Fall in Elderly

Topics: Tai chi chuan, Randomized controlled trial, Epidemiology Pages: 13 (4939 words) Published: March 3, 2010
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...

References: Alessi, C.A. (2000). Sleep disorders. In Beers MH, Berkow R, eds. The Merck Manual of Geriatrics. 3rd edition. NJ: Merck & Co, 459-463. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention (2001). Guideline for the prevention of falls in older persons. Journal of American Geriatrics Society, 49, 664-672. Chan, K., Qin, L., Lau. M et al. (2004). A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density. Archrivals of Physical Medicine Rehabilitation 85, 717-722. Channer, K., S., Barrow, D., Barrow, R., Osborne, M., & Ives, G. (1996). Changes in haemodynamic parameters following tai chi chuan and aerobic exercise in patients recovering from acute myocardial infarction. Postgard Medicine, 72, 349-351. Chen, S. (2002). A modified Tai Chi program for individuals with physical disabilities. Palaestra, 18(2), 43–47. China National Sports Commission. (1983). Simplified Taijiquan. Beijing, China: People’s Sports. China Sports (1980). Simplified “Taijuquan.” Beijing: Foreign Language Printing House. Christou, E.A., Yang, Y., & Rosengren, K.S. (2003). Taiji training improves knee extensor strength and force control in older adults. Journal of Gerontology: Medicine Sciences, 58, 763-766. Fasko, D., & Grueninger, R. W. (2001). T’ai Chi Ch’uan and physical and psychological health: A review. Clinical Kinesiology, 55, 4-12. Hartman, C. A., Manos, T. M., Winter, C. et al. effects of Tai Chi training on function and quality of life indicators in older adults with osteoarthritis Journal of American Geriatrics Society, 48, 1553-1559. Kutner, N.G., Barnhart, H., Wolf, S.L., McNeely, E., & Xu, T. (1997). Self-report benefits of Tai Chi practice by older adults. Journal of Gerontology: Psychological Science, 52, 242–246. Lai, J., S., Lan, C., Wong, M. K., & Teng, S. H. (1995).Two-year trends in cardiorespiratory function among older tai chi chuan practitioners and sedentary subjects. Journal of American Geriatrics Society, 43, 1222-1227. Lan, C., Lai, J. S., & Chen, S. Y. (2002). Tai Chi Chuan: An ancient wisdom on exercise and health promotion. Sports Medicine, 32, 217-224.
9 Lan, C, Lai, J. S., Chen, S., Y., Wong, M. K. (1998). 12-month Tai Chi training in the elderly: its effect on health fitness. Medicine Science & Sports Exercise, 30, 345-351. Lan, C., Chen, S. Y., Lai, J. S., & Wong, M. K. (1999). The effect of Tai Chi on cardiorespiratory function in patients with coronary artery bypass surgery. Medicine Science & Sports Exercise, 31, 634-638. Li, J. X., Hong, Y., & Chan, K. M. (2001). Tai Chi: Physiological characteristics and beneficial effects on health. British Journal of Sports Medicine, 35, 148–156. Li, F., Duncan, T. E., Duncan, S. C., McAuley, E., Chaumeton, N. R., & Harmer, P. (2001a). Enhancing the psychological well-being of elderly individuals through Tai Chi exercise: A latent growth curve analysis. Structural Equation Modeling: A Multidisciplinary Journal, 8, 53-83. Li, F., Fisher, K. J., Harmer, P., Irbe, D., Tearse, R. G., & Weimer, C. (2004). Tai Chi and selfrated quality of sleep and daytime sleepiness in older adults: A randomized controlled trial. Journal of American Geriatrics Society, 52, 892-900. Li, F., Fisher, K. J., Harmer, P., & McAuley, M. (2002a). Delineating the impact of Tai Chi training of physical function among the elderly. American Journal of Preventive Medicine, 23, 92–97. Li, F., Harmer, P., Duncan, T. E., Duncan, S. C., & Chaumeton, N. R. (2002b). Tai Chi as a means to enhance self-esteem: A randomized controlled trial. Journal of Applied Gerontology, 21, 70–89. Li, F., Harmer, P., Fisher, K. J., & McAuley, E. (2004). Tai Chi: improving functional balance and predicting subsequent falls in older adults. Medicine & Science in Sports & Exercise, 36, 2046-52. Li, F., Harmer, P., Fisher, K J., McAuley, E., Chaumeton, N. Eckstrom, E., & Wilson, N. L. (2005). Tai Chi and fall reductions in older adults: A randomized controlled trial. Journal of Gerontology: Medical Sciences, 60A, 66-74. Li, F., Harmer, P., McAuley, E., Duncan, T. E., Duncan, S. C., Chaumeton, N., & Fisher, K. J. (2001b). An evaluation of the effects of Tai Chi exercise on physical function among older persons: A randomized controlled trial. Annals of Behavioral Medicine, 23, 139–146. Li, F., McAuley, E., Harmer, P., Duncan, T., & Chaumeton, N. R. (2001c). Tai Chi enhances self-efficacy and exercise behavior in older adults. Journal of Aging and Physical Activity, 9, 161–171. Li, F., McAuley, E., Harmer, P., Duncan, T. E., Duncan, S. C., & Chaumeton, N. R. (2001d). Tai Chi, self-efficacy, and perceived physical function. Prevention Science, 2, 229-239.
