significant improvements in handgrip strength (2.34 kg, 95% CI 1.53 to 3.14), walking distance during 6 min (43.37 m, 95% CI 29.12 to 57.63), standing time in single-leg-stance with open eyes (6.41 s, 95% CI 4.58 to 8.24) and thoracolumbar spine flexibility (2.33 cm, 95% CI 0.11 to 4.55) were observed.
Conclusion
Tai Chi training seems to moderately improve physical fitness when evaluated by tests used in health-related fitness or competitive sports. Moreover, thoracolumbar spine flexibility seems to be a factor in the improvement of postural balance. Further research is needed, including younger healthy participants performing a widely used, standardised form (eg, Peking-style routine) with high-intensity movements (eg, use of lower stances).
... The TC is aimed at greater body awareness. The practice of TC in the elderly population as in other populations has favorable effects on the physiological effect (Zhang, Ishikawa-Takata, Yamazaki, Morita, & Ohta, 2006), balance control, flexibility, cardiorespiratory system, mental control and in the psychosocial aspect, improving the proprioception of the body system (Tsang & Hui-Chan, 2004a;Tsang & Hui-Chan, 2004b;Wang, Collet, & Laud, 2004;Taylor-Piliae & Froelicher, 2004). TC has an increase in flexibility and a psychological improvement, as in the improvement of moods and in the reduction of salivary cortisol concentrations (Jin, 1989;Li, Hong & Chan, 2001) in the increase of IgG in men and in the decrease of IgM in women. ...
The application of psychological strategies allows an optimal adaptation to the requirements of the sport and competition, developing and optimizing the use of individual psychological and emotional capacities. We developed a Emotional Control Program (PCE). The genesis of PCE is introspection, internal dialogue and moment analysis, containing breathing exercises, TaiChi, Mental Visualization and Biofeedback.
... There is research that was based on yoga and tai chi [21,22]. In other cases [23], in addition to tai chi, cognitive behavioral therapy and posture control exercises were used, and there has also been research that compared a group that practiced tai chi with another that underwent a well-being education intervention [24]. Other studies were based on vibration training [25], as well as on the improvement of balance and flexibility [26][27][28]. ...
Background: The aim of the research was to analyze the effects of an intervention program based on Adapted Utilitarian Judo (AUJ) to teach fall control, over fear of falling syndrome (FOF) in a group of older adults. Method: A quasi-experimental design (pre-post measurement) was adopted, with a healthy and pre-fragile sample of 19 subjects in the experimental group and 11 subjects in the control group (65-85 years), chosen using non-probabilistic-incidental accessibility sampling. The intervention program was conducted over six weeks, with two 60-minute sessions each week. To evaluate FOF, it was applied (pretest and post-test) the 16-item version of the Falls Efficacy Scale-International (FES-I). Results: The data show significant differences between pre-and post-test in reducing FOF into both specific variables (do the shopping, walk on a slippery surface, walk in a crowded place, walk on an uneven surface, and go up and down a ramp), as in the overall score (the global values of the experimental group decreased six points in the perceived fear scale, while the global values of the group increased three points). Conclusion: The application of the AUJ program meant significant improvements in subjects' perception of FOF.
... Studies show that effects do not only vary between types of interventions, but can also vary within intervention types. For example, Logghe and colleagues (2009) reported a tai chi chuan intervention had no effects on FoF, whereas Zhang, Ishikawa-Takata, Yamazaki, Morita, and Ohta (2006) demonstrated a tai chi chuan intervention caused a significant reduction in FoF. This variation in intervention effects may be partly explained by differences in content; for example, 24 tai chi positions were used in the study by Zhang and colleagues (2006), whereas only 10 were used in the study by Logghe and colleagues (2009). ...
Background and objectives:
Fear of falling (FoF) is associated with decreased physical functioning and an increased fall risk. Interventions generally demonstrate moderate effects and optimized interventions are needed. Intervention characteristics, such as setting or delivery method may vary. We investigated which overarching intervention characteristics are associated with a reduction in FoF in community-dwelling older people.
Research design and methods:
A systematic review and meta-analysis of randomized controlled trials (RCTs) in community-dwelling older people without specific diseases was performed. Associations between intervention characteristics and standardized mean differences (SMD) were determined by univariate meta-regression. Sensitivity analyses were performed.
Results:
Data on 62 RCTs were extracted, 50 intervention groups were included in the meta-analysis. Most intervention characteristics and intervention types were not associated with the intervention effect. Supervision by a tai chi instructor (SMD: -1.047, 95% confidence interval [CI]: -1.598; -0.496) and delivery in a community setting (SMD: -0.528, 95% CI: -0.894; -0.161) were-compared to interventions without these characteristics-associated with a greater reduction in FoF. Holistic exercise, such as Pilates or yoga (SMD: -0.823, 95% CI: -1.255; -0.392), was also associated with a greater reduction in FoF. Delivery at home (SMD: 0.384, 95% CI: 0.002; 0.766) or with written materials (SMD: 0.452, 95% CI: 0.088; 0.815) and tailoring were less effective in reducing FoF (SMD: 0.687, 95% CI: 0.364; 1.011).
Discussion and implications:
Holistic exercise, delivery with written materials, the setting and tailoring potentially represent characteristics to take into account when designing and improving interventions for FoF in community-dwelling older people. PROSPERO international prospective register of systematic reviews, registration ID CRD42018080483.
... However, most of these studies report a positive relationship between aerobic exercise and improve memory function (58)(59). Tai-Chi is considered to be a low-intensity exercise (60)(61). Ai-Chi is performed in warm water and has the advantages of the aquatic environment. ...
Background: Normal aging is associated with balance, mobility and working memory decline that increase fall risk and influence activity of daily living functions. Mounting evidence suggests that physical activity is beneficial for decreasing aging effects. Previous studies have focused on land-based physical activity. Research concerning the aquatic environment is scarce.
The primary objectives of this three arm intervention pilot study were to examine the effects of an aquatic physical intervention program on balance, gait, fall risk and working memory among community-dwelling older individuals. The secondary objective was to examine the effects of an aquatic physical intervention program on safety of street–crossing among community-dwelling older individuals.
Methods: Forty-two healthy participants aged 65 or older were enrolled into one of three intervention groups: aquatic physical intervention (API) (N=13), on-land physical intervention (OLPI) (N=14) or non-physical intervention (NPI) (N=15). The intervention took place from 2018 until 2019 at Tel-Aviv University, Sheba medical center and Reich Center. The protocol included 30-minute sessions twice a week for 12 weeks. Balance, gait and fall risk were assessed by the Tinneti test, working memory abilities were assessed by digit span and Corsi blocks tests and simulated safe streets-crossing was assessed by the hazard perception test for pedestrians.
Testing and data collection was conducted at baseline, after six weeks and 12 weeks of intervention. All members of the professional team involved in evaluating participants were blind to the intervention group to which participants were allocated.
Results: The differences in Tinetti balance (F(2,39)=10.03, p<0.01), fall risk (F(2,39)=5.62, p0>.05), digit span forward (F(2,39)=8.85, p<0.01) and Corsi blocks forward (F(2,39)=3.54, p<0.05) and backward (F(2,39)=6.50, p<0.05) scores after 12 weeks between the groups were significant. The API group showed improved scores.
The differences in hazard perception test for pedestrians scores after 12 weeks of intervention between the groups were marginally significant (F(2,39)=3.13, p=0.055). The API group showed improved scores.
Conclusions: These findings may affect experts working with the elderly population when making decisions concerning therapeutic prevention interventions for the deficiencies of elderly patients. Older adults practicing aquatic physical activity could contribute to their increased safety.
Trial registration
Trial registration number: ClinicalTrials.gov Registry NCT03510377.
Date of registration: 10/31/2017
... However, most of these studies report a positive relationship between aerobic exercise and improve memory function [57,58]. Tai-Chi is considered to be a low-intensity exercise [59,60]. Ai-Chi is performed in warm water and has the advantages of the aquatic environment. ...
Background: Normal aging is associated with balance, mobility and working memory decline that increase fall risk and influence activity of daily living functions. Mounting evidence suggests that physical activity is beneficial for decreasing aging effects. The environment in which the physical activity occurs influences the results of the activity. Previous studies have focused on land-based physical activity. Research concerning the aquatic environment is scarce. The purpose of this study was to examine the effects of an aquatic physical intervention program on fall risk, working memory and safety of streets–crossing among community-dwelling older individuals.
Methods: Forty-two healthy participants aged 65 or older were divided into one of three intervention groups: aquatic physical intervention (API), on-land physical intervention (OLPI) or non-physical intervention (NPI). The intervention took place from 2018 until 2019 and the protocol included 30-minute sessions twice a week for 12 weeks. Balance, gait and fall risk, working memory abilities and simulated safe streets-crossing were tested. Testing and data collection was conducted at baseline, after six weeks and 12 weeks of intervention.
Results: After six and 12 weeks of intervention, the API group achieved higher improvement on fall-risk score as compared to the NPI group, and both OLPI and NPI groups achieved less improvement on balance score compared to the API group. Additionally, after 12 weeks of intervention, both OLPI and NPI groups scored significantly lower than the API group in verbal and visuospatial working memory tests. Finally, a trend of improvement was found on the hazard-perception as pedestrians test after 12 weeks of intervention only among the API group.
Conclusions: These findings may affect experts working with the elderly population when making decisions concerning therapeutic prevention interventions for the deficiencies of elderly patients. Such interventions may help reduce falling and cognitive deficits, which can lead to decreased injuries and fatalities of older pedestrians. Older adults practicing aquatic physical activity could contribute to their increased safety. Trial registration Trial registration number: ClinicalTrials.gov Registry NCT03510377. Date of registration: 10/31/2017 https://clinicaltrials.gov/ct2/show/NCT03510377
... However, most of these studies report a positive relationship between aerobic exercise and improve memory function [57,58]. Tai-Chi is considered to be a low-intensity exercise [59,60]. Ai-Chi is performed in warm water and has the advantages of the aquatic environment. ...
