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Modified tai chi training reduced falls in at-risk elderly

Tai ji quan balance training more effective than conventional exercise in reducing falls incidence

Louise Prime

Tuesday, 11 September 2018

For older adults at high risk of falling, a therapeutically tailored tai ji quan programme designed to improve balance was significantly more effective than stretching or multimodal exercises in reducing the incidence of falls, according to a randomised clinical trial* published in JAMA Internal Medicine.

The study authors designed a single-blind, three-arm, parallel design, randomised clinical trial to determine the effectiveness of a therapeutically tailored tai ji quan intervention, 'Tai Ji Quan: Moving for Better Balance' (TJQMBB), developed on the classic concept of tai ji (also known as tai chi), and a multimodal exercise (MME) programme relative to stretching exercise in reducing falls among older adults at high risk of falling.

They conducted their study in seven urban and suburban cities in Oregon, and included 670 community-dwelling adults aged at least 70 years (mean 77.7 years) who had fallen in the preceding year or had impaired mobility consented and were enrolled. About two-thirds of participants were women, and more than nine in 10 were white.

They randomised participants to one of three interventions, each of which involved two 60-minute classes weekly for 24 weeks. The three groups did either: TJQMBB, entailing modified forms and therapeutic movement exercises; MME, integrating balance, aerobics, strength, and flexibility activities; or stretching exercises.

During the trial, 152 falls occurred (in 85 individuals) in the TJQMBB group, there were 218 falls (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. At six months, the incidence rate ratio was significantly lower in the TJQMBB (IRR 0.42) and MME groups (IRR 0.60) compared with the stretching group. Falls were reduced by 31% for the TJQMBB group compared with the MME group (IRR 0.69).

The study authors noted certain limitations of their study – for example, that it was conducted in a single state, had a small number of African American participants, and used self-reported fall data – and said that although they had tried to minimise any effects of these factors, a multicentre trial involving multiple states would improve the generalisability of their findings.

They concluded: “Among community-dwelling older adults at high risk for falls, a therapeutically tailored tai ji quan balance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls.”

*Li F, Harmer P, Fitzgerald K, et al. Effectiveness of a therapeutic Tai Ji Quan intervention vs a multimodal exercise intervention to prevent falls among older adults at high risk of falling: a randomized clinical trial. JAMA Intern Med. Published online September 10, 2018. doi:10.1001/jamainternmed.2018.3915

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