Senior Citizens Improve Mobility Better With Balance Training than Tai Chi

December 11, 2006 - Physicians and physical therapists in recent years have explored whether tai chi, balance programs and fitness routines can help decrease the likelihood that older adults will fall and injure themselves. Many of these programs have shown promise, but their relative value is still open to debate.

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Now, a study from researchers at the University of Michigan Health System and the Veterans Affairs Ann Arbor Healthcare System suggests that a program focusing on increasing step length and speed is more effective at improving mobility and balance than tai chi.

While tai chi – a Chinese martial art form consisting of slow, rotational movements and weight-shifting – offers many benefits, the researchers say, they’re not as great as those produced by a balance-training program.

"Our results indicate that in older adults with at least mild balance impairment, Combined Balance and Stepping Training (CBST) results in modestly greater improvement in balance, stepping and functional mobility compared to tai chi training," says senior author Neil B. Alexander, M.D., professor in the Division of Geriatric Medicine, Department of Internal Medicine, at the U-M Health System, and acting director of the Geriatric Research, Education, and Clinical Center, VA Ann Arbor Healthcare System.

"What this tells us is that if you want to improve your ability to balance and walk, try a program that focuses on improving balance while moving and the ability to step quickly and further," he says of the study, which appears in the new edition of the Journal of the American Geriatrics Society.

"Data from this study can help determine which balance training program may be most optimal to improve balance and eventually reduce falls. Among older adults, falls are becoming an increasing problem, so it is important that we find ways to help prevent them in the first place."

This is the first comparison of two balance training programs in which each type of program has been proven to reduce falls, notes lead author Joseph O. Nnodim, M.D., Ph.D., clinical instructor in the Division of Geriatric Medicine at the U-M Health System and a research scientist at the VA Ann Arbor GRECC.

The researchers add that the CBST program requires no specialized equipment or advanced training for the instructor. "It’s a very easy program to implement," says Alexander, director of the Mobility Research Center at the U-M Geriatrics Center.

The study lasted 10 weeks, and participants did three one-hour sessions a week with an instructor. Of the 162 people in the study, 81 were in the CBST group and 81 were in the Tai Chi classes. All were ages 65 and older.

Participants performed several tests at the beginning and end of the study, including balance measures in which they were timed while they stood with one foot forward and while they stood on one leg – tests called tandem stance and unipedal stance. They also were measured while stepping as far as they could in three directions: forward, to the side and backward (the maximal step length test). Another measure had them take a series of steps and return quickly to the starting position (rapid step test), and a final test measured how quickly they rose from sitting in a chair, walked three meters, turned and returned to the seat (timed up and go).

After initial testing, the participants were assigned to one of the two fall-prevention training options.

● The CBST classes included activities in which participants moved their upper bodies while bouncing and catching a ball; increasing the complexity of ambulatory tasks, such as changing direction to walk forward or laterally; walking on a plank; turning, bending and stepping on and off curbs; stepping over obstacles; and more.

● The tai chi classes focused on body alignment; weight shifts, including standing on one leg; hip and ankle rotations; stepping motions backward, forward and laterally; and more. Emphasis was on awareness of one’s body alignment, relaxation and distribution of weight, and 12 sequences from the tai chi Yang Short Form were practiced.

At the end of the 10 weeks, improvements in unipedal stance were roughly the same between the two groups. But compared to tai chi, CBST had greater improvements in the timed up and go measure (9.4 percent faster than the tai chi group); and in the two step measurements, (9.8 percent higher in the CBST group for the maximal step length test, and 5.4 percent higher in the rapid step test).

"This research is very promising in our efforts toward reducing falls among older adults," Nnodim says. "We would like future research to include a comparison of fall rates in response to these two programs so we can develop an even better sense of what works best in the prevention of falls."

Editor's Notes:

In addition to Alexander and Nnodim, authors were Debra Strasburg, M.S., and Martina Nabozny, B.A., both of the Mobility Research Center, Division of Geriatric Medicine, at the U-M Health System; and Lynda Nyquist, Ph.D., Andrzej Galecki, Ph.D., M.D., and Shu Chen, M.S., all of the Institute of Gerontology at the U-M Health System.