Abstract Background Normal aging is associated with balance, mobility and working memory decline that increase fall risk and influence activity of daily living functions. Mounting evidence suggests that physical activity is beneficial for decreasing aging effects. Previous studies have focused on land-based physical activity. Research concerning the aquatic environment is scarce. The primary objectives of this three arm intervention pilot study were to examine the effects of an aquatic physical intervention program on balance, gait, fall risk and working memory among community-dwelling older individuals. The secondary objective was to examine the effects of an aquatic physical intervention program on safety of street–crossing among community-dwelling older individuals. Methods Forty-two healthy participants aged 65 or older were enrolled into one of three intervention groups: aquatic physical intervention (API) (N = 13), on-land physical intervention (OLPI) (N = 14) or non-physical intervention (NPI) (N = 15). The intervention took place from 2018 until 2019 at Tel-Aviv University, Sheba medical center and Reich Center. The protocol included 30-min sessions twice a week for 12 weeks. Balance, gait and fall risk were assessed by the Tinneti test, working memory abilities were assessed by digit span and Corsi blocks tests and simulated safe streets-crossing was assessed by the hazard perception test for pedestrians. Testing and data collection was conducted at baseline, after six weeks and 12 weeks of intervention. All members of the professional team involved in evaluating participants were blind to the intervention group to which participants were allocated. Results The differences in Tinetti balance (F (2, 39)=10.03, p .05), digit span forward (F (2, 39)=8.85, p
... A partir disso, o estudo conclui que a prática intensa do TCC resulta em aumento significativo na redução do medo de cair em relação ao grupo controle, nos idosos em transição para a fragilidade. 24 ZHANG et al. 40 Ganhos na redução da incidência de quedas e no medo de cair em idosos, adquiridos com a prática do TCC, são mantidos por alguns meses após a intervenção, e no caso dos estudos selecionados para esta revisão, a manutenção variou de dois a 12 meses. Isso sugere que o TCC foi responsável pela manutenção desses ganhos em longo prazo, como comprovado anteriormente pelo estudo de Wolfson et al.. 36 Na análise descritiva da população total, observa-se certa homogeneidade das amostras dos estudos selecionados para esta revisão, uma vez que todos utilizaram idosos que vivem na comunidade e inativos, o que per-mite uma conclusão específica para essa amostra. ...
The aging process is one of the factors that influence the increasing number of falls and result in complications like fear of falling. The Tai Chi Chuan (TCC) is an oriental martial art considered as light to moderate intensity exercise. The practice of TCC has positive effects on balance, occurrence of falls and fear of falling on the elderly. This study aimed to, through a systematic review, investigate the effects of TCC in risk of falls, fear of falling and balance in the elderly. Randomized controlled trials were investigated on databases Medline, Lilacs, Cochrane and PEDro. Two reviewers analyzed the quality of the studies and extract data independently. Six studies were selected, covering 816 participants. The results demonstrated a positive effect of TCC on decreasing occurrences of falls and fear of falling in sedentary community-dwelling elderly. The same effect was not observed for the postural stability.
... In addition, since our focus was on more than 70 years old participants, we needed to be extra careful of selected forms of Tai Chi. In literature, 10-12 forms of Tai Chi were often used as an intervention [29,[33][34][35]. Only a few researches adopted 8-form Tai Chi and found improvement after training [2]. ...
The aim of this study was to determine the effectiveness of an 8-form Tai Chi training exercise on balance performance, falling risk, and muscle strengths in elderly with limited strength. Twenty-six females between 70-85 years old with balance problem and moderate lower extremity muscular strengths (grade 2+ to 3+) without prior Tai Chi training volunteered for the study. The participants underwent the 8-form Tai Chi training exercise for 45 minutes/session, 3 sessions a week for 12 weeks. Balance performance (m-CTSIB, Postural Stability Balance Test, and 8-foot up-and-go Test), falling risk (Fall Risk Overall Stability Test and Fear of Falling Assessment), and muscle strengths (30-second Chair Stand Test and Pressure Biofeedback Unit Test) were assessed during pretest, mid-test, and post-test. One-way repeated measures ANOVA was conducted at the significant level of 0.05. The results after 6 weeks of training showed that balance and falling risk were improved where 8 foot up-and-go test and fear of falling assessment were significantly better than pre-experiment, while after 12 weeks, balance, falling risk, and lower extremity muscular strengths were significantly improved when compared to the pre-experiment. The 12-week 8-form Tai Chi training exercise was safe and effective in improving balance, falling risk, and lower extremity muscular strengths in ageing people with limited strengths.
... Maintenance of physical function and pain management might be important for older adults with fear of falling. Several authors reported that exercise programs, including strength training, balance, endurance, mobility, and Tai-Chi programs decrease fear of falling in older adults [39,[46][47][48]. ...
... [12] In recent years, Tai Chi gradually attracted attention of the public and has been used as a method to improve balance and prevent falls for both healthy and unhealthy people. [13][14][15][16][17][18][19][20][21][22] There were many randomized controlled trials (RCTs) using Tai Chi to improve balance function of people, and the results showed that Tai Chi did have a positive effect on it. So far, we did a search of related SRs and retrieved 18 published meta-analyses. ...
Introduction:
To investigate the effectiveness and safety of Tai Chi for improving balance and reducing falls on people.
Methods and analysis:
The following databases will be searched: China Biology Medicine (CBM), China National Knowledge infrastructure (CNKI), Wan Fang Data, the Chinese Science and Technology Periodical Database (VIP), Medline, EMBASE, Web of Science, The Cochrane Library from inception to March 2019. All randomized controlled trials (RCTs) utilized Tai Chi to improve balance ability and reduce falls will be included. Primary outcomes are the fall-related indicators, including the number of falls, fall rate, and other fall-related outcomes. Additional outcomes include the Berg Balance Scale (BBS), standing-walk test, single-legged time, or other balance-related outcomes. Study selection, data extraction, and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be performed using Review Manager V5.3 software.
Ethics and dissemination:
The findings of this systematic review will be disseminated through peer-reviewed publication or conference presentations.Trial registration number PROSPERO CRD42019127810.
... Stroth et al. 2009). On-land Tai Chi is considered to be a low-intensity exercise (Verhagen et al. 2004;Zhang et al. 2006). However, Ai Chi is performed in warm water and has the advantages of the aquatic environment. ...
Background
Aquatic motor intervention has been found to be effective in reducing falls and improving verbal working memory among the general population. However, effects among older adults with intellectual disabilities (ID) have never been explored. The aim of this study was to examine the effects of aquatic motor intervention on fall risk and verbal working memory among older adults with ID.
Methods
Forty‐one older adults with mild to moderate ID (age: 50–66 years) were randomly assigned to 14 weeks of aquatic motor intervention (Ai Chi: N = 19) or identical on‐land motor intervention (Tai Chi: N = 22). Fall risk, measured with the Tinetti balance assessment tool (TBAT), and verbal working memory, measured with the digit span forward test, were assessed pre‐intervention, after 7 weeks of intervention and post‐intervention.
Results
Study results indicate positive effects of both aquatic and on‐land motor intervention on TBAT fall risk score, while the aquatic motor intervention group improved TBAT fall risk score quicker as compared with the on‐land motor intervention group. Moreover, the lower the pre‐intervention TBAT score was, the higher the improvement. In addition, study findings support the positive effects of aquatic motor intervention on verbal working memory ability as measured with the digit span forward test.
Conclusions
Motor intervention, and particularly in an aquatic environment, can potentially reduce fall risk. Aquatic motor intervention may help to improve verbal working memory among older adults with ID.
... (FranzFaul, Universitat Kiel, Kiel, Germany) for analysis of covariance (ANCOVA), with an alpha level of 0.05, effect size of 0.50, and power of 0.90 [15][16][17] . The effect size was calculated as described by two previous randomized controlled trial studies 18,19) . The analyses were performed on an intention-to-treat principle; thus, all available data from all subjects were included in the analysis. ...
[Purpose] The purpose of this study was to examine the effects of Taekkyon training on balance control during stair descent in community-dwelling older adults. [Participants and Methods] Participants were randomly assigned to either the Taekkyon group or wellness education group. The participants in the Taekkyon group received Taekkyon training 2 times a week for 12 weeks. The participants in the wellness education group participated in a health education program 1 hour weekly for 12 weeks. Subjects stood in a predetermined position on the top of the custom-built 3-step staircase and then descended the stairs at a self-paced speed. The changes in the translation of the center of pressure before and after Taekkyon training were measured. [Results] The Taekkyon group showed a greater increase in the displacement of the center of pressure in the anteroposterior and mediolateral directions as well as the average velocity of the center of pressure in posttesting than the wellness education group. The Taekkyon group also showed a significant increase in all measures after Taekkyon training. However, little change was found in all measures in the wellness education group. [Conclusion] These findings support the use of Taekkyon training as an effective fall-preventive rehabilitation program to reduce falling in older adults.
... Similar research agrees by indicating that a way to boost self-confidence in elderly people is to involve them in aerobic exercise or programs which increase flexibility and balance [3,56]. Furthermore, Huang et al [13], reported that because exercise improves muscle strength [57,58], it is a way to reduce the number of falls in elderly persons [58], and in turn may reduce their fear of falling [59]. ...
... For instance, Yang et al. (2015) found that Tai Chi Chuan had positive effects on the balance, gait, and quality of life in older adults with Parkinson disease after 8 weeks. Several factors contribute to impaired balance during the aging process, including a reduction in fast twitch fibers, nerve conduction velocity, muscle flexibility, and development of osteoarthritis that indicate a need for intervention (Zhang et al., 2006). It is expected that Tai Chi Chuan movements could improve the balance in the older adults by shifting the center of gravity, weight shifting between legs, heel to toe and multidirectional stepping (Wu et al., 2016). ...
