The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques.
Province M A,Hadley E C,Hornbrook M C,Lipsitz L A,Miller J P,Mulrow C D,Ory M G,Sattin R W,Tinetti M E,Wolf S L
OBJECTIVE:To determine if short-term exercise reduces falls and fall-related injuries in the elderly. DESIGN:A preplanned meta-analysis of the seven Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT)--independent, randomized, controlled clinical trials that assessed intervention efficacy in reducing falls and frailty in elderly patients. All included an exercise component for 10 to 36 weeks. Fall and injury follow-up was obtained for up to 2 to 4 years. SETTING:Two nursing home and five community-dwelling (three health maintenance organizations) sites. Six were group and center based; one was conducted at home. PARTICIPANTS:Numbers of participants ranged from 100 to 1323 per study. Subjects were mostly ambulatory and cognitively intact, with minimum ages of 60 to 75 years, although some studies required additional deficits, such as functionally dependent in two or more activities of daily living, balance deficits or lower extremity weakness, or high risk of falling. INTERVENTIONS:Exercise components varied across studies in character, duration, frequency, and intensity. Training was performed in one area or more of endurance, flexibility, balance platform, Tai Chi (dynamic balance), and resistance. Several treatment arms included additional nonexercise components, such as behavioral components, medication changes, education, functional activity, or nutritional supplements. MAIN OUTCOME MEASURES:Time to each fall (fall-related injury) by self-report and/or medical records. RESULTS:Using the Andersen-Gill extension of the Cox model that allows multiple fall outcomes per patient, the adjusted fall incidence ratio for treatment arms including general exercise was 0.90 (95% confidence limits [CL], 0.81, 0.99) and for those including balance was 0.83 (95% CL, 0.70, 0.98). No exercise component was significant for injurious falls, but power was low to detect this outcome. CONCLUSIONS:Treatments including exercise for elderly adults reduce the risk of falls.
Advances in rehabilitation for chronic diseases: improving health outcomes and function.
Richardson Caroline R,Franklin Barry,Moy Marilyn L,Jackson Elizabeth A
BMJ (Clinical research ed.)
Much of the burden on healthcare systems is related to the management of chronic conditions such as cardiovascular disease and chronic obstructive pulmonary disease. Although conventional outpatient cardiopulmonary rehabilitation programs significantly decrease morbidity and mortality and improve function and health related quality of life for people with chronic diseases, rehabilitation programs are underused. Barriers to enrollment are multifactorial and include failure to recommend and refer patients to these services; poor communication with patients about potential benefits; and patient factors including logistical and financial barriers, comorbidities, and competing demands that make participation in facility based programs difficult. Recent advances in rehabilitation programs that involve remotely delivered technology could help deliver services to more people who might benefit. Problems with intensity, adherence, and safety of home based programs have been investigated in recent clinical trials, and larger dissemination and implementation trials are under way. This review summarizes the evidence for benefit of in-person cardiac and pulmonary rehabilitation programs. It also reviews the literature on newer developments, such as home based remotely mediated exercise programs developed to decrease cost and improve accessibility, high intensity interval training in cardiac rehabilitation, and alternative therapies such as tai chi and yoga for people with chronic obstructive pulmonary disease.
A Hybridized Triboelectric-Electromagnetic Water Wave Energy Harvester Based on a Magnetic Sphere.
Wu Zhiyi,Guo Hengyu,Ding Wenbo,Wang Yi-Cheng,Zhang Lei,Wang Zhong Lin
Blue energy harvested from ocean waves is an important and promising renewable energy source for sustainable development of our society. Triboelectric nanogenerators (TENGs) and electromagnetic energy harvesters (EMGs) both are considered promising approaches for harvesting blue energy. In this work, a hybridized triboelectric-electromagnetic water wave energy harvester (WWEH) based on a magnetic sphere is presented. A freely rolling magnetic sphere senses the water motion to drive the friction object sliding on a solid surface for TENG back and forth. At the same time, two coils transform the motion of the magnetic sphere into electricity according to the electromagnetic induction effect. For harvesting the blue energy from any direction, the electrodes of the TENG are specified as the Tai Chi shape, the effective of which is analyzed and demonstrated. Based on a series of experimental comparisons, the two friction layers and the two coils are specified to be connected in parallel and in series, respectively. A paper-based supercapacitor of ∼1 mF is fabricated to store the generated energy. The WWEH is placed on a buoy to test in Lake Lanier. During 162 s, the supercapacitor can be charged to 1.84 V, the electric energy storage in it is about 1.64 mJ. This work demonstrates that the WWEH can be successfully used for driving distributed, self-powered sensors for environmental monitoring.
Physical Activity Interventions in Preventing Cognitive Decline and Alzheimer-Type Dementia: A Systematic Review.