10 Lumsden, D. B., Baccala, A., & Aartire, J. (1998). Tai Chi for osteoarthritis: an introduction for primary care physicians. Geriatrics, 53, 87-88. National Action Plan (2005). Falls Free: Promoting a national falls prevention action plan: Nation Action Plan. Neubauer, D. N. (1999). Sleep problems in the elderly. Am Family Physician, 59, 25512558. Murphy, S.L. (2000). Deaths: Final data for 1998. National Vital Statistics Reports, Vol. 48, No. 11. Hyattsville (MD): National Center for Health Statistics. People Sports. (1996). Tai Chi Chuan: Collected works. Beijing, China: People’s Sports Publications (Chinese). Preventive Services Task Force (1996). Guide to clinical preventive services: report of the U.S. Preventive Services Task Force, 2nd ed (pp. 659-685). Baltimore: Williams & Wilkins. Song, R., Lee, E. O., Lam, P et al. Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. Journal of Rheumatology, 30, 2039-1049. Stevens, J. A. (2005). Falls among older adults – Risk factors and prevention strategies. Falls free: Promoting a national falls prevention action plan. Swaim, L. (1999). Fu Zhongwen: Mastering Yang style Taijiquan. Berkeley, CA: North Atlantic Books. van der Bij, A. K. Laurant, M. G. H. & Wensing, M. (2002). Effectiveness of physical activity intervention for older adults. American Journal of Preventive Medicine, 33, 120-133. Verhagen, A. P., Immink, M., va der Meulen et al. (2004). The efficacy of Tai Chi Chuan in older adults: a systematic review. Family Practice, 21, 107-113. Wayne, P. M., Krebs, D. E., Wolf, S. L., Gill-body, JK. M., Scarborough, D. M., McGibbon, C. A., Kaptchuk, T. J., & Parker, S. W. (2004). Can Tai Chi improve vestibulopathic postural control? Archives of Physical Medicine and Rehabilitation, 85, 142-152. Wang, C., Collet, J. P, & Lau, J. (2004). The effect of Tai Chi on health outcomes in patients with chronic conditions. Archives of Internal Medicine, 164, 493-501. Wilson, C. J., & Datta, S. K. (2001). Tai chi for the prevention of fractures in nursing home population: an economic analysis. Journal of Clinical Outcome Management, 8, 19-27. Wolf, S. L., Barnbart, H. X., Kutner, N. G., McNeely, E., Coogler, C., Xu, T., & the
11 Atlanta FICSIT Group. (1996). Reducing frailty and falls in older persons: An investigation of Tai Chi and computerized balance training. Journal of American Geriatrics Society, 44, 489–497. Wolf, S. L., Coogler, C., & Xu, T. (1997). Exploring the basis for Tai Chi Chuan as a therapeutic exercise approach. Archives of Physical Medicine & Rehabilitation, 78, 886– 892. Wolf, S.L., Sattin, R. W., Kutner, M. et al. (2003). Intense Tai Chi exercise training and fall occurrences in older, transitionally frail adults: A randomized, controlled trial. Journal of American Geriatrics Society, 51, 1693-1701. Wolfson, L., Whipple, R., Derby, C., Judge, J., King, M. Amerman, P., Schmidt J., & Smyers, D. (1996). Balance and strength training in older adults: intervention gains and Tai Chi maintenance. Journal of American Geriatrics Society, 44, 498-506. Wu, G. (2002). Evaluation of the effectiveness of Tai Chi for improving balance and preventing falls in the older population – A review. Journal of American Geriatrics Society, 50, 746-754. Young, D. R., Appel, L. J., Jee, S. H., & Miller, E. R. (1999). The effects of aerobic exercise and T’ai Chi on blood pressure in older people: Results of a randomized trial. Journal of American Geriatrics Society, 47, 277–284. Yu, T., & Johnson, J. (1999). T’ai Chi fundamentals for health care professionals and instructors: A simplified approach for mastering T’ai Chi basics. Uncharted Country.
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