Fear of falling and balance impairment are prevalent in older adults and cause major morbidities for this population. The aim of this study was to evaluate the effect of Tai Chi Chuan on balance and fear of falling in community-dwelling older adults. This study was a single-blind random-ized control trial. Sixty older adults were randomly allocated into two groups using a 4-cell random block design. The participants of interven-tion group were trained in Tai Chi Chuan for eight weeks, twice a week, and 55 min in each session. Balance and fear of falling were assessed by Timed Up and Go (TUG) test, Tinetti test and Falls Efficacy Scale In-ternational in baseline and after 8 weeks. After eight weeks of interven-tion, the mean scores of the TUG and Tinetti scales in the intervention group were improved significantly compared to the baseline and the control group (P < 0.001). Moreover, the intervention group showed a significant reduction in fear of falling scores (P < 0.001), while those in the control group remained unchanged. Tai Chi Chuan effectively im-proves the balance and fear of falling and could be considered as a practical and useful method for fall prevention in community-dwelling older adults.
... Yine benzer şekilde Zhang ve arkadaşları (2006) tai chi egzersizi sonrasında denge ve esneklikte anlamlı fark elde etmiş, yürümede ise anlamlı fark olmamıştır (30). GHYP içeriği TDYD toplam puanında anlamlı değişiklik sağlayarak, düşme riskini azaltmada etkili olmuştur. ...
... In that study [30], quiet walking during 90 sec bouts also did not differ between Tai Chi experts vs. Tai Chi naïve controls (and walking speed was nearly identical suggesting fatigue was not a factor contributing to observed speeds in this study), but groups did differ in measures of stride time variability during dual task challenges (Tai Chi experts had lower and "better" variability). Other studies in older adults have also reported no impact of Tai Chi on walking speed, even when other measures of function or fall risk were improved [47][48][49], although multiple studies have also reported positive effects of Tai Chi on gait speed [50][51][52][53][54]. ...
Purpose:
To determine if Tai Chi (TC) has an impact on long-range correlations and fractal-like scaling in gait stride time dynamics, previously shown to be associated with aging, neurodegenerative disease, and fall risk.
Methods:
Using Detrended Fluctuation Analysis (DFA), this study evaluated the impact of TC mind-body exercise training on stride time dynamics assessed during 10 minute bouts of overground walking. A hybrid study design investigated long-term effects of TC via a cross-sectional comparison of 27 TC experts (24.5 ± 11.8 yrs experience) and 60 age- and gender matched TC-naïve older adults (50-70 yrs). Shorter-term effects of TC were assessed by randomly allocating TC-naïve participants to either 6 months of TC training or to a waitlist control. The alpha (α) long-range scaling coefficient derived from DFA and gait speed were evaluated as outcomes.
Results:
Cross-sectional comparisons using confounder adjusted linear models suggest that TC experts exhibited significantly greater long-range scaling of gait stride time dynamics compared with TC-naïve adults. Longitudinal random-slopes with shared baseline models accounting for multiple confounders suggest that the effects of shorter-term TC training on gait dynamics were not statistically significant, but trended in the same direction as longer-term effects although effect sizes were very small. In contrast, gait speed was unaffected in both cross-sectional and longitudinal comparisons.
Conclusion:
These preliminary findings suggest that fractal-like measures of gait health may be sufficiently precise to capture the positive effects of exercise in the form of Tai Chi, thus warranting further investigation. These results motivate larger and longer-duration trials, in both healthy and health-challenged populations, to further evaluate the potential of Tai Chi to restore age-related declines in gait dynamics.
Trial registration:
The randomized trial component of this study was registered at ClinicalTrials.gov (NCT01340365).
... Σε ορισµένα αθλήµατα, τα επιτρεπτά όρια του εύρους της κίνησης είναι συγκεκριµένα και επηρεάζονται από την ηλικία (Bozanic & Miletic, 2011), τη µορφολογία του σώµατος, τους γενετικούς παράγοντες, το φύλο, τα οστά, τα νεύρα, τους µύες και τους συνδέσµους (Deighan, 2005). Οι Koutedakis και Sharp (2004) βρήκαν ότι η ευλυγισία περιορίζεται 85% από τους συνδέσµους, τις αρθρικές επιφάνειες των οστών και των χόνδρων και χρειάζεται προσοχή ως προς το ποιοί µύες θα διαταθούν καθώς κάθε µυς έχει συγκεκριµένο µυϊκό τόνο (Zhang, Ishikawa-Takata & Yamazaki, 2006). Η ευλυγισία αξιολογείται µε εργαλεία όπως τα γωνιόµετρα που µετρούν τις γωνίες των αρθρώσεων, τα ευλυγισιόµετρα που µετρούν το βαθµό της κάµψης των αρθρώσεων και τα αρθρόµετρα που µετρούν την προσθιοπίσθια µετατόπιση της κνήµης σε σχέση µε το µηρό (DeVries, 1980). ...
Στον τρέχοντα Ολυμπιακό κύκλο (2013-16), η Παγκόσμια Ομοσπονδία Γυμναστικής δίνει ιδιαίτερη έμφαση στην αισθητική αξία των προγραμμάτων Ρυθμικής Γυμναστικής αφενός για να περιορίσει την υπέρμετρη αύξηση της δυσκολίας των ασκήσεων και αφετέρου για να ενισχύσει τη θεαματικότητά τους. Παρατηρείται όμως ότι η συμβολή του επιπέδου των φυσικών ικανοτήτων στην αισθητική απόδοση αθλητριών ρυθμικής γυμναστικής δεν έχει διερευνηθεί, παρόλο που αποτελεί σημαντικό κομμάτι της συνολικής εκτέλεσής τους και ιδιαίτερα στην ηλικία μεταξύ 8 και 12 ετών. Σκοπός αυτής της εργασίας είναι να διερευνήσει τη σχέση μεταξύ αισθητικών δεικτών εκτέλεσης και φυσικών παραμέτρων σε αθλήτριες ρυθμικής γυμναστικής, ηλικίας 8-12 ετών. Η κυρίως έρευνα πραγματοποιήθηκε: 1. Ως προς στους αισθητικούς δείκτες εκτέλεσης της χορογραφίας (artistry) όπως καθορίζονται από τον Κώδικα Βαθμολογίας ρυθμικής γυμναστικής της Παγκόσμιας Ομοσπονδίας Γυμναστικής για τον Ολυμπιακό Κύκλο 2013-16 και 2. Ως προς τη σχέση των αισθητικών δεικτών με τις επιλεγμένες φυσικές ικανότητες των αθλητριών.
Στην έρευνα συμμετείχαν 46 αθλήτριες Γ’ και Δ ́ κατηγορίας (ηλικία: 9.9±1.3 έτη, προπονητική εμπειρία: 2.4±1.3 έτη) από 5 συλλόγους ρυθμικής γυμναστικής της ευρύτερης περιοχής της Αθήνας. Οι αθλήτριες εκτέλεσαν τα επίσημα υποχρεωτικά προγράμματα της Ελληνικής Ομοσπονδίας Γυμναστικής χωρίς όργανο που αφορούν στην ηλικία τους για τις παγκορασίδες-κορασίδες με την ακόλουθη σειρά για κάθε αθλήτρια ξεχωριστά:
1) Αισθητική εκτίμηση της χορογραφίας από μία έμπειρη και διεθνή κριτή της ρυθμικής γυμναστικής.
2) Αξιολόγηση σωματομετρικών χαρακτηριστικών, λιπομέτρηση, σωματότυπος και 3) Αξιολόγηση της φυσικής κατάστασης μέσω επιλεγμένων φυσικών
vi
δοκιμασιών (στατική και ενεργητική ευλυγισία των ώμων, των ισχίων, ευλυγισία της σπονδυλικής στήλης, μυϊκή αντοχή των άνω άκρων και του κορμού, μυϊκή ισχύς των κάτω άκρων, ευκινησία, ισορροπία).
Στη συνέχεια δημιουργήθηκαν 3 ομάδες με βάση τη διάμεσο τιμή των μειώσεων στο βαθμό καλλιτεχνίας (ΜΣΚ): η ομάδα με τις μεγαλύτερες μειώσεις (>0.9), η ομάδα με μειώσεις ίσες με τη διάμεσο (=0.9) και η ομάδα με τις μικρότερες μειώσεις (<0.9). Οι μέσες τιμές των μεταβλητών ελέγχθηκαν για σημαντικές διαφορές μεταξύ των τριών ομάδων με ανάλυση διασποράς. Επίσης χρησιμοποιήθηκαν και οι συντελεστές συσχέτισης κατά Pearson ανάμεσα στις μειώσεις στην καλλιτεχνία και τις υπόλοιπες παραμέτρους. Τέλος η πρόβλεψη των ΜΣΚ με βάση τα ανθρωπομετρικά χαρακτηριστικά και τις παραμέτρους φυσικής κατάστασης έγινε τόσο με ανάλυση σε διακρίνουσες συναρτήσεις, όσο και με ιεραρχική γραμμική παλινδρόμηση. Όλες οι αναλύσεις πραγματοποιήθηκαν σε επίπεδο σημαντικότητας p<0.05 χρησιμοποιώντας το στατιστικό πρόγραμμα SPSS (version 22.0 Ιnc., Chicago, IL). Σημαντικές διαφορές μεταξύ των τριών ομάδων αθλητριών βρέθηκαν στη δοκιμασία ευλυγισίας «άρση του σκέλους στο πλάϊ» (147.2±13.9, 155.4±17.7, 164.7±9.3, p=0.008), στη μυϊκή αντοχή κοιλιακών (27.6±7.2, 35.5±6.4, 31.2±7.5, p=0.008) και ραχιαίων (19.6±4.3, 23.1±2.9, 23.2±4.4, p=0.015) και στην ευκινησία (20.5±1.6, 18.8±1.3, 19.0±0.9, p=0.001). Ως προς τα ανθρωπομετρικά χαρακτηριστικά σημαντικές διαφορές μεταξύ των τριών ομάδων στο ανάστημα (134.8±7.8,137.4±6.4,143.0±6.7, p=0.013), στο ανάστημα με τα χέρια στην ανάταση (157.9±10.8, 158.3±8.2, 166.0±7.7, p=0.047), στην περιφέρεια του βραχιόνιου δικεφάλου σε σύσπαση (20.3±1.2, 21.1±1.0, 21.5±1.3, p=0.016), στην υπερλαγόνια (6.6±1.4, 5.4±1.2, 5.1±1.1, p=0.004) και υποπλατιαία δερματοπτυχή (7.7±1.2, 6.8±0.9, 6.8±1.1, p= 0.023), στην άλιπη σωματική μάζα (22.9±3.6, 23.9±3.6, 26.3±3.6, p=0.030) και στο ποσοστό σωματικού λίπους (18.4±2.0, 17.2±1.8, 16.8±1.8, p=0.050). Όπως έδειξαν η ανάλυση σε διακρίνουσες συναρτήσεις και η ανάλυση παλινδρόμησης, οι πιο σημαντικές μεταβλητές που προβλέπουν σημαντικά τις μειώσεις στην καλλιτεχνία είναι η ευκινησία, η
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ευλυγισία ισχίων, η ισορροπία σε ακροστασία στο ένα σκέλος με τα μάτια ανοιχτά και το ύψος με χέρια σε ανάταση.