Brasure Michelle,Desai Priyanka,Davila Heather,Nelson Victoria A,Calvert Collin,Jutkowitz Eric,Butler Mary,Fink Howard A,Ratner Edward,Hemmy Laura S,McCarten J Riley,Barclay Terry R,Kane Robert L
Annals of internal medicine
Background:The prevalence of cognitive impairment and dementia is expected to increase dramatically as the population ages, creating burdens on families and health care systems. Purpose:To assess the effectiveness of physical activity interventions in slowing cognitive decline and delaying the onset of cognitive impairment and dementia in adults without diagnosed cognitive impairments. Data Sources:Several electronic databases from January 2009 to July 2017 and bibliographies of systematic reviews. Study Selection:Trials published in English that lasted 6 months or longer, enrolled adults without clinically diagnosed cognitive impairments, and compared cognitive and dementia outcomes between physical activity interventions and inactive controls. Data Extraction:Extraction by 1 reviewer and confirmed by a second; dual-reviewer assessment of risk of bias; consensus determination of strength of evidence. Data Synthesis:Of 32 eligible trials, 16 with low to moderate risk of bias compared a physical activity intervention with an inactive control. Most trials had 6-month follow-up; a few had 1- or 2-year follow-up. Evidence was insufficient to draw conclusions about the effectiveness of aerobic training, resistance training, or tai chi for improving cognition. Low-strength evidence showed that multicomponent physical activity interventions had no effect on cognitive function. Low-strength evidence showed that a multidomain intervention comprising physical activity, diet, and cognitive training improved several cognitive outcomes. Evidence regarding effects on dementia prevention was insufficient for all physical activity interventions. Limitation:Heterogeneous interventions and cognitive test measures, small and underpowered studies, and inability to assess the clinical significance of cognitive test outcomes. Conclusion:Evidence that short-term, single-component physical activity interventions promote cognitive function and prevent cognitive decline or dementia in older adults is largely insufficient. A multidomain intervention showed a delay in cognitive decline (low-strength evidence). Primary Funding Source:Agency for Healthcare Research and Quality.
Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners.
Hong Y,Li J X,Robinson P D
British journal of sports medicine
BACKGROUND:Tai Chi Chuan (TTC) exercise has beneficial effects on the components of physical condition and can produce a substantial reduction in the risk of multiple falls. Previous studies have shown that short term TCC exercise did not improve the scores in the single leg stance test with eyes closed and the sit and reach test. There has apparently been no research into the effects of TCC on total body rotation flexibility and heart rate responses at rest and after a three minute step test. METHODS:In this cross sectional study, 28 male TCC practitioners with an average age of 67.5 years old and 13.2 years of TCC exercise experience were recruited to form the TCC group. Another 30 sedentary men aged 66.2 were selected to serve as the control group. Measurements included resting heart rate, left and right single leg stance with eyes closed, modified sit and reach test, total body rotation test (left and right), and a three minute step test. RESULTS:Compared with the sedentary group, the TCC group had significantly better scores in resting heart rate, three minute step test heart rate, modified sit and reach, total body rotation test on both right and left side (p < 0.01), and both right and left leg standing with eyes closed (p < 0.05). According to the American Fitness Standards, the TCC group attained the 90th percentile rank for sit and reach and total body rotation test, right and left. CONCLUSION:Long term regular TCC exercise has favourable effects on the promotion of balance control, flexibility, and cardiovascular fitness in older adults.
Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials.
de Zoete Rutger Mj,Armfield Nigel R,McAuley James H,Chen Kenneth,Sterling Michele
British journal of sports medicine
OBJECTIVE:To compare the effectiveness of different physical exercise interventions for chronic non-specific neck pain. DESIGN:Systematic review and network meta-analysis. DATA SOURCES:Electronic databases: AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Physiotherapy Evidence Database, PsycINFO, Scopus and SPORTDiscus. ELIGIBILITY CRITERIA:Randomised controlled trials (RCTs) describing the effects of any physical exercise intervention in adults with chronic non-specific neck pain. RESULTS:The search returned 6549 records, 40 studies were included. Two networks of pairwise comparisons were constructed, one for pain intensity (n=38 RCTs, n=3151 participants) and one for disability (n=29 RCTs, n=2336 participants), and direct and indirect evidence was obtained. Compared with no treatment, three exercise interventions were found to be effective for pain and disability: motor control (Hedges' , pain -1.32, 95% CI: -1.99 to -0.65; disability -0.87, 95% CI: -1.45 o -0.29), yoga/Pilates/Tai Chi/Qigong (pain -1.25, 95% CI: -1.85 to -0.65; disability -1.16, 95% CI: -1.75 to -0.57) and strengthening (pain -1.21, 95% CI: -1.63 to -0.78; disability -0.75, 95% CI: -1.28 to -0.22). Other interventions, including range of motion (pain -0.98 CI: -2.51 to 0.56), balance (pain -0.38, 95% CI: -2.10 to 1.33) and multimodal (three or more exercises types combined) (pain -0.08, 95% CI: -1.70 to 1.53) exercises showed uncertain or negligible effects. The quality of evidence was very low according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. CONCLUSION:There is not one superior type of physical exercise for people with chronic non-specific neck pain. Rather, there is very low quality evidence that motor control, yoga/Pilates/Tai Chi/Qigong and strengthening exercises are equally effective. These findings may assist clinicians to select exercises for people with chronic non-specific neck pain. PROSPERO REGISTRATION NUMBER:CRD42019126523.
Short-form Sun-style t'ai chi as an exercise training modality in people with COPD.
