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Martial Arts Exercise
Tai Chi Reduces Falls in Older People: New Study
Confirms Earlier Reports
 June
27, 2005 – A new study confirms what has been reported by other
researchers since 1996 – Tai Chi, a martial arts form that enhances
balance and body awareness through slow, graceful and precise body
movements, can improve balance, build strength and reduce the risk of
falls in the elderly.
The new study published in the Journal of Advanced
Nursing reported on a group of fall-prone senior citizens, with an
average age of 78, living in residential care. Twenty nine undertook a
12-week Tai Chi course three times a week and 30 formed the non-exercise
control group.
They found that the physical fitness of the
exercise group showed significant improvement, with stronger knee and
ankle muscles, improved mobility and flexibility and better balance.
For example, after the exercise program had
finished, the time taken by the exercise group to walk six meters had
fallen by 25 per cent, while the control group took 14 per cent longer.
"As people get older they are more likely to
experience falls and this can lead to some very serious health issues"
says co-author Professor Rhayun Song from the Chung Nam National
University in South Korea.
"Regular exercise is very important as we get older
because when we get to 65 we start losing muscle strength at a rate of
up to two per cent per year," Song added.
Tai Chi, an ancient Chinese martial art consisting of a series of slow,
gentle, continuous movements, is particularly suitable for older people
as it helps them to develop stronger muscles and better balance and
concentration.
The exercise program used in the research consisted
of 10 minutes of warming up exercises, 20 minutes of Sun-style Tai Chi
movement and five minutes of cooling down exercises. Traditional
instrumental music was used to help the group maintain slow and
continuous movements and provide a soothing effect.
Both groups underwent a series of tests before the
12-week exercise program and again after it had been completed. This
measured their muscle strength, balance and confidence in avoiding
falls.
Participants were also asked to report any falls
they experienced during the test period. 31 per cent of the exercise
group said they had had a fall, compared with 50 per cent of the control
group.
In the year before the research started, 66 per
cent of the exercise group had reported a fall, together with 57 per
cent of the control group.
"Our study shows that low-intensity exercise such
as Tai Chi has great potential for health promotion as it can help older
people to avoid falls by developing their balance, muscle strength and
confidence" says Professor Song.
"We believe that regular exercise should be a
fundamental part of caring for older people living in the community and
in residential care."
Earlier Studies
Two studies in the May 1996 issue of the Journal of
the American Geriatrics Society claimed to be the first involving Tai
Chi to be reported by scientists in a special frailty reduction program
sponsored by the National Institute on Aging (NIA).
Not only did they find the risk of falls was
reduced by Tai Chi, but they reported it may be beneficial in
maintaining gains made by people age 70 and older who undergo other
types of balance and strength training.
In the first study, Steven L. Wolf, Ph.D., and
colleagues at the Emory University School of Medicine, Atlanta, Ga.,
found that older people taking part in a 15-week Tai Chi program reduced
their risk of falling by 47.5 percent. A second study, by Leslie Wolfson,
M.D., and colleagues at the University of Connecticut Health Center,
Farmington, found that several interventions to improve balance and
strength among older people were effective. These improvements,
particularly in strength, were preserved over a 6-month period while
participants did Tai Chi exercises.
The projects are among several in the NIA's Frailty
and Injuries: Cooperative Studies of Intervention Techniques, or FICSIT,
initiative, launched in 1990 to improve physical function in old age.
Research from these and other FICSIT trials has
demonstrated the benefits of strength training for older people and the
value and cost-effectiveness of targeted, fall prevention programs for
the elderly. It is estimated that each year falls are responsible for
costs of over $12 billion in the U.S., and the costs due to physical
frailty are much higher.
The news on Tai Chi is a reminder that relatively
"low tech" approaches should not be overlooked in the search for ways to
prevent disability and maintain physical performance in late life. "The
FICSIT studies have shown that a range of techniques, from the most
sophisticated medical interventions to more 'low tech' methods, can help
older people avoid frailty and falling," says Chhanda Dutta, Ph.D.,
Director of Musculoskeletal Research in the NIA's Geriatrics Program.
"We must make sure that we look at every approach, especially relatively
inexpensive ones like Tai Chi," says Dutta. "People can do this at home
and with friends once they have had the proper training."
The Wolf study included 200 participants age 70 and
older. The participants were divided into groups for Tai Chi,
computerized balance training, and education. In addition to 15 weekly
sessions in which they progressed to more complex forms of Tai Chi, the
participants were asked to practice at home at least 15 minutes, twice
daily. Another group received balance training using a computer-operated
balance platform in which participants tried to improve control of their
body sway under increasingly difficult conditions. The education group
was asked to not change any of its current exercise regimens, and took
part in weekly meetings on a variety of topics with a nurse
gerontologist.
Wolf's group compared several factors before and
after the interventions, and found improvements in certain key areas.
The most notable change involved the reduction in the rate of falling
for the Tai Chi group. The groups receiving computerized balance
platform training did not have significantly lower rates of falling. The
Tai Chi participants also took more deliberate steps and decreased their
walking speed slightly compared to the other groups. Fear of falling
also was reduced for the Tai Chi group. After the intervention, only 8
percent of the Tai Chi group said they feared falling, compared with 23
percent before they had the training.
"The Tai Chi group seemed to have more confidence,"
says Wolf, noting that "they had an increased sense of being able to do
all that they would like to do." Wolf notes that almost half of the Tai
Chi participants chose to continue meeting informally after the study
was finished.
The Connecticut FICSIT site used sophisticated
techniques for balance and strength training. Some 110 participants,
averaging age 80, received training for 3 months. They were divided into
four groups: one group received balance training in 45-minute sessions
three times per week, including a computerized balance platform (of a
different type than the one used in the Wolf study) as well as low-tech
balance exercises; another took part in resistance training and weight
lifting three times a week to improve strength; a third group did both
balance and strength training, and a fourth "education" group
participated in sessions on fall prevention and stress management.
Everyone in the study took part in weekly Tai Chi classes for 6 months
following the intensive training period.
The people in the study were evaluated before
undergoing any training, immediately after the training, and after a
6-month follow-up Tai Chi program. The interventions of major focus in
the study -- intensive balance and strength training -- produced marked
effects. Participants had a 25 to 50 percent improvement in three
different measures of balance after completing balance training, while
strength training resulted in a 17 percent improvement in strength. Some
of the gains immediately following the balance and strength training
were lost after 6 months of the Tai Chi follow-up program. However, the
participants tested significantly higher than they had before the
interventions began.
Without a comparable group who did not receive Tai
Chi training after exercise training, it is difficult to know for
certain whether the Tai Chi contributed to maintaining gains in strength
and balance. Wolfson noted that study participants might have done even
better at the end of the maintenance phase had they continued the more
intensive balance and strength training, but he also suggested that Tai
Chi might be further studied as a less intensive way to hold onto the
benefits of prior strength and balance training.
The NIA, part of the National Institutes of Health,
leads the Federal effort conducting and supporting research on the aging
process and the diseases and disabilities that accompany advancing age.
The Institute's program focuses on biomedical, clinical, and social and
behavioral research, and supports the Claude D. Pepper Older American
Independence Centers at medical centers across the U.S., whose research
is aimed at maintaining healthy function well into old age.
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