Τα αποτελέσματα της εργασίας τονίζουν τη σημασία συγκεκριμένων ανθρωπομετρικών χαρακτηριστικών (σωματικό ανάστημα, ανάστημα με χέρια στην ανάταση, υπερλαγόνια και υποπλάτια δερματοπτυχή, άλιπη σωματική μάζα και στο ποσοστό σωματικού λίπους) για την καλλιτεχνική απόδοση των νεαρών αθλητριών και ότι οι αθλήτριες με υψηλότερη απόδοση σε επιλεγμένες φυσικές παραμέτρους ευλυγισίας των ισχίων (developé à la seconde, straight leg raise, sit- and-reach), μυϊκής αντοχής (κοιλιακών και ραχιαίων μυών) ευκινησίας, και ισορροπίας (με τα μάτια ανοιχτά) παρουσιάζουν υψηλότερη βαθμολογία στην καλλιτεχνία των προγραμμάτων τους.
Λέξεις κλειδιά: αισθητικοί δείκτες, φυσικές παράμετροι, τεχνική εκτέλεση, χορογραφία, κώδικας βαθμολογίας ρυθμικής γυμναστικής.
Objective
To report the prevalence and risk factors for the fear of falling (FOF) among older individuals living in residential care facilities in India.
Design
Cross-sectional study.
Setting
Homes for the aged centres in Hyderabad, India.
Participants
The study included individuals aged ≥60 years from homes for the aged centres. The participants underwent a comprehensive eye examination in make-shift clinics setup in homes. Trained investigators collected the personal and demographic information of the participants and administered the Patient Health Questionnaire-9 and Hearing Handicap Inventory for Elderly questionnaire in the vernacular language. FOF was assessed using the Short Falls Efficacy Scale. The presence of hearing and visual impairment in the same individual was considered dual sensory impairment (DSI). A multiple logistic regression analysis was done to assess the factors associated with FOF.
Primary outcome measure
FOF.
Results
In total, 867 participants were included from 41 homes for the aged centres in the analyses. The mean (±SD) age of the participants was 74.2 (±8.3) years (range 60–96 years). The prevalence of FOF was 56.1% (95% CI 52.7% to 59.4%; n=486). The multivariate analysis showed that those with DSI had eleven times higher odds of reporting FOF than those with no impairment (OR 11.14; 95% CI 3.15 to 41.4.) Similarly, those with moderate depression had seven times higher odds (OR 6.85; 95% CI 3.70 to 12.70), and those with severe depression had eight times higher odds (OR 8.13; 95% CI 3.50 to 18.90) of reporting FOF. A history of falls in the last year was also associated with increased odds for FOF (OR 1.52; 95% CI 1.03 to 2.26).
Conclusion
FOF is common among older individuals in residential care in India. Depression, falling in the previous year and DSI were strongly associated with FOF. A cross-disciplinary approach may be required to address FOF among the older people in residential care in India.
Background:
There is a need for comprehensive programs that address both the physical and psychosocial aspects of fall prevention for the elderly.
Objective:
This study assessed the efficacy of the exercise regimen on various health metrics for elderly community dwellers.
Methods:
Forty-four participants were divided into experimental and control groups. The experimental group adhered to a 9-step core exercise regimen for fall prevention, practicing three times a week for 30 minutes across 10 weeks, while the control group maintained their regular daily activities without any specific exercise program. Before and after the intervention, participants underwent the timed up-and-go t est to evaluate the physical function, the berg balance scale (BBS) and one-legged stance test (OLST) for balance assessment, the activity-specific balance confidence scale for fall-related self-efficacy, and measures for health-related quality of life.
Results:
Participants in the experimental group showed significant improvements in physical function (p = .04, Cohen's effect size (d) = 0.2). and balance ability on BBS (p < .01, d = 0.2) and OLST (p < .01, d = 1.3) compared to the control group. Furthermore, there was a notable enhancement in the quality of life indicators for this group, especially in areas such as physical function (p = .04, d = 0.2), physical-role limitation (p = .04, d = 0.2), mental health (p = .01, d = 0.3), vitality (p = .02, d = 0.4), body pain (p = .04, d = 0.5), and general health (p = .04, d = 0.4).
Conclusion:
These findings highlight the potential of the fall prevention exercise program in improving physical health aspects, but its influence on specific psychosocial elements remains to be determined.
Doğurganlığın azalması, tıp ve sağlık hizmetlerindeki kalite artışı ile ölüm oranlarındaki azalma, yaşam süresinin uzamasını sağlamıştır. Bu koşullar altında dünya nüfusunun yaşlanması doğaldır. Kaçınılmaz olarak yaşanacak bu süreç yaşlılıktır. O zaman yaşlılık; bireyin fiziksel, bilişsel fonksiyonlarında meydana gelen gerilemeyle birlikte psikolojik olarak sorunların baş gösterdiği, ekonomik gelirde düşüşün yaşandığı, sağlık problemlerinin arttığı, sosyal rollerin değiştiği, özgürlüklerin sınırlandığı ve destek ihtiyacının arttığı bir gerileme dönemidir. Yani yaşlılık kaçınılmaz bir sondur ve bunun için gerek sağlık gerek psikolojik gerekse sosyal yönden hazırlıklı olmak, kaliteli bir yaşlılık döneminin geçirilmesini sağlar. Bu sürecin daha kolay atlatılabilmesi için gerçekleşmesi gereken en önemli unsur bireylerin maddi ve manevi yatırımlarını yapmış olmaları, özellikle de kişisel gelişimlerine önem vermelidirler.
The aim of this study was to investigate the effect of suspended stabilization exercises on functional ability, balance and fear of falling in women with MS. Thirty women with MS were divided into control and experimental groups. The training protocol consisted of 12 weeks of suspended exercise that was performed for 12 weeks, 3 sessions per week and about 30 minutes per session. Covariance analysis was used to data analyze. The results showed that there was a significant difference between the experimental and control groups in balance, functional ability and fear of falling in women with MS. Also, there was a difference between motor performance scores. Balance and fear of falling before and after suspended stabilization exercises were significant in the experimental group. The findings of the present study showed that suspension exercises improve balance, fear of falling and functional ability of women with MS. It is recommended that suspension exercises be used to control and improve the motor function of people with MS.
Background and objective
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.
Methods
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.
Results
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.
Conclusion
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.
Systematic review registration
https://clinicaltrials.gov/, identifier CRD42022354594.
Objective:
To assess the effect of Tai Chi exercise on fear of falling (FOF) and balance in older adults.
Method:
Chinese and English databases were searched for randomized controlled trials (RCTs) on the effect of Tai Chi on the fear of falling and balance of older adults. The search time limit was from inception until 13 December 2022.
Results:
A total of 13 RCTs were included and the overall quality was moderate. The results showed that Tai Chi exercise could significantly improve fear of falling [SMD = -0.54, 95%CI(-1.09, 0.01), Z =1.94, P = 0.05], dynamic balance [SMD = -2.23, 95%CI(-3.89, -0.75), Z=2.90, P = 0.004] and fall incidence [RR = 0.48, 95%CI(0.35, 0.65), Z =4.67, P <0.001] in older adults. However, its significant benefits in improving the static balance [MD = 4.16, 95%CI(-3.71, 12.04), Z =1.04, P = 0.30] in older adults were not found. The results of the subgroup analysis showed that the short-term effect of Tai Chi in reducing the fear of falling was more significant (P = 0.002).
Conclusion:
Tai Chi could alleviate the FOF of older adults, improve balance and reduce fall incidence. However, large-sample, multi-center, high-quality randomized controlled studies are still verified in the future.
Aging is a normal physiological process that is individual and affects the whole organism. The most noticeable changes that occur are the loss of muscle mass and strength, and significant reduction of endurance and bone density. Therefore it can be said that aging is one of the biggest health, social and economic challenges in the 21st century. It has been proven that programmed physical exercise has a long-term effect on maintaining the body functionality, autonomy and independence, preventing falls and overall improvement of health and quality of life. The main goal of this study is to determine the effect of 12 weeks programmed exercises on the motor abilities of people older than 64. The study involved 132 participants of both sex; 62 in experimental gropu and 70 in control group. For the purposes of this study, battery of Senior Fitness Test (SFT) and standard static balance tests were used: One-legged endurance (RIJN), One-legged endurance with eyes closed (RIJNZ) and Tandem balance test (RTTR). Statistical data processing was done with the statistical package SPSS and statistics. The results of the research showed that there`s statistically significant difference (p <0.05) between experimental and control group in motor skills at the final measurement. One-factor analysis of covariance (assessment of motor skills) found a statistically significant difference (p <0.05) between experimental and control group in the results of the following variants: FUSTS, FPLTS, FFRP, FPNS, RIJN and RTTR. The value of multivariate indicators Wilks Lambda = 0.656 and Pillai's Trace = 0.349 indicate a statistically significant difference between experimental and control group in motor skills at the final measurement. This research indicates that with adequate training, older people can improve their motor skills. Further research should focus on the analysis and selection of the best training models for elderly.