Leung Regina Wai Man,McKeough Zoe J,Peters Matthew J,Alison Jennifer A
The European respiratory journal
The aims of the study were to determine the effect of short-form Sun-style t'ai chi (SSTC) (part A) and investigate exercise intensity of SSTC (part B) in people with chronic obstructive pulmonary disease (COPD). Part A: after confirmation of eligibility, participants were randomly allocated to either the t'ai chi group or control group (usual medical care). Participants in the t'ai chi group trained twice weekly for 12 weeks. Part B: participants who had completed training in the t'ai chi group performed a peak exercise test (incremental shuttle walk test) and SSTC while oxygen consumption (VO₂) was measured. Exercise intensity of SSTC was determined by the per cent of VO₂ reserve. Of 42 participants (mean ± sd forced expiratory volume in 1 s 59 ± 16% predicted), 38 completed part A and 15 completed part B. Compared to control, SSTC significantly increased endurance shuttle walk time (mean difference 384 s, 95% CI 186-510); reduced medial-lateral body sway in semi-tandem stand (mean difference -12.4 mm, 95% CI -21- -3); and increased total score on the chronic respiratory disease questionnaire (mean difference 11 points, 95% CI 4-18). The exercise intensity of SSTC was 53 ± 18% of VO2 reserve. SSTC was an effective training modality in people with COPD achieving a moderate exercise intensity which meets the training recommendations.
Systematic reviews of t'ai chi: an overview.
Lee Myeong Soo,Ernst Edzard
British journal of sports medicine
Several systematic reviews (SRs) have assessed the effectiveness of t'ai chi for many conditions including hypertension, osteoarthritis and fall prevention; however, their conclusions have been contradictory. The aim of this overview was to critically evaluate the SRs of t'ai chi for any improvement of medical conditions or clinical symptoms. English, Chinese and Korean electronic databases were searched for relevant articles, and data were extracted according to predefined criteria; 35 SRs met our inclusion criteria. They were related to the following conditions: cancer, older people, Parkinson's disease, musculoskeletal pain, osteoarthritis, rheumatoid arthritis (RA), muscle strength and flexibility, improving aerobic capacity, cardiovascular disease and risk factors, lowering resting blood pressure, osteoporosis or bone mineral density, type 2 diabetes, psychological health, fall prevention and improving balance, and any chronic conditions. In several instances, the conclusions of these articles were contradictory. Relatively clear evidence emerged to suggest that t'ai chi is effective for fall prevention and improving psychological health and was associated with general health benefits for older people. However, t'ai chi seems to be ineffective for the symptomatic treatment of cancer and RA. In conclusion, many SRs of t'ai chi have recently been published; however, the evidence is convincingly positive only for fall prevention and for improvement of psychological health.
Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis.
Northey Joseph Michael,Cherbuin Nicolas,Pumpa Kate Louise,Smee Disa Jane,Rattray Ben
British journal of sports medicine
BACKGROUND:Physical exercise is seen as a promising intervention to prevent or delay cognitive decline in individuals aged 50 years and older, yet the evidence from reviews is not conclusive. OBJECTIVES:To determine if physical exercise is effective in improving cognitive function in this population. DESIGN:Systematic review with multilevel meta-analysis. DATA SOURCES:Electronic databases Medline (PubMed), EMBASE (Scopus), PsychINFO and CENTRAL (Cochrane) from inception to November 2016. ELIGIBILITY CRITERIA:Randomised controlled trials of physical exercise interventions in community-dwelling adults older than 50 years, with an outcome measure of cognitive function. RESULTS:The search returned 12 820 records, of which 39 studies were included in the systematic review. Analysis of 333 dependent effect sizes from 36 studies showed that physical exercise improved cognitive function (0.29; 95% CI 0.17 to 0.41; p<0.01). Interventions of aerobic exercise, resistance training, multicomponent training and tai chi, all had significant point estimates. When exercise prescription was examined, a duration of 45-60 min per session and at least moderate intensity, were associated with benefits to cognition. The results of the meta-analysis were consistent and independent of the cognitive domain tested or the cognitive status of the participants. CONCLUSIONS:Physical exercise improved cognitive function in the over 50s, regardless of the cognitive status of participants. To improve cognitive function, this meta-analysis provides clinicians with evidence to recommend that patients obtain both aerobic and resistance exercise of at least moderate intensity on as many days of the week as feasible, in line with current exercise guidelines.
Effects of long term Tai Chi practice and jogging exercise on muscle strength and endurance in older people.
Xu D Q,Li J X,Hong Y
British journal of sports medicine
OBJECTIVES:To investigate the influence of regular Tai Chi (TC) practice and jogging on muscle strength and endurance in the lower extremities of older people. METHODS:Twenty one long term older TC practitioners were compared with 18 regular older joggers and 22 sedentary counterparts. Maximum concentric strength of knee flexors and extensors was tested at angular velocities of 30 degrees/s and 120 degrees/s. Ankle dorsiflexors and plantar flexors were tested at 30 degrees/s and the dynamic endurance of the knee flexors and extensors was assessed at a speed of 180 degrees/s. RESULTS:The differences in the muscle strength of the knee joint amongst the three experimental groups were significant at the higher velocity. The strengths of knee extensors and flexors in the control group were significantly lower than those in the jogging group and marginally lower than those in the TC group. For the ankle joint, the subjects in both the TC and jogging groups generated more torque in their ankle dorsiflexors. In addition, the muscle endurance of knee extensors was more pronounced in TC practitioners than in controls. CONCLUSION:Regular older TC practitioners and joggers showed better scores than the sedentary controls on most muscle strength and endurance measures. However, the magnitude of the exercise effects on muscles might depend on the characteristics of different types of exercise.
Regular tai chi chuan exercise enhances functional mobility and CD4CD25 regulatory T cells.