Primary financial support came from the National Institute on Aging Michigan Claude Pepper Older Americans Independence Center and the K24 Mid-Career Investigator Award in Patient-Oriented Research. The authors also acknowledge support from the Department of Veterans Affairs Research and Development. Nnodim was a fellow in the VA Special Fellowship Program in Academic Geriatrics. The authors have no conflict of interest to disclose.

Source: Journal of the American Geriatrics Society, Dec. 2006, 54:1825–1831.

For more about the Mobility Research Center at the U-M Health System, visit www.med.umich.edu/geriatrics%20/moblab/index.htm. The MRC focuses on studies of mobility and physical activity assessment and enhancement in older adults and is part of the U-M Geriatrics Center. For information about the Geriatrics Center's Mobility Enhancement Clinic, call 734-764-6831 to make an appointment with Dr. Alexander. For more information about the VA Ann Arbor GRECC, visit www.med.umich.edu/geriatrics_center/grecc/.

Learning More About Preventing Falls Among Older Adults

Among people 65 years and older, falls are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for trauma. Each year in the United States, nearly one third of older adults experience a fall.

In 2003, more than 13,700 people 65 years or older died of fall-related injuries. Another 1.8 million were treated in emergency departments for nonfatal injuries related to falls. The total direct cost for falls among older adults in 2000 was about $19 billion. Given the growing population of this age group, this cost is expected to reach $43.8 billion by 2020.

To learn more about falls among older adults and what can be done to prevent them, check out the materials that follow.

Fact Sheets

Falls Among Older Adults: An Overview
Provides an overview of the problem of falls among older adults in the United States and a brief outline of prevention strategies.

Costs of Falls Among Older Adults
Discusses the direct costs associated with fatal and nonfatal falls among older adults in the United States.

Hip Fractures Among Older Adults
Provides information about the occurrence, consequences, and costs of hip fractures, which are common fall-related injuries.

Falls in Nursing Homes
Discusses falls and their prevention among nursing home residents.

CDC Fall Prevention Activities
Highlights CDC-sponsored projects aimed at preventing falls among older adults.

Brochures

Two brochures, developed by CDC and redesigned in partnership with the CDC Foundation and MetLife Foundation, provide steps that older adults and those who care for them can take to reduce the risk of falls and related injuries. Both are available in English, Spanish, and Chinese.

What YOU Can Do to Prevent Falls
Highlights four personal strategies for preventing falls.

Check for Safety: A Home Fall Prevention Checklist for Older Adults
Lists things to check for and fix in the home to reduce the risk of falls.

Posters

Four posters were developed in partnership with the CDC Foundation and MetLife Foundation. Each highlights one of four key strategies for preventing falls among older adults. All are available in English, Spanish, and Chinese.

Figures and Maps

Charts, tables, and maps depict statistics about fall-related deaths and injuries. See trends in fall-related death and nonfatal injury rates and compare death rates by sex and by state.

Websites About Older Adults and Falls

Looking for more information? Click on the links below for other organizations working to prevent older adult falls.

American Association of Retired Persons - An organization for people 50 and older that provides information and education, advocacy, and community services through a national network of local chapters and experienced volunteers.

Gerontological Society of America - A multidisciplinary organization dedicated to the scientific study of aging and to the translation and dissemination of research for practice and policy.

Home Safety Council - A national nonprofit organization dedicated to preventing home-related injuries.

National Council on Aging - An advocacy organization dedicated to improving the health and independence of older persons and to increasing their contributions to communities, society, and future generations.

National Institute on Aging - One of the National Institutes of Health, the NIA promotes healthy aging by conducting and supporting biomedical, social, and behavioral research and public education.

National Osteoporosis Foundation - A voluntary, nonprofit health organization and resource for information about the causes, prevention, and treatment of osteoporosis, a risk factor for fall-related fractures.

National Resource Center for Safe Aging – The Center gathers and shares information and resources on senior safety with public health professionals, older adults, and their families.

U.S. Administration on Aging - The Administration works to raise awareness among other federal agencies, organizations, groups, and the public about both the contributions and needs of older Americans. It also informs older people and their caregivers about the benefits and services available to help them.

U.S. Consumer Product Safety Commission - The federal regulatory agency that protects the public against unreasonable risks of injuries and deaths from consumer products.

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