The aim of this systematic review (SR) and meta-analysis was to assess what type of exercise is associated with fall risk reduction among apparently healthy adults aged 50 and older. We conducted a SR by searching for randomized controlled trials (RCTs) included in Cochrane SRs published until October 2019. Five SRs that compared exercise versus any type of control included 32 RCTs. The outcomes examined were falls, fallers, fractures, and fear of falling. A random effects-based meta-analysis by type of exercise was performed. Almost all the interventions were effective for fall rate reduction, with a major effect for three-dimensional exercise, strength/resistance exercises, and mixed exercises. The number of fallers was reduced by three-dimensional exercise and mixed exercises. Fall-related fractures were generally reduced by all types of exercises considered all together, but none singly resulted in statistically effective fracture prevention. Fear of falling was slightly decreased with endurance exercises.
Background:
Tai chi is considered a safe and low-cost treatment for improving balance ability among an older population. However, there is no existing evidence on the optimal exercise parameters of tai chi for improving balance in older adults.
Objectives:
To investigate the optimal parameters of a tai chi intervention to improve balance performance of older adults.
Design:
Systematic review and meta-analysis of randomized controlled trials (RCTs).
Setting:
PubMed, Embase, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure, Wanfang, Chinese Science and Technology Periodical and China Biology Medicine were searched from inception until November 30, 2020.
Participants:
Adults aged 60 years and over.
Measurements:
Two reviewers independently extracted the data and assessed the quality of the included studies according to the Physiotherapy Evidence Database (PEDro) scale. Subgroup analyses and meta-regressions were conducted to elucidate the impact of tai chi training programs on balance measures.
Results:
Twenty-six eligible RCTs were included in the meta-analysis. Pooled results showed that tai chi has moderate effects for improving proactive balance (weighted mean standardized mean differences [SMDwm ] = 0.61, 95% CI 0.33-0.89) and static steady-state balance (SMDwm = 0.62, 95% CI 0.30-0.95) and small effects for improving dynamic steady-state balance (SMDwm = 0.38, 95% CI 0.03-0.73) and balance test batteries (SMDwm = 0.47, 95% CI 0.13-0.81) in adults over 60 years of age. The practice frequency could predict the effects of tai chi on static steady-state balance, and the 24-form simplified Yang style tai chi (45-60 min/session, more than four sessions per week and at least 8 weeks) was the most optimal.
Conclusions:
Tai chi is effective at improving the balance ability of adults over 60 years of age. A medium duration and high frequency of 24-form tai chi may be the optimal program for improving balance, but this evidence should be recommended with caution due to limitations of the methodology and small sample sizes.
This chapter starts with an analysis of self-identity and then reviews emotions and cognition in the elderly. Aspects of memory and personality and how they can affect the psychology of older people are addressed next, to then conclude with a section devoted to an analysis of psychological stress in the elderly, followed by one on retirement and how the experience of retired people can be improved through an active life.
This develops the topic of Ageing in better health. Here we return to the biology of ageing, that was first introduced in Chap. 1, but with a special emphasis on brain plasticity, a very important topic that is the focus of a fast-developing research program, and we also review psychological health in old age. Initially mentally healthy persons may be at risk of experiencing serious deterioration of their mental capacities as they age; therefore, we devote a section in this chapter to review mental pathologies in the elderly. Special emphasis is given to the analysis of the various forms of dementia, including Alzheimer’s disease. From there we proceed to address those aspects of ageing that affect sexual behaviour. The challenges experienced by people with a disability (mental or physical) who are becoming older are also the topic of a section in this chapter. We conclude the chapter with a section devoted to older people who reach very advanced ages: the centenarians, semi-supercentenarians, and supercentenarians.
This article aims to examine factors associated with falls in older adults residing in apartments designed with age-friendly features in Singapore. A cross-sectional study was conducted with 925 older adults aged 55 years and older, residing in studio apartments in Singapore. Multivariable backward logistic regression and independent factors associated with falls include older age, cataracts, urinary-tract disorders, general weakness, participation in family gatherings, and functional difficulty in dressing. Interaction effects were found for gender and walking long distances. Environmental factors were not independent factors for falls, although they were associated on bivariate analysis. Findings have implications on the importance of age-friendly design setting on fall prevention. Fall prevention efforts should be multidimensional and target modifiable risk factors for falls.
Background:
Taekkyon, a Korean form of martial arts, has been trained for a long period. However, it is not yet known whether the Taekkyon exercise has better effects on functional mobility or balance in older adults than other types of well-investigated exercise programs such as Tai Chi (TC).
Objective:
This study aimed to compare the effects of TC and Taekkyon exercise programs on the lower-extremity strength, balance, and gait ability of community-dwelling older women as a fall prevention method.
Methods:
Community-dwelling older women were randomly allocated into the TC group (n1= 23) and the Taekkyon group (n2= 23). Both groups completed 1 h of either TC or Taekkyon exercises twice weekly for 12 consecutive weeks (24 sessions in total). We measured the Timed Up and Go test (TUG), Functional Reach test (FR), one-leg standing test (OLS), Five Times Sit-to-Stand test (5 × STS), 30 Second Sit-to-Stand test (30 s STS), and spatiotemporal gait parameters (gait velocity, step length, step width, stride time, and cadence) before and after the intervention.
Results:
Both groups similarly showed statistically significant improvements in balance (TUG, FR, and OLS), lower-extremity strength (5 × STS and 30 s STS), and spatiotemporal gait parameters except for step width (P< 0.05). Moreover, the TC group showed greater improvement in the OLS test than the Taekkyon group (P< 0.05).
Conclusions:
The results from this study support the efficacy of the TC and Taekkyon exercise programs at improving mobility in this population of older women. However, this study did not clarify which exercise program is more effective as general balance and mobility training program for older women.
Worldwide societies are experiencing rapid increase in the number and proportion of the elderly (60 years and above). This may be considered as a result of improved healthcare facilities but it also poses a major challenge for healthcare professionals. Majority of the elderly population suffers from a variety of physical, psychological and social problems and challenges. This requires manifold interventions. Despite usual healthcare strategies, active and alternative interventions like social support, interaction with the community, yoga and exercise, spirituality and religion, and technology etc. may play a vital role in managing the lives of the elderly. These interventions not only reduce the physical, psychological and social burden, but also help fortifying health and well-being of the elderly.
By 2030, one in five Singaporeans will be aged 65 and over. This Chapter examines the current state of policy, practice and research in Singapore on ageing and the arts, tracing the growth of aged care as it matures to provide a more comprehensive mind-body approach, not just meeting physiological needs.
This study examined relationships among physical activity patterns, self-efficacy, balance, and fear of falling in older adults. Fifty-eight older adults (52-85 years) completed measures of physical activity, self-efficacy, and fear of falling. Subjects then performed the items found in the Berg Balance Scale (Berg, Wood-Dauphinee, Williams, & Maki, 1992). More physically active adults were less fearful of falling, had better balance, and had stronger perceptions of efficacy. Those with better balance were less fearful of falling, and females were more fearful than males. Balance and self-efficacy had significant independent effects on fear, whereas the contribution of history of physical activity was nonsignificant. The findings suggest that behavioral, social cognitive, and biological factors may be important correlates of fear of falling. Further support is provided for the utility of self-efficacy measures in the prediction of fear of falling, although reliance on any one measure to assess this construct may underestimate the role of self-efficacy.
Fear of falling has been recognized as a potentially debilitating consequence of falling in elderly persons. However, the prevalence and the correlates of this fear are unknown.
Prevalence of fear of falling was calculated from the 1-year follow-up of an age- and gender-stratified random sample of community-dwelling elderly persons. Cross-sectional associations of fear of falling with quality of life, frailty, and falling were assessed.
The prevalence of fear increased with age and was greater in women. After adjustment for age and gender, being moderately fearful of falling was associated with decreased satisfaction with life, increased frailty and depressed mood, and recent experience with falls. Being very fearful of falling was associated with all of the above plus decreased mobility and social activities.
Fear of falling is common in elderly persons and is associated with decreased quality of life, increased frailty, and recent experience with falls.
The aim of this study was to assess the impact of fear of falling on the health of older people.
A total of 528 subjects (mean age 77 years) were recruited from two hospitals in Sydney, Australia, and followed for approximately 12 months. Eighty-five subjects died during follow-up, and 31 were admitted to an aged care institution. Tinetti's Falls Efficacy Scale (FES) was successfully administered to 418 subjects as part of the baseline assessment. Among those with baseline FES scores, ability to perform 10 activities of daily living (ADLs) was assessed at baseline and follow-up in 307 subjects, and SF-36 scores were assessed at baseline and follow-up in 90 subjects recruited during the latter part of the study. Falls during follow-up were identified using a monthly falls calendar.
Compared with those with a high fall-related self-efficacy (FES score = 100), those with a low fall-related self-efficacy (FES score < or = 75) had an increased risk of falling (adjusted relative risk 2.09, 95% confidence interval [CI] 1.31-3.33). Those with poorer fall-related self-efficacy had greater declines in ability to perform ADLs (p < .001): the total ADL score decreased by 0.69 activities among persons with low FES scores (< or =75) but decreased by only 0.04 activities among persons with FES scores of 100. Decline in ADLs was not explained by the higher frequency of falls among persons with low FES scores. SF-36 scores (particularly scores on the Physical Function and Bodily Pain subscales) tended to decline more among persons with poor fall-related self-efficacy. Nonfallers who said they were afraid of falling had an increased risk of admission to an aged care institution.
Fear of falling has serious consequences for older people. Interventions that successfully reduce fear of falling and improve fall-related self-efficacy are likely to have major health benefits.
Balance confidence is an important indicator of functional mobility and independence in older adults. Preliminary psychometric evidence for the Activities-specific Balance Confidence (ABC) Scale is promising, with a series of four studies adding information on the discriminative and evaluative properties of this tool.
The original validation sample was reinterviewed one year later. In the second study, the ABC was administered to 475 older adults ranging from home care clients to highly functioning individuals in community exercise programs. The third study compared 31 residents of retirement homes given a 10-week balance control exercise program and fall education with 32 residents who received only fall education. The fourth study examined balance confidence preoperatively and postoperatively for 27 patients undergoing hip or knee replacement.