Yeh S-H,Chuang H,Lin L-W,Hsiao C-Y,Eng H L
British journal of sports medicine
BACKGROUND:The duration and vigour of physical exercise are widely considered to be critical elements that may positively or negatively affect physical health and immune response. OBJECTIVES:To investigate the effect of a 12 week programme of regular tai chi chuan exercise (TCC) on functional mobility, beliefs about benefits of exercise on physical and psychological health, and immune regulation in middle aged volunteers. METHODS:This quasi-experimental research design involving one group with testing before and after the programme was conducted to measure the effect of 12 weeks of TCC exercise in 14 men and 23 women from the normal community. RESULTS:Regular TCC exercise had a highly significant positive effect on functional mobility (p = 0.001) and beliefs about the health benefits of exercise (p = 0.013) in the 37 participants. Total white blood cell and red blood cell count did not change significantly, but a highly significant (p<0.001) decrease in monocyte count occurred. A significant (p = 0.05) increase in the ratio of T helper to suppressor cells (CD4:CD8) was found, along with a significant (p = 0.015) increase in CD4CD25 regulatory T cells. Production of the regulatory T cell mediators transforming growth factor beta and interleukin 10 under specific antigen stimulation (varicella zoster virus) was also significantly increased after this exercise programme. CONCLUSIONS:A 12 week programme of regular TCC exercise enhances functional mobility, personal health expectations, and regulatory T cell function.
Effect of tai chi exercise on proprioception of ankle and knee joints in old people.
Xu D,Hong Y,Li J,Chan K
British journal of sports medicine
OBJECTIVES:To assess if tai chi, a traditional Chinese form of exercise, could improve proprioception in old people and if the effects of tai chi on proprioception are more evident than other exercise forms in the elderly. METHODS:By detecting the threshold of passive movement, ankle and knee joint kinaesthesis was measured in 21 elderly long term tai chi practitioners (TC group), 20 elderly long term swimmers/runners (S/R group), and 27 elderly sedentary controls (control group). RESULTS:Ankle joint kinaesthesis differed significantly among the three groups (p = 0.001). Subjects in the TC group could detect a significantly smaller amount of motion than those in the S/R group (p = 0.022) and control group (p = 0.001). No significant difference was found between the S/R group and the control group (p = 0.701). The threshold for detection of passive motion was significantly different in knee extension and flexion. For knee flexion, the TC group showed a significantly lower mean threshold for detection of passive motion than the control group (p = 0.026). There were no significant differences between the S/R group and control group (p = 0.312), or between the TC group and S/R group (p = 0.533). For knee extension, no significant difference was noted among the three groups (p = 0.597). CONCLUSIONS:The elderly people who regularly practiced tai chi not only showed better proprioception at the ankle and knee joints than sedentary controls, but also better ankle kinaesthesis than swimmers/runners. The large benefits of tai chi exercise on proprioception may result in the maintenance of balance control in older people.
Kinematic and electromyographic analysis of the push movement in tai chi.
Chan S P,Luk T C,Hong Y
British journal of sports medicine
BACKGROUND:Tai chi is a form of exercise derived from the martial art folk traditions of China. The force used in tai chi includes different principles of mechanical advantage. No studies on the kinematic features of tai chi exercise have been published. OBJECTIVE:To analyse the kinematics and electromyographic characteristics of tai chi. METHODS:An experienced tai chi master was asked to perform a sequence of basic movements: ward off, roll back, press, and push. The movements were videotaped and digitised using a motion analysis system. Electromyographic activities of the lumbar erector spinae, rectus femoris, medial hamstrings, and medial head of gastrocnemius were recorded by surface electrodes. The push movement data were analysed. RESULTS:The medial hamstrings and medial head of gastrocnemius muscle groups maintained low activity, with higher electromyographic values in the lumbar erector spinae and substantially higher ones in the rectus femoris during the push movement. Both concentric and eccentric contractions occurred in muscles of the lower limbs, with eccentric contraction occurring mainly in the anti-gravity muscles such as the rectus femoris and the medial head of gastrocnemius. The forward and backward shifts in centre of gravity (CG) were mainly accomplished by increasing and decreasing respectively the joint angles of the bilateral lower limbs rather than by adopting a forward or backward postural lean. The path of the CG in the anteroposterior and mediolateral component was unique, and the sway or deviation from the path was small. The master maintained an upright posture and maintained a low CG (hips, knees, and ankles bent) while travelling slowly and steadily from one position to another. CONCLUSION:The eccentric muscle contraction of the lower limbs in the push movement of tai chi may help to strengthen the muscles.
A preliminary study of the effects of Tai Chi and Qigong medical exercise on indicators of metabolic syndrome, glycaemic control, health-related quality of life, and psychological health in adults with elevated blood glucose.
