Fall in Elderly

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1 The Role of Tai Chi Exercise in Promoting Health Benefits for Older Persons Fuzhong Li, Ph.D., Oregon Research Institute Tai Chi, or Taijiquan to be exact, originated in China about 300 hundreds years ago (China Sports, 1980) and began as a form of martial arts like boxing. It has continued to evolve from being originally used as a combative and self-defense form to a health-enhancing exercise, practiced by individuals of all ages to maintain health and prevent disease. As an alternative exercise, Tai Chi has drawn increasing research interest, with accumulating evidence showing the therapeutic value of Tai Chi to overall health and well-being. The goal of this paper is to summarize current research findings with a particular focus on geriatric populations, discuss findings with respect to their practical implications, and highlight future research directions. Overview of Research Findings A number of excellent review articles exist showing evidence that Tai Chi generates various health benefits for individuals of varying age groups and patient populations (Fasko & Grueninger, 2001; Lan, Lai, & Chen, 2002; Li, Hong, & Chan, 2001; Verhagen, Immink, va der Meulen et al., 2004; Wang, Collet, & Lau, 2004; Wayne, Krebs, Wolf, et al., 2004; Wu, 2002). Without overdue redundancy, the following provides a summary review of research studies that involve randomized controlled trials (RCTs) although results from non-RCTs are reported in the absence of RCTs. With aging processes, declines in physical and mental status in older adults often result in balance control impairments, functional limitations in locomotor activities, disability in particular activities, and decreased quality of life. Therefore, this review also focuses on health outcomes that have been shown to be clinically most relevant to this population. These include balance and falls, musculoskeletal conditions, sleep quality, cardiovascular and respiratory function, and psychosocial wellbeing. Balance Control, Falls, and Fear of Falling Falls are significant public health problem among older adults (Murphy, 2000; Stevens, 2005), making it a major threat to the independence and quality of life of older adults, as well as imposing significant burden to individuals, society, and national health systems (National Action Plan, 2005). As a stand-alone exercise intervention, Tai Chi has been shown to reduce the risk for falls. Wolf and his colleagues (1996) conducted the very first randomized controlled trial comparing the efficacy of two methods of exercise on falls. Community living healthy adults were randomized to one of three groups: Tai Chi training; computerized balance training; and an attention control. Results of this 15-week trial showed that Tai Chi participants experienced significant reductions (by about 47%) in falls compared to the exercise control participants. In a follow-up 48-week RCT, Wolf et al (2003) evaluated Tai Chi with older adults who were less robust (that is, transitioning to frailty). No significant between-experimental group reductions in falls were observed. However, by analyzing fall data from month four through month twelve, the study showed a significantly reduced risk of falls in the Tai chi group compared with the exercise control group. In an independent study, Li et al. (2005) confirmed the general findings of those reported by Wolf and his colleagues. These researchers reported that, at the end of a 6-month Tai Chi intervention, significantly fewer falls (38 versus 73), lower proportions of fallers (28% versus

2 46%), and injurious falls (7% versus 18%) were observed in the Tai Chi condition, compared to a low-impact stretching control condition. Overall, the risk of multiple falls in the Tai Chi group was 55% lower than that of the stretching controls. In addition, compared to stretching control participants, Tai Chi participants showed significant improvements in measures of functional balance, physical performance, and reduced...
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