ABC scores remained stable over 12 months in higher functioning elders, but deteriorated in retirement home residents over 26 weeks. Ten weeks of balance training significantly improved balance confidence, as did hip or knee replacement with standard physical therapy. ABC scores lower than 50 indicated a low level of physical functioning characteristic of home care clients. ABC scores above 50 and lower than 80 indicated a moderate level of functioning characteristic of elders in retirement homes and persons with chronic health conditions. ABC scores above 80 are indicative of highly functioning, usually physically active older adults, and are achievable through exercise and rehabilitative therapies. CONCLUSIONS. Balance confidence is amenable to change and able to distinguish between elders at various levels of functional mobility. These results provide comparative benchmarks for researchers and clinicians working with different groups of older adults.
The purpose of this study was to investigate activity fitness of daily living of elderly women in Korea. The subjects were 253 elderly women ranging in age from 65 to 84 years. Twenty items related to the activity fitness of daily living were measured. The Pearson's correlation coefficients between the performance test items and age were significant (P<0.05) and the score of all items remarkably decreased with advancing age. In order to extract activity fitness of daily living, the principal component analysis was applied to the 20×20 correlation matrix. The first principal component was interpreted as fundamental activity fitness (FAF) of daily living. The results of the comparison clearly indicated that the 75-79 and 80-84 age groups were inferior in FAF of daily living. Furthermore, in order to analyze the factorial structure of these elderly women, extracted factors were rotated with normal varimax criterion. The activity fitness (AF) of daily living were categorized to 7 factors : muscular strength and movement of the whole body, flexibility, balance, coordination of upper limbs, agility of upper and lower limbs, endurance, and reaction time. Results of the comparison of AF factors showed that a decline with advancing age was significant for muscular strength and movement of the whole body. The prediction equations of FAF were developed using multiple regression analyses. Results indicated that 8 selected items from 7 factors were significant predictors of the dependent variable FAF. Equally clarified was that 3 of our 8 items could be excluded, while still yielding comparable precision in predicting FAF. On the basis of all our analyses and considering the practicability of the measurement, we recommend the equation FAFS=1.504 X1-0.838 X2-0.489 X3-0.363 X4-0.686 X5 +68.71, with an R=0.850; where FAFS= fundamental activity fitness score, X1=arm curl, X2=walking around two chairs in a figure 8, X3= one foot tapping in a sitting position, X4=sit and reach, X5carrying beans using chopsticks, which can predict FAF with high precision in elderly Korean women.
Background —Tai Chi Chuan (TTC) exercise has beneficial effects on the components of physical condition and can produce a substantial reduction in the risk of multiple falls. Previous studies have shown that short term TCC exercise did not improve the scores in the single leg stance test with eyes closed and the sit and reach test. There has apparently been no research into the effects of TCC on total body rotation flexibility and heart rate responses at rest and after a three minute step test.
Methods —In this cross sectional study, 28 male TCC practitioners with an average age of 67.5 years old and 13.2 years of TCC exercise experience were recruited to form the TCC group. Another 30 sedentary men aged 66.2 were selected to serve as the control group. Measurements included resting heart rate, left and right single leg stance with eyes closed, modified sit and reach test, total body rotation test (left and right), and a three minute step test.
Results —Compared with the sedentary group, the TCC group had significantly better scores in resting heart rate, three minute step test heart rate, modified sit and reach, total body rotation test on both right and left side (p<0.01), and both right and left leg standing with eyes closed (p<0.05). According to the American Fitness Standards, the TCC group attained the 90th percentile rank for sit and reach and total body rotation test, right and left.
Conclusion —Long term regular TCC exercise has favourable effects on the promotion of balance control, flexibility, and cardiovascular fitness in older adults.
OBJECTIVE : To evaluate the effects of two exercise approaches, Tai Chi (TC) and computerized balance training (BT), on specified primary outcomes (biomedical, functional, and psychosocial indicators of frailty) and secondary outcomes (occurrence of falls).
DESIGN : The Atlanta FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques), a prospective, randomized, controlled clinical trial with three arms (TC, BT, and education [ED]). Intervention length was 15 weeks, with primary outcomes measured before and after intervention and at 4‐month follow‐up. Falls were monitored continuously throughout the study.
SETTING : Persons aged 70 and older living in the community.
PARTICIPANTS : A total of 200 participants, 162 women and 38 men; mean age was 76.2.
MEASUREMENTS : Biomedical (strength, flexibility, cardiovascular endurance, body composition), functional (IADL), and psychosocial well‐being (CES‐D scale, fear of falling questionnaire, self‐perception of present and future health, mastery index, perceived quality of sleep, and intrusiveness) variables.
RESULTS : Grip strength declined in all groups, and lower extremity range of motion showed limited but statistically significant changes. Lowered blood pressure before and after a 12‐minute walk was seen following TC participation. Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group ( P = .046 and P = .058, respectively). After adjusting for fall risk factors, TC was found to reduce the risk of multiple falls by 47.5%.
CONCLUSIONS : A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty. This intervention can also have favorable effects upon the occurrence of falls. Tai Chi warrants further study as an exercise treatment to improve the health of older people.
Objective: to investigate and compare the predictive values of four physical performance measures for the onset of functional dependence in older Japanese people living at home. Design: a population-based prospective cohort study. Setting: Nangai village, Akita Prefecture, Japan. Methods: out of the population aged 65 years and older living in Nangai (n a 940) in 1992, we measured hand grip-strength, one-leg standing, and usual and maximum walking speeds in 736 subjects who were independent in the five basic activities of daily living. Their functional status was assessed each year for the subsequent 6 years. The outcome event was the onset of functional dependence, defined as a new disability in one or more of the five basic activities of daily living, or death of a subject who had shown no disability at the previous follow-up. Results: even after controlling for age, sex and a number of chronic conditions, lower scores on each baseline performance measure showed increased risk for the onset of functional dependence. Maximum walking speed was most sensitive in predicting future dependence for those aged 65‐74 years, while usual walking speed was most sensitive for people aged $75 years. Conclusion: walking speed was the best physical performance measure for predicting the onset of functional dependence in a Japanese rural older population.
We conducted a prospective study of the consequences of falls in 325 elderly community-dwelling persons, all of whom had fallen in the previous year. We contacted subjects every week for one year to ascertain falls and to determine the circumstances and consequences of falls. Only 6% of 539 falls resulted in a major injury (fracture, dislocation, or laceration requiring suture), but over half (55%) resulted in minor soft tissue injury. One in ten falls left the faller unable to get up for at least 5 minutes, and one in four falls caused subjects to limit their activities. The risk of injury per fall was about the same regardless of the number of falls a person had during follow-up. The risk of major injury was increased (age- and sex-adjusted odds ratio: 5.9, 95% confidence interval: 2.3-14.9) in falls associated with loss of consciousness compared to nonsyncopal falls. In multivariate analyses of nonsyncopal falls, the risk of major injury per fall was higher in persons having a previous fall with fracture (6.7; 2.1-21.5), a slower Trail Making B time (1.9; 1.1-3.2), and in Whites (18.4; 7.5-44.6). The risk that a nonsyncopal fall would result in minor injury (versus no injury) was increased in persons with a slower hand reaction time (1.8; 1.0-3.2) decreased grip strength (1.5; 1.0-2.3), in Whites (2.0; 1.0-3.7), in falls while using stairs and steps (2.2; 1.0-5.0), and turning around or reaching (3.5; 1.7-7.3). Our findings suggest that neuromuscular and cognitive impairment, as well as the circumstances of falls, affect the risk of injury when a fall occurs.
A cross-sectional study was performed to investigate the association between fear of falling and postural performance in the elderly. One hundred ambulatory and independent volunteers (aged 62-96) were subjected to five types of balance tests: (a) spontaneous postural sway, (b) induced anterior-posterior sway, (c) induced medial-lateral sway, (d) one-leg stance, and (e) a clinical balance assessment scale. Pseudorandom platform motions were used in the induced-sway tests. The subjects were classified into both "faller"/"nonfaller" and "fear"/"no-fear" categories, to allow the influence of fear of falling and falling history to be separated in the analyses. Subjects who expressed a fear of falling were found to exhibit significantly poorer performance in blindfolded spontaneous-sway tests and in eyes-open, one-leg stance tests. The clinical scale was the only balance measure that showed a significant association with retrospective, self-reported falling history. We could not ascertain whether the fear of falling affected balance-test performance in an artifactual manner, or whether the fear and poorer performance were related to a true deterioration in postural control. Until this issue can be resolved, balance-test performance should be interpreted with caution when testing apprehensive individuals. Furthermore, studies of postural control and falling should allow for the potentially confounding influence of fear of falling.
We developed the Falls Efficacy Scale (FES), an instrument to measure fear of falling, based on the operational definition of this fear as "low perceived self-efficacy at avoiding falls during essential, nonhazardous activities of daily living." The reliability and validity of the FES were assessed in two samples of community-living elderly persons. The FES showed good test-retest reliability (Pearson's correlation 0.71). Subjects who reported avoiding activities because of fear of falling had higher FES scores, representing lower self-efficacy or confidence, than subjects not reporting fear of falling. The independent predictors of FES score were usual walking pace (a measure of physical ability), anxiety, and depression. The FES appears to be a reliable and valid method for measuring fear of falling. This instrument may be useful in assessing the independent contribution of fear of falling to functional decline among elderly people.
The study analyzes the characteristics of 54 nursing home patients (12 male, 42 female; mean age 81.9 +/- 7.9 years) with and without the complaint of the fear of falling, and the association of this fear with falling and functional status. Patients who had a fear of falling at baseline (n = 25) had a lower functional status (Barthel Index) score (69.8 +/- 22.3 vs. 79.3 +/- 15.4), lower scores for balance (8.4 +/- 4.4 vs. 10.6 +/- 3.7) and gait (Tinetti; 6.7 +/- 3.3 vs. 8.3 +/- 2.6) and were taking a higher number of psychotropic drugs (0.8 +/- 1.1 vs. 0.2 +/- 0.5) than those with no fear (n = 29). At 24 months' follow-up, 25 subjects were still available for evaluation. Fear of falling at baseline was predictive of a decline in activities of daily living, as measured by the Barthel Index, in a multiple regression model, after controlling for baseline cognitive function and change in cognitive function, age, gender, balance and gait, frequency of psychotropic drug usage, and number of chronic symptoms. The findings of this study suggests that, in mobile patients, the fear of falling can be a clinically important predictor of functional decline.