Liu X,Miller Y D,Burton N W,Brown W J
British journal of sports medicine
OBJECTIVES:To evaluate the feasibility, acceptability and effects of a Tai Chi and Qigong exercise programme in adults with elevated blood glucose. DESIGN, SETTING, AND PARTICIPANTS:A single group pre-post feasibility trial with 11 participants (3 male and 8 female; aged 42-65 years) with elevated blood glucose. INTERVENTION:Participants attended Tai Chi and Qigong exercise training for 1 to 1.5 h, 3 times per week for 12 weeks, and were encouraged to practise the exercises at home. MAIN OUTCOME MEASURES:Indicators of metabolic syndrome (body mass index (BMI), waist circumference, blood pressure, fasting blood glucose, triglycerides, HDL-cholesterol); glucose control (HbA1c, fasting insulin and insulin resistance (HOMA)); health-related quality of life; stress and depressive symptoms. RESULTS:There was good adherence and high acceptability. There were significant improvements in four of the seven indicators of metabolic syndrome including BMI (mean difference -1.05, p<0.001), waist circumference (-2.80 cm, p<0.05), and systolic (-11.64 mm Hg, p<0.01) and diastolic blood pressure (-9.73 mm Hg, p<0.001), as well as in HbA1c (-0.32%, p<0.01), insulin resistance (-0.53, p<0.05), stress (-2.27, p<0.05), depressive symptoms (-3.60, p<0.05), and the SF-36 mental health summary score (5.13, p<0.05) and subscales for general health (19.00, p<0.01), mental health (10.55, p<0.01) and vitality (23.18, p<0.05). CONCLUSIONS:The programme was feasible and acceptable and participants showed improvements in metabolic and psychological variables. A larger controlled trial is now needed to confirm these promising preliminary results.
Is tai chi beneficial for improving aerobic capacity? A systematic review.
Lee M S,Lee E-N,Ernst E
British journal of sports medicine
Tai chi has been claimed to generate beneficial effects with respect to a wide range of diseases. The purpose of this systematic review was to evaluate evidence from randomised clinical trials (RCTs) testing the effectiveness of tai chi for increasing aerobic capacity. Systematic searches were conducted on 14 electronic databases without restrictions on population characteristics or the language of publication. The outcome measures considered for inclusion were changes in maximal oxygen consumption as a test for aerobic capacity. Five RCTs met all inclusion criteria. Three RCTs compared the effects of tai chi with no treatment. The meta-analysis failed to show an effect of tai chi on aerobic capacity compared with sedentary controls (n = 151, weight mean difference, ml/kg/min, 0.50, 95% CI -1.14 to 2.15, p = 0.55). Two RCTs compared tai chi with conventional physical exercise including brisk, low intensity and moderate intensity walking, and aerobic exercise. The results show that tai chi was not statistically significantly superior to physical exercise. In conclusion, the existing evidence does not suggest that regular tai chi is an effective way of increasing aerobic capacity.
Tai chi and postural stability in patients with Parkinson's disease.
Li Fuzhong,Harmer Peter,Fitzgerald Kathleen,Eckstrom Elizabeth,Stock Ronald,Galver Johnny,Maddalozzo Gianni,Batya Sara S
The New England journal of medicine
BACKGROUND:Patients with Parkinson's disease have substantially impaired balance, leading to diminished functional ability and an increased risk of falling. Although exercise is routinely encouraged by health care providers, few programs have been proven effective. METHODS:We conducted a randomized, controlled trial to determine whether a tailored tai chi program could improve postural control in patients with idiopathic Parkinson's disease. We randomly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale (which ranges from 1 to 5, with higher stages indicating more severe disease) to one of three groups: tai chi, resistance training, or stretching. The patients participated in 60-minute exercise sessions twice weekly for 24 weeks. The primary outcomes were changes from baseline in the limits-of-stability test (maximum excursion and directional control; range, 0 to 100%). Secondary outcomes included measures of gait and strength, scores on functional-reach and timed up-and-go tests, motor scores on the Unified Parkinson's Disease Rating Scale, and number of falls. RESULTS:The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion (between-group difference in the change from baseline, 5.55 percentage points; 95% confidence interval [CI], 1.12 to 9.97; and 11.98 percentage points; 95% CI, 7.21 to 16.74, respectively) and in directional control (10.45 percentage points; 95% CI, 3.89 to 17.00; and 11.38 percentage points; 95% CI, 5.50 to 17.27, respectively). The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training. The effects of tai chi training were maintained at 3 months after the intervention. No serious adverse events were observed. CONCLUSIONS:Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson's disease, with additional benefits of improved functional capacity and reduced falls. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00611481.).
Tai Chi Chih Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial.
Irwin Michael R,Olmstead Richard,Carrillo Carmen,Sadeghi Nina,Nicassio Perry,Ganz Patricia A,Bower Julienne E
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
Purpose Cognitive behavioral therapy for insomnia (CBT-I) and Tai Chi Chih (TCC), a movement meditation, improve insomnia symptoms. Here, we evaluated whether TCC is noninferior to CBT-I for the treatment of insomnia in survivors of breast cancer. Patients and Methods This was a randomized, partially blinded, noninferiority trial that involved survivors of breast cancer with insomnia who were recruited from the Los Angeles community from April 2008 to July 2012. After a 2-month phase-in period with repeated baseline assessment, participants were randomly assigned to 3 months of CBT-I or TCC and evaluated at months 2, 3 (post-treatment), 6, and 15 (follow-up). Primary outcome was insomnia treatment response-that is, marked clinical improvement of symptoms by the Pittsburgh Sleep Quality Index-at 15 months. Secondary outcomes were clinician-assessed remission of insomnia; sleep quality; total sleep time, sleep onset latency, sleep efficiency, and awake after sleep onset, derived from sleep diaries; polysomnography; and symptoms of fatigue, sleepiness, and depression. Results Of 145 participants who were screened, 90 were randomly assigned (CBT-I: n = 45; TCC: n = 45). The proportion of participants who showed insomnia treatment response at 15 months was 43.7% and 46.7% in CBT-I and TCC, respectively. Tests of noninferiority showed that TCC was noninferior to CBT-I at 15 months ( P = .02) and at months 3 ( P = .02) and 6 ( P < .01). For secondary outcomes, insomnia remission was 46.2% and 37.9% in CBT-I and TCC, respectively. CBT-I and TCC groups showed robust improvements in sleep quality, sleep diary measures, and related symptoms (all P < .01), but not polysomnography, with similar improvements in both groups. Conclusion CBT-I and TCC produce clinically meaningful improvements in insomnia. TCC, a mindful movement meditation, was found to be statistically noninferior to CBT-I, the gold standard for behavioral treatment of insomnia.
