Fall Prevention in Older Adults
There is evidence that tai chi may reduce the risk of falling in older adults. There is also some evidence that tai chi may improve balance and stability with normal aging and in people with neuro-degenerative conditions, including mild-to-moderate Parkinson’s disease and stroke.
The Evidence Base
- The evidence base on efficacy of tai chi for reducing the risk of falls in older adults consists of several small studies and a few systematic reviews and meta-analyses of randomized controlled trials of exercise interventions, including tai chi, for fall prevention.
- A 2013 Cochrane review examined which fall prevention interventions, including tai chi, are effective for older people living in the community. The review included 159 randomized controlled trials of 79,193 participants. Reviewers found that tai chi significantly reduced risk of falling.
- Results of a 2015 systematic review and meta-analysis of seven randomized controlled trials involving 1,088 older adults suggest that practicing tai chi is beneficial to improve the balance control ability and flexibility in this population.
- A 2014 Cochrane review of 30 studies involving 2,878 older adults assessed the effects of exercise interventions, which included tai chi, for reducing fear of falling in community-dwelling older people. Reviewers concluded that exercise interventions had low quality evidence that they reduce the fear of falling immediately following the intervention and insufficient evidence to determine whether these interventions reduce fear of falling after the intervention has ended. The review also examined whether exercise interventions reduced the number of falls in participants as a secondary outcome, but was considered incomplete because only a portion of the studies in the analysis evaluated this outcome.
- Findings from a 2012 randomized controlled trial of 195 patients with Parkinson’s disease demonstrated that tai chi improved balance impairments better than resistance training or stretching in patients with mild–to-moderate Parkinson’s disease. Additional benefits of improved functional capacity and reduced falls were also examined. A 2014 follow-up analysis showed that patient-reported outcomes from tai chi practice were associated with greater probability of continued exercise behavior than were either clinical outcomes or patient-reported outcomes from resistance training or stretching. Tai chi also improved patient-reported perceptions of health-related benefits.
There is some evidence to suggest that practicing tai chi may help people manage chronic pain associated with knee osteoarthritis and fibromyalgia.
The Evidence Base
- The evidence base on efficacy of tai chi for chronic pain associated with osteoarthritis consists of several small-to-moderately sized randomized trials included in systematic reviews and meta-analyses evaluating more broadly the effects of exercise on osteoarthritis symptoms.
Efficacy: Knee Osteoarthritis
- A 2013 meta-analysis of seven randomized controlled trials involving 348 participants assessed the effectiveness of tai chi for pain, stiffness, and physical function in people with osteoarthritis. The meta-analysis concluded that a 12-week tai chi training is beneficial for improving physical function and symptoms of osteoarthritis; however, the studies included in the analysis have methodological flaws and may be limited by potential biases.
- A 2015 Cochrane review of 54 studies involving 3,913 participants assessed the effects of non-aquatic exercise on osteoarthritis symptoms. Five of the studies examined the effects of tai chi on osteoarthritis, while the remaining studies evaluated exercise programs consisting of traditional muscle strengthening, functional training, and aerobic fitness. The reviewers concluded that high-quality evidence suggests exercise provides short-term benefit in terms of reduced knee pain that is sustained for at least 2 to 6 months after cessation of intervention. There was moderate-quality evidence for improvement in physical function among people with knee osteoarthritis. They further noted that the treatment effect would be moderate to small but comparable with estimates reported for NSAIDs.
- A 2010 randomized controlled trial with 66 participants found that practicing tai chi was more efficacious than wellness education and stretching in improving sleep and coping with pain, fatigue, and depression in patients with fibromyalgia. After 12 weeks, participants who practiced tai chi also had better self-reported scores on certain daily activities such as walking, housecleaning, shopping, and preparing a meal.
- Findings from a 2012 randomized controlled trial in 101 participants suggest that combining tai chi movements with mindfulness improves fibromyalgia symptoms and functional mobility.
There is some evidence that tai chi may improve lower extremity range of motion in people with rheumatoid arthritis. Results of studies suggest that tai chi does not exacerbate symptoms. It is not known if tai chi improves pain associated with rheumatoid arthritis or quality of life.
The Evidence Base
- The evidence base on efficacy of tai chi for symptoms of rheumatoid arthritis consists of several small, randomized controlled trials and a Cochrane systematic review.