The relationships of fear of falling and fall-related efficacy with measures of basic and instrumental activities of daily living (ADL-IADL) and physical and social functioning were evaluated in a cohort of community-living elderly persons.
Sociodemographic, medical, psychological, and physical performance (e.g., gait speed, timed hand function) measures were administered, during an in-home assessment, to a probability sample of 1,103 residents of New Haven, Connecticut, who were > or = 72 years of age. Falls and injuries in the past year, fear of falling, and responses to the Falls Efficacy Scale were also ascertained. The three dependent variables included a 10-item ADL-IADL scale, an 8-item social activity scale, and a scale of relative physical activity level.
Among cohort members, 57% denied fear of falling whereas 24% acknowledged fear but denied effect on activity; 19% acknowledged avoiding activities because of fear of falling. Twenty-four percent of recent fallers vs 15% of nonfallers acknowledged this activity restriction (chi 2 = 13.1; p < .001). Mean fall-related efficacy score among the cohort was 84.9 (SD 20.5), 79.8 (SD 23.4), and 88.1 (SD 17.9) among fallers and nonfallers, respectively (p < or = .0001). Fall-related efficacy proved a potent independent correlate of ADL-IADL (partial correlation = .265, p < .001); physical (partial correlation = .234, p < .001); and social (partial correlation = .088, p < .01), functioning in multiple regression models after adjusting for sociodemographic, medical, psychological, and physical performance covariates as well as history of recent falls and injuries. Fear of falling was only marginally related (p = .05) with ADL-IADL functioning and was not associated with higher level physical or social functioning.
The strong independent association between self-efficacy and function found in this study suggests that clinical programs in areas such as prevention, geriatric evaluation and management, and rehabilitation should attempt simultaneously to improve physical skills and confidence. Available knowledge of the factors influencing efficacy should guide the development of these efficacy-building programs.
To evaluate the effects of two exercise approaches, Tai Chi (TC) and computerized balance training (BT), on specified primary outcomes (biomedical, functional, and psychosocial indicators of frailty) and secondary outcomes (occurrence of falls).
The Atlanta FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques), a prospective, randomized, controlled clinical trial with three arms (TC, BT, and education [ED]. Intervention length was 15 weeks, with primary outcomes measured before and after intervention and at 4-month follow-up. Falls were monitored continuously throughout the study.
Persons aged 70 and older living in the community.
A total of 200 participants, 162 women and 38 men; mean age was 76.2.
Biomedical (strength, flexibility, cardiovascular endurance, body composition), functional (IADL), and psychosocial well-being (CES-D scale, fear of falling questionnaire, self-perception of present and future health, mastery index, perceived quality of sleep, and intrusiveness) variables.
Grip strength declined in all groups, and lower extremity range of motion showed limited but statistically significant changes. Lowered blood pressure before and after a 12-minute walk was seen following TC participation. Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group (P = .046 and P = .058, respectively). After adjusting for fall risk factors, TC was found to reduce the risk of multiple falls by 47.5%.
A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty. This intervention can also have favorable effects upon the occurrence of falls. Tai Chi warrants further study as an exercise treatment to improve the health of older people.
The purpose of this study was to determine the effects of Tai Chi Chih on balance, flexibility, mood, health status, and blood pressure in a sample of community-dwelling elders. A quasi-experimental pretest-posttest design was used in the study. Participants were recruited from a senior center located in the suburbs of a large metropolitan area. The experimental group consisted of 24 volunteers over the age of 55 who performed 60 minutes of Tai Chi Chih once a week for 10 weeks and practiced at home. The control group consisted of 22 volunteers who continued with their current level of activity. Analysis of covariance revealed a significant difference between the two groups on balance (F = 4.3, p < .05). This study suggests that Tai Chi Chih is a safe and enjoyable form of exercise that might improve balance in community-dwelling elders.
Older persons who are willing to begin exercise programs are often not willing to continue them. At the Atlanta FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) site, individuals aged 70+ were randomized to Tai Chi (TC), individualized balance training (BT), and exercise control education (ED) groups for 15 weeks. In a follow-up assessment 4 months post-intervention, 130 subjects responded to exit interview questions asking about perceived benefits of participation. Both TC and BT subjects reported increased confidence in balance and movement, but only TC subjects reported that their daily activities and their overall life had been affected; many of these subjects had changed their normal physical activity to incorporate ongoing TC practice. The data suggest that when mental as well as physical control is perceived to be enhanced, with a generalized sense of improvement in overall well-being, older persons' motivation to continue exercising also increases.
To assess the incidence of falls and the prevalence, intensity, and covariates of fear of falling among community-dwelling elderly, the authors surveyed a random sample of 196 residents (> or = 58 years of age) of housing developments for the elderly in Brookline and Plymouth, Massachusetts. Forty-three percent reported having fallen in recent years, 28% in the last year. Of those who had fallen within the year prior to the interview, 65% reported injury, 44% sought medical attention, and 15% required hospitalization as a consequence of their fall(s). Fear of falling ranked first when compared to other common fears (i.e., fear of robbery, financial fears). Self-rated health status and experience of previous falls were significantly associated with fear of falling. Further analysis suggests that fear of falling may affect social interaction, independent of risks for falling.
Falls are a major cause of morbidity in old age. A small number of fall prevention trials in cognitively intact community-dwelling older people have been effective. This study set out to examine the preventability of falls in older people living in institutional care.
To evaluate the effectiveness of falls risk factor assessment/modification and seated balance exercise training in reducing falls among elderly people living in residential care.
133 residents with a mean age of 84+/- (SD) 6.8 years were allocated at random by home to receive either a 6-month falls risk factor assessment/modification and seated balance exercise training programme (n = 77) or 6 months of reminiscence therapy (n = 56). The risk factors targeted were postural hypotension, polypharmacy, visual acuity, and ambient lighting levels. Falls risk factor assessments and recommendation for modifications were performed at baseline in the intervention group and assessments repeated at 6 months. Functional reach, reaction time, timed up-and- go, grip strength, spinal flexibility, and Philadelphia Geriatric Centre Morale Scale and Mini-Mental State Examination scores were determined at baseline and at 6 months by a 'blind' observer. Falls and fractures were then monitored in both groups during a 7- to 12-month falls-monitoring follow-up period.
Only 90 of 133 (67.7%) residents completed the 6-month intervention period, and 84 (63.2%) completed the 7- to 12-month falls-monitoring follow-up period. Both prevalence of postural hypotension (p = 0.0005) and poor visual acuity (p = 0.04) were reduced in the intervention group. There was no difference between the groups in the number of falls sustained, the risk of falling [odds ratio 0.45 (95% CI 0.19-1.14)], or in the risk of recurrent falling [odds ratio 1.07 (95% CI 0.40-2.97)]. No significant differences were found between the groups with regard to change in other outcome measures.
The high drop-out rate reduced the power of this study to detect any effect of the interventions used. It is possible that either the exercises were not sufficiently vigorous or that to improve balance exercises must be performed standing. Further research is required to identify effective fall prevention strategies for elderly people in residential settings.
To assess the characteristic effects of Tai Chi Chuan (TCC) exercise on metabolism and cardiorespiratory response, and to measure its effect on cardiorespiratory function, mental control, immune capacity, and the prevention of falls in elderly people.
A review of controlled experimental studies and clinical trials designed with one of two aims: either to assess physiological responses during the performance of TCC or to assess the impact of this exercise on general health and fitness.
Metabolic rate, heart rate, blood pressure, ventilation, maximal oxygen uptake (VO(2)MAX), immune capacity, falls, and fall related factors.
A total of 2216 men and women.
Under review were 31 original studies, published in Chinese or English journals, that met the criteria for inclusion. Most of the papers written in Chinese had not been introduced into the Western literature. Nine of these studies showed that TCC can be classified as moderate exercise, as its does not demand more than 55% of maximal oxygen intake. When this form of exercise and others conducted at equal intensity were compared, TCC showed a significantly lower ventilatory equivalent (VE/VO(2)MAX). Evidence provided by cross sectional and longitudinal studies suggests that TCC exercise has beneficial effects on cardiorespiratory and musculoskeletal function, posture control capacity, and the reduction of falls experienced by the elderly.
TCC is a moderate intensity exercise that is beneficial to cardiorespiratory function, immune capacity, mental control, flexibility, and balance control; it improves muscle strength and reduces the risk of falls in the elderly.
This study was designed to determine whether a 6-month Tai Chi exercise program can improve self-reported physical functioning limitations among healthy, physically inactive older individuals. Ninety-four community residents ages 65 to 96 (Mage = 72.8 years, SD = 5.1) volunteered to participate in the study. Participants were randomly assigned to either a 6-month experimental (Tai Chi) group (n = 49), which exercised twice per week for 60 min, or a wait-list control group (n = 45). A 6-item self-report physical functioning scale, assessing the extent of behavioral dysfunction caused by health problems, was used to evaluate change in physical functioning limitations as a result of Tai Chi intervention. Results indicated that compared to the control group, participants in the Tai Chi group experienced significant improvements in all aspects of physical functioning over the course of the 6-month intervention. Overall, the experimental group had 65% improvement across all 6 functional status measures ranging from daily activities such as walking and lifting to moderate-vigorous activities such as running. It was concluded that the 6-month Tai Chi exercise program was effective for improving functional status in healthy, physically inactive older adults. A self-paced and self-controlled activity such as Tai Chi has thepotential to be an effective, low-cost means of improving functional status in older persons.