A randomized trial of tai chi for fibromyalgia.
Wang Chenchen,Schmid Christopher H,Rones Ramel,Kalish Robert,Yinh Janeth,Goldenberg Don L,Lee Yoojin,McAlindon Timothy
The New England journal of medicine
BACKGROUND:Previous research has suggested that tai chi offers a therapeutic benefit in patients with fibromyalgia. METHODS:We conducted a single-blind, randomized trial of classic Yang-style tai chi as compared with a control intervention consisting of wellness education and stretching for the treatment of fibromyalgia (defined by American College of Rheumatology 1990 criteria). Sessions lasted 60 minutes each and took place twice a week for 12 weeks for each of the study groups. The primary end point was a change in the Fibromyalgia Impact Questionnaire (FIQ) score (ranging from 0 to 100, with higher scores indicating more severe symptoms) at the end of 12 weeks. Secondary end points included summary scores on the physical and mental components of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). All assessments were repeated at 24 weeks to test the durability of the response. RESULTS:Of the 66 randomly assigned patients, the 33 in the tai chi group had clinically important improvements in the FIQ total score and quality of life. Mean (+/-SD) baseline and 12-week FIQ scores for the tai chi group were 62.9+/-15.5 and 35.1+/-18.8, respectively, versus 68.0+/-11 and 58.6+/-17.6, respectively, for the control group (change from baseline in the tai chi group vs. change from baseline in the control group, -18.4 points; P<0.001). The corresponding SF-36 physical-component scores were 28.5+/-8.4 and 37.0+/-10.5 for the tai chi group versus 28.0+/-7.8 and 29.4+/-7.4 for the control group (between-group difference, 7.1 points; P=0.001), and the mental-component scores were 42.6+/-12.2 and 50.3+/-10.2 for the tai chi group versus 37.8+/-10.5 and 39.4+/-11.9 for the control group (between-group difference, 6.1 points; P=0.03). Improvements were maintained at 24 weeks (between-group difference in the FIQ score, -18.3 points; P<0.001). No adverse events were observed. CONCLUSIONS:Tai chi may be a useful treatment for fibromyalgia and merits long-term study in larger study populations. (Funded by the National Center for Complementary and Alternative Medicine and others; ClinicalTrials.gov number, NCT00515008.)
The effect of Tai Chi on four chronic conditions-cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: a systematic review and meta-analyses.
Chen Yi-Wen,Hunt Michael A,Campbell Kristin L,Peill Kortni,Reid W Darlene
British journal of sports medicine
BACKGROUND:Many middle-aged and older persons have more than one chronic condition. Thus, it is important to synthesise the effectiveness of interventions across several comorbidities. The aim of this systematic review was to summarise current evidence regarding the effectiveness of Tai Chi in individuals with four common chronic conditions-cancer, osteoarthritis (OA), heart failure (HF) and chronic obstructive pulmonary disease (COPD). METHODS:4 databases (MEDLINE, EMBASE, CINAHL and SPORTDiscus) were searched for original articles. Two reviewers independently screened the titles and abstracts and then conducted full-text reviews, quality assessment and finally data abstraction. 33 studies met the inclusion criteria. Meta-analyses were performed on disease-specific symptoms, physiological outcomes and physical performance of each chronic condition. Subgroup analyses on disease-specific symptoms were conducted by categorising studies into subsets based on the type of comparison groups. RESULTS:Meta-analyses showed that Tai Chi improved or showed a tendency to improve physical performance outcomes, including 6-min walking distance (6MWD) and knee extensor strength, in most or all four chronic conditions. Tai Chi also improved disease-specific symptoms of pain and stiffness in OA. CONCLUSIONS:The results demonstrated a favourable effect or tendency of Tai Chi to improve physical performance and showed that this type of exercise could be performed by individuals with different chronic conditions, including COPD, HF and OA.
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.