- A 2010 Cochrane review of four studies involving 206 participants found that tai chi had no clinically important or statistically significant effect on most outcomes of disease activity, which included activities of daily living, tender and swollen joints and patient global overall rating. However, participants in the tai chi group had statistically significant and clinically important improvements in range of motion outcomes of ankle plantar flexion. No detrimental effects were observed.
There is some limited evidence that suggests tai chi may be a useful nonpharmacologic approach to improve sleep quality.
The Evidence Base
- The evidence base on efficacy of tai chi for insomnia consists of only a few randomized controlled trials and a systematic review of a range of complementary health approaches, including tai chi.
- A 2011 systematic review of 20 studies involving eight complementary health approaches for insomnia found evidentiary support in the treatment of chronic insomnia for tai chi.
- A 2008 randomized controlled study in 112 healthy older adults aged 59 to 86 years found that participants with moderate sleep complaints were more likely to achieve a treatment response than those in the health education control group. Findings suggest that tai chi has the potential to ameliorate sleep complaints possibly before syndromal insomnia develops.
A range of research has examined the relationship between exercise and depression. Results from a much smaller body of research suggest that exercise may also affect anxiety symptoms. Even less certain is the role of tai chi—for these and other psychological factors.
The Evidence Base
- The evidence base on efficacy of tai chi for stress, anxiety, and depression consist of several randomized, nonrandomized, and observational studies, systematic reviews and meta-analyses.
- Some studies suggest that practicing tai chi may be associated with improvements in stress, anxiety, and depression, mood, and self-esteem. However, a 2010 systematic review and meta-analysis of 40 studies involving 3,817 participants could not provide definitive conclusions due to variation in designs, comparisons, heterogeneous outcomes and inadequate controls.
- A 2010 review of 29 studies with more than 2,500 participants did not offer clear evidence about the effectiveness of tai chi on anxiety, depression, stress, mood, and self-esteem. The majority of these studies did not look at psychological distress as the primary goal and did not intentionally recruit participants with mental health issues.
There is some evidence that suggests tai chi may have the potential to provide modest enhancements of cognitive function in older adults without cognitive impairment.
The Evidence Base
- The evidence base on efficacy of tai chi for cognitive function in older adults consists of several randomized controlled trials and a systematic review and meta-analysis.
- A 2014 systematic review and meta-analysis of 20 studies (11 of which were randomized controlled trials) involving 2,553 participants aged 60 and older with and without cognitive impairment found beneficial effects in healthy adults who practiced tai chi, compared with nonintervention and exercise controls. Eleven of the studies examined changes in cognitive function among older adults without reported cognitive impairment. Four were randomized controlled trials reporting positive effects of tai chi on cognitive function. In cognitively impaired adults, smaller but statistically significant effects with tai chi were seen when compared with nonintervention control and other active interventions.
- A 2015 systematic review of nine prospective studies (four randomized controlled trials and five non-randomized controlled trials) in 632 healthy adults concluded that compared with usual physical activities, tai chi shows potential beneficial effects on cognitive ability in healthy adults.
There is only limited, inconsistent evidence available on the effectiveness of tai chi for cardiovascular health. A few studies suggest beneficial effects of tai chi on cardiovascular risk factors, but most of the studies have been small, of short duration, and of poor quality to draw conclusions.
The Evidence Base
- The evidence base on efficacy of tai chi for cardiovascular health consists of systematic reviews and meta-analyses of several small studies of low methodological quality.
- A 2015 systematic review and meta-analysis of 20 studies involving 1,868 participants showed that tai chi had beneficial effects on outcomes of cardiovascular function, including blood pressure, heart rate, stroke volume, lung capacity, and V02 peak. However, no definitive conclusions could be drawn due to the low methodological quality of the studies included in the analysis.
- A 2014 Cochrane systematic review of 13 small trials of short duration concluded that because of the limited evidence available, no conclusions can be drawn as the effectiveness of tai chi on cardiovascular disease risk factors.
- A 2015 single-blind randomized controlled trial in patients with a recent myocardial infarction found that after 12 weeks of practicing tai chi, those in the tai chi group had a significant (14%) increase in VO2 peak from baseline, whereas those in the control group had a nonsignificant (5%) decrease in VO2 peak.
- Tai chi appears to be a safe practice.
- Complaints of musculoskeletal pain after starting tai chi may occur, but have been found to improve with continued practice.
- Women who are pregnant and those with heart conditions should talk with their health care providers before beginning tai chi or any other exercise program.
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