Since the identification of the post-fall syndrome(1) and use of the term "ptophobia" (the phobic reaction to standing or walking)(2) in the early 1980s, fear of falling (FOF) has gained recognition as a health problem of older adults. In an attempt to measure this entity, various definitions have evolved. Tinetti and Powell(3) described FOF as an ongoing concern about falling that ultimately limits the performance of daily activities. Other authors(4.5) have referred to FOF as a patient's loss of confidence in his or her balance abilities. Still other authors(6) defined FOF as a general concept that described low fall-related efficacy (low confidence at avoiding falls) and being afraid of falling. Subjects in one study(7) indicated then did not describe themselves as being "afraid of falling," but rather were "worried" about falling. In the early phase of research, FOF was largely believed to be a consequence of falling. Researchers discussed FOF as resulting from the psychological trauma of the fall, leading to reduced activity and subsequent losses in physical capabilities.(2.8-10) Recent research, however, has revealed FOF in those who have not fallen(4.11,12) and, furthermore, leas uncovered a relationship to physical, psychological, and functional changes in older adults.(6) Ongoing studies are focusing on the causes of FOF, dispelling misconceptions (eg, FOF being a result of the normal aging process), and identifying the interventions that address FOF most effectively. The researchers, however, agree that FOF is multifactorial in etiology,(12,13) and they suggest that FOF may be a more pervasive and serious problem than falls in older adults(6.13) and thus deserves attention. The purpose of this update is to increase the reader's awareness of the current findings about FOF, including its prevalence among the growing older adult population in the United States, how it is measured, the relationships of FOF to other conditions, and the interventions that are being used to address this problem. The need for further research in the areas of measurement and intervention will be discussed.
One of the challenges faced by people with advancing age is decreased postural stability and increased risks for falls. There has been an increased interest over the last decade in using Tai Chi as an intervention exercise for improving postural balance and preventing falls in older people. Despite the increased number of studies in recent years relating Tai Chi to balance and fall prevention, results are scattered and inconsistent. There is wide variation in the use of balance measures, subject population, type and duration of Tai Chi exercise, and type of study. This paper provides a systematic review/analysis of currently available study reports. The goal of the review is to address the following concerns: how the effect of Tai Chi on balance or fall prevention has been evaluated to date, what level of evidence exists supporting Tai Chi as an effective exercise for improving balance or preventing falls, and what factors could possibly affect the benefit of Tai Chi on balance or falls. This review also helps identify directions for future research.
Through a re-analysis of a Tai Chi intervention data set, the study objective was to determine which, if any, subgroups of the study sample evidenced differential benefits from the intervention.
Re-analysis of a Tai Chi intervention study, a randomized controlled trial in Eugene and Springfield, Oregon. Physically inactive participants aged > or =65 years were randomly assigned to one of two groups: Tai Chi (n=49) and a wait-list control (n=45). The main outcome measure was self-reported physical function.
Initial latent curve analyses indicated significant Tai Chi training effects: Participants in the Tai Chi group reported significant improvements in perceived physical function compared to those in the control group. However, there was significant interindividual variability in response to Tai Chi. The overall intervention effect was further delineated by identifying two subgroups. This delineation showed that Tai Chi participants with lower levels of physical function at baseline benefited more from the Tai Chi training program than those with higher physical function scores. Inclusion of additional measures of individual characteristics at baseline, change in movement confidence, and class attendance further explained differences in treatment responses.
Findings from this study suggest that although an intervention may show an overall effect (or no overall effect), it may be differentially effective for subgroups of participants that differ in their pre-intervention characteristics. Examination of variability in outcome measures can provide important information for refining and tailoring appropriate interventions targeted to specific subgroups.
This study examined falls self-efficacy and fear of falling to determine whether self-efficacy acts as a mediator between fear of falling and functional ability.
Using the Survey of Activities and Fear of Falling in the Elderly as a fear-of-falling measure and the Activities-Specific Balance Confidence Scale for falls self-efficacy, structural relationships among fear of falling, self-efficacy, functional balance, and physical functioning outcomes were tested with older adults (N = 256, M age = 77.5).
Lower levels of fear of falling were significantly related to higher levels of falls self-efficacy, which was in turn associated with better functional outcomes. Moreover, falls self-efficacy mediated the effects of fear of falling on functional outcomes.
Results substantiate the hypothesized mediational role of falls self-efficacy in fear of falling and underscore the need to consider ways of enhancing falls self-efficacy in interventions aimed at reducing falls and fear of falling.
Falls are a significant problem for older adults. Individuals who have sustained a fall come to the attention of health care providers and are at risk of further falls. To promote the highest quality of care and reduce variation in care, a practice guideline is needed. Summarization of evidence regarding falls may be useful to researchers in this field.
To provide evidence-based guidelines of assessment and treatment to prevent falls in older adults and to provide researchers with tables of risk factor studies and randomized controlled trials of falls prevention.
A template for the development of practice guidelines from the Agency for Health Care Policy and Research was used. Evidence for risk factors was accepted from prospective studies with more than 80% follow-up. Potentially modifiable risk factors were selected and a schema for evaluating the importance of each risk factor was used. Evidence for interventions was examined from randomized controlled trials and strength of the evidence was graded. Recommendations for aspects of care where judgment was required were made by panel consensus.
Information was drawn from 46 risk factor studies and 37 randomized controlled trials to develop a practice guideline consisting of assessment items and recommended interventions for community-dwelling and institution-dwelling older adults separately. For clinicians, a check list is provided. Summary tables of the results of studies are given to substantiate the recommendations.
For community-dwelling older adults, there is strong evidence for multi-factorial specific risk assessment and targeted treatment. Balance exercises are recommended for all individuals who have had a fall and there is evidence for a program of home physiotherapy for women over 80 years of age regardless of risk factor status. For institutional settings, the establishment of a falls program for safety checks, ongoing staff education and monitoring is substantiated by research. Residents who have fallen need to be assessed for specific risk factors and clinical indicators to determine relevant management options.
Background:
Approximately 30 per cent of people over 65 years of age and living in the community fall each year; the number is higher in institutions. Although less than one fall in 10 results in a fracture, a fifth of fall incidents require medical attention.
Objectives:
To assess the effects of interventions designed to reduce the incidence of falls in elderly people (living in the community, or in institutional or hospital care).
Search strategy:
We searched the Cochrane Musculoskeletal Group specialised register (January 2001), Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2001), MEDLINE (1966 to February 2001), EMBASE (1988 to 2001 Week 14), CINAHL (1982 to March 2001), The National Research Register, Issue 1, 2001, Current Controlled Trials (www.controlled-trials.com accessed 25 May 2001), and reference lists of articles. We also contacted researchers in the field.
Selection criteria:
Randomised trials of interventions designed to minimise the effect of, or exposure to, risk factors for falling in elderly people. Main outcomes of interest were the number of fallers, or falls. Trials reporting only intermediate outcomes were excluded.
Data collection and analysis:
Two reviewers independently assessed trial quality and extracted data. Data were pooled using the fixed effect model where appropriate.
Main results:
Interventions likely to be beneficial: ~bullet~A programme of muscle strengthening and balance retraining, individually prescribed at home by a trained health professional (3 trials, 566 participants, pooled relative risk (RR) 0.80, 95% confidence interval (95%CI) 0.66 to 0.98). ~bullet~A 15 week Tai Chi group exercise intervention (1 trial, 200 participants, risk ratio 0.51, 95%CI 0.36 to 0.73). ~bullet~Home hazard assessment and modification that is professionally prescribed for older people with a history of falling (1 trial, 530 participants, RR 0.64, 95% CI 0.49 to 0.84). A reduction in falls was seen both inside and outside the home. ~bullet~Withdrawal of psychotropic medication (1 trial, 93 participants, relative hazard 0.34, 95%CI 0.16 to 0.74). ~bullet~Multidisciplinary, multifactorial, health/environmental risk factor screening/intervention programmes, both for unselected community dwelling older people (data pooled from 3 trials, 1973 participants, pooled RR 0.73, 95%CI 0.63 to 0.86), and for older people with a history of falling, or selected because of known risk factors (data pooled from 2 trials, 713 participants, pooled RR 0.79, 95%CI 0.67 to 0.94). Interventions of unknown effectiveness: ~bullet~Group-delivered exercise interventions (9 trials, 2177 participants). ~bullet~Nutritional supplementation (1 trial, 50 participants). ~bullet~Vitamin D supplementation, with or without calcium (3 trials, 679 participants). ~bullet~Home hazard modification in association with advice on optimising medication (1 trial, 658 participants), or in association with an education package on exercise and reducing fall risk (1 trial, 3182 participants). ~bullet~Pharmacological therapy (raubasine-dihydroergocristine, 1 trial, 95 participants). ~bullet~Fall prevention programmes in institutional settings. ~bullet~Interventions using a cognitive/behavioural approach alone (2 trials, 145 participants). ~bullet~Home hazard modification for older people without a history of falling (1 trial, 530 participants). ~bullet~ Hormone replacement therapy (1 trial, 116 participants). Interventions unlikely to be beneficial: ~bullet~Brisk walking in women with an upper limb fracture in the previous two years (1 trial, 165 participants).
Reviewer's conclusions:
Interventions to prevent falls that are likely to be effective are now available; less is known about their effectiveness in preventing fall-related injuries. Costs per fall prevented have been established for four of the interventions and careful economic modelling in the context of the local healthcare system is important. Some potential interventions are of unknown effectiveness and further research is indicated.
The Chinese Exercise Book
- D Zhou
- Marks Hartley
- Let
- J.-G Vancouver
- Zhang
Zhou, D., 1984. The Chinese Exercise Book. Hartley and Marks Let. Vancouver. J.-G. Zhang et al. / Archives of Gerontology and Geriatrics 42 (2006) 107–116
Risk factors for all falls and injurious falls in the elderly in Nanjing, People's Republic of China
- J G Zhang
- H Yamazaki
- K Ishikawa-Takata
Zhang, J.G., Yamazaki, H., Ishikawa-Takata, K., 2003. Risk factors for all falls and injurious falls in the elderly in Nanjing, People's Republic of China. Health Sci. 19, 37–43.
Risk factors for all falls and injurious falls in the elderly in Nanjing, People's Republic of China
- Zhang
Kankoku korei zyosei ni okeru nichizyo seikatsu no katsudo tairyoku ni kansuru kento [Characteristics of activity fitness of daily living in Korean older women]
- Kim