Li Fuzhong,Harmer Peter,Fitzgerald Kathleen,Eckstrom Elizabeth,Akers Laura,Chou Li-Shan,Pidgeon Dawna,Voit Jan,Winters-Stone Kerri
JAMA internal medicine
Importance:Falls in older adults are a serious public health problem associated with irreversible health consequences and responsible for a substantial economic burden on health care systems. However, identifying optimal choices from among evidence-based fall prevention interventions is challenging as few comparative data for effectiveness are available. Objective: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) program relative to stretching exercise in reducing falls among older adults at high risk of falling. Design, Setting, and Participants:A single-blind, 3-arm, parallel design, randomized clinical trial (February 20, 2015, to January 30, 2018), in 7 urban and suburban cities in Oregon. From 1147 community-dwelling adults 70 years or older screened for eligibility, 670 who had fallen in the preceding year or had impaired mobility consented and were enrolled. All analyses used intention-to-treat assignment. Interventions:One of 3 exercise interventions: two 60-minute classes weekly for 24 weeks of TJQMBB, entailing modified forms and therapeutic movement exercises; MME, integrating balance, aerobics, strength, and flexibility activities; or stretching exercises. Main Outcomes and Measures:The primary measure at 6 months was incidence of falls. Results:Among 670 participants randomized, mean (SD) age was 77.7 (5.6) years, 436 (65%) were women, 617 (92.1%) were white, 31 (4.6%) were African American. During the trial, there were 152 falls (85 individuals) in the TJQMBB group, 218 (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. At 6 months, the incidence rate ratio (IRR) was significantly lower in the TJQMBB (IRR, 0.42; 95% CI, 0.31-0.56; P < .001) and MME groups (IRR, 0.60; 95% CI, 0.45-0.80; P = .001) compared with the stretching group. Falls were reduced by 31% for the TJQMBB group compared with the MME group (IRR, 0.69; 95% CI, 0.52-0.94; P = .01). Conclusions and Relevance: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. Trial Registration:ClinicalTrials.gov identifier: NCT02287740.
Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial.
Wang Chenchen,Schmid Christopher H,Fielding Roger A,Harvey William F,Reid Kieran F,Price Lori Lyn,Driban Jeffrey B,Kalish Robert,Rones Ramel,McAlindon Timothy
BMJ (Clinical research ed.)
OBJECTIVES:To determine the effectiveness of tai chi interventions compared with aerobic exercise, a current core standard treatment in patients with fibromyalgia, and to test whether the effectiveness of tai chi depends on its dosage or duration. DESIGN:Prospective, randomized, 52 week, single blind comparative effectiveness trial. SETTING:Urban tertiary care academic hospital in the United States between March 2012 and September 2016. PARTICIPANTS:226 adults with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010 criteria) were included in the intention to treat analyses: 151 were assigned to one of four tai chi groups and 75 to an aerobic exercise group. INTERVENTIONS:Participants were randomly assigned to either supervised aerobic exercise (24 weeks, twice weekly) or one of four classic Yang style supervised tai chi interventions (12 or 24 weeks, once or twice weekly). Participants were followed for 52 weeks. Adherence was rigorously encouraged in person and by telephone. MAIN OUTCOME MEASURES:The primary outcome was change in the revised fibromyalgia impact questionnaire (FIQR) scores at 24 weeks compared with baseline. Secondary outcomes included changes of scores in patient's global assessment, anxiety, depression, self efficacy, coping strategies, physical functional performance, functional limitation, sleep, and health related quality of life. RESULTS:FIQR scores improved in all five treatment groups, but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks (difference between groups=5.5 points, 95% confidence interval 0.6 to 10.4, P=0.03) and several secondary outcomes (patient's global assessment=0.9 points, 0.3 to 1.4, P=0.005; anxiety=1.2 points, 0.3 to 2.1, P=0.006; self efficacy=1.0 points, 0.5 to 1.6, P=0.0004; and coping strategies, 2.6 points, 0.8 to 4.3, P=0.005). Tai chi treatment compared with aerobic exercise administered with the same intensity and duration (24 weeks, twice weekly) had greater benefit (between group difference in FIQR scores=16.2 points, 8.7 to 23.6, P<0.001). The groups who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks (difference in FIQR scores=9.6 points, 2.6 to 16.6, P=0.007). There was no significant increase in benefit for groups who received tai chi twice weekly compared with once weekly. Participants attended the tai chi training sessions more often than participants attended aerobic exercise. The effects of tai chi were consistent across all instructors. No serious adverse events related to the interventions were reported. CONCLUSION:Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement. This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia. TRIAL REGISTRATION:ClinicalTrials.gov NCT01420640.
Comparative Effectiveness of Tai Chi Versus Physical Therapy for Knee Osteoarthritis: A Randomized Trial.
Wang Chenchen,Schmid Christopher H,Iversen Maura D,Harvey William F,Fielding Roger A,Driban Jeffrey B,Price Lori Lyn,Wong John B,Reid Kieran F,Rones Ramel,McAlindon Timothy
Annals of internal medicine
BACKGROUND:Few remedies effectively treat long-term pain and disability from knee osteoarthritis. Studies suggest that Tai Chi alleviates symptoms, but no trials have directly compared Tai Chi with standard therapies for osteoarthritis. OBJECTIVE:To compare Tai Chi with standard physical therapy for patients with knee osteoarthritis. DESIGN:Randomized, 52-week, single-blind comparative effectiveness trial. (ClinicalTrials.gov: NCT01258985). SETTING:An urban tertiary care academic hospital. PATIENTS:204 participants with symptomatic knee osteoarthritis (mean age, 60 years; 70% women; 53% white). INTERVENTION:Tai Chi (2 times per week for 12 weeks) or standard physical therapy (2 times per week for 6 weeks, followed by 6 weeks of monitored home exercise). MEASUREMENTS:The primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 12 weeks. Secondary outcomes included physical function, depression, medication use, and quality of life. RESULTS:At 12 weeks, the WOMAC score was substantially reduced in both groups (Tai Chi, 167 points [95% CI, 145 to 190 points]; physical therapy, 143 points [CI, 119 to 167 points]). The between-group difference was not significant (24 points [CI, -10 to 58 points]). Both groups also showed similar clinically significant improvement in most secondary outcomes, and the benefits were maintained up to 52 weeks. Of note, the Tai Chi group had significantly greater improvements in depression and the physical component of quality of life. The benefit of Tai Chi was consistent across instructors. No serious adverse events occurred. LIMITATION:Patients were aware of their treatment group assignment, and the generalizability of the findings to other settings remains undetermined. CONCLUSION:Tai Chi produced beneficial effects similar to those of a standard course of physical therapy in the treatment of knee osteoarthritis. PRIMARY FUNDING SOURCE:National Center for Complementary and Integrative Health of the National Institutes of Health.
A Randomized Trial of Tai Chi on Preventing Hypertension and Hyperlipidemia in Middle-Aged and Elderly Patients.
Wen Jiansheng,Su Min
International journal of environmental research and public health
In our randomized controlled trial, we investigated whether Wu-style Tai Chi (Tai Chi combined with Daoyin) as a potential exercise prescription is more effective than simplified Tai Chi in the prevention and treatment of hypertension and hyperlipidemia in the middle-aged and elderly. We randomly assigned 66 patients with hypertension and hyperlipidemia to one of the two groups: the Wu-style Tai Chi group or the simplified Tai Chi group; the simplified Tai Chi group only exercised simplified Tai Chi three times a week for 6 weeks. The Wu-style Tai Chi group participated in 60 min of Wu-style Tai Chi three times a week for 6 weeks. Serum biochemical tests were conducted at baseline and at the end of the study. Measurements of blood pressure were performed at the same time. Primary outcomes were compared within and between groups at baseline and at 6 weeks. The participants in the Wu-style Tai Chi group performed, at 6 weeks, significantly better than baseline on all of the primary outcomes ( value ≤ 0.05). The results also show significant difference within the simplified Tai Chi group from baseline to 6 weeks in TCHO (mmol/L), SBP (mmHg), and LDL-C (mmol/L) ( value < 0.05). From baseline to 6 weeks, the Wu-style Tai Chi group had significant differences at more test indexes in serum and blood pressure than the simplified Tai Chi group. At 6 weeks, the Wu-style Tai Chi group had a significantly greater mean improvement in the SBP (mmHg) than did the simplified Tai Chi group (mean between-group difference, -5.80 (mmHg) [95% CI, -14.01 to 2.41]; = 0.007). The results showed that, compared with simplified Tai Chi, Wu-style Tai Chi had a better effect on hypertension in the middle-aged and elderly. At 6 weeks in LDL-C (mmol/L), the Wu-style Tai Chi group had significantly greater improvement between the two groups (means between-group difference, -0.45 (mmol/L) [95% CI, -0.89 to -0.17]; = 0.03). The results showed that Wu-style Tai Chi protected the cardiovascular system of the middle-aged and elderly in improving LDL-C (mmol/L), and was more significant than simplified Tai Chi. After 6 weeks of exercise, Wu-style Tai Chi could effectively improve hyperlipidemia and hypertension. The total effective rate of cardiovascular disease was 90.00%. There was significant difference in the treatment effect of hypertension and hyperlipidemia between the two groups during 6 weeks ( = 0.039), showing that, in a small population of middle-aged and elderly subjects, Wu style Tai Chi could be useful in managing important CV risk factors, such as hypertension and hyperlipidemia.
Balance improvements in older women: effects of exercise training.
Judge J O,Lindsey C,Underwood M,Winsemius D
BACKGROUND AND PURPOSE:Loss of lower-extremity strength increases the risk of falls in older persons. The purpose of this study was to test the hypothesis that a vigorous program of lower-extremity strengthening, walking, and postural control exercises would improve the single-stance balance of healthy older women and lower their risk of falls and fall-associated injuries. SUBJECTS:From a total of 38 respondents, 21 women were randomly assigned to either a treatment group (combined training, n = 12) or a control group (flexibility training, n = 9). The subjects ranged in age from 62 to 75 years (mean = 68, SD = 3.5). METHODS:A randomized control trial compared the effects of two exercise programs on static balance. The combined training group exercised three times per week on knee extension and sitting leg press machines, walked briskly for 20 minutes, and performed postural control exercises, which included simple tai chi movements. The flexibility training group performed postural control exercises weekly. Measurements of balance were obtained on a force platform in double and single stance, at baseline and following 6 months of exercise training. RESULTS:Double-stance measurements were unchanged after training. The mean displacement of the center of pressure in single stance improved 17% in the combined training group and did not change in the flexibility training group. A repeated-measures analysis of variance revealed that the difference in improvement between the combined training and flexibility training groups was not significant. DISCUSSION AND CONCLUSION:This is the first intervention trial to demonstrate improvements in single-stance postural sway in older women with exercise training. Additional studies with more subjects will be needed to determine whether a combined training program of resistance training, walking, and postural exercises can improve balance more than a program of postural control exercises alone.
The effects of a short-term exercise program on movement, pain, and mood in the elderly. Results of a pilot study.
Ross M C,Bohannon A S,Davis D C,Gurchiek L
Journal of holistic nursing : official journal of the American Holistic Nurses' Association
Therapeutic effects of a short-term Tai Chi exercise program for the elderly were evaluated in a pretest-posttest quasi-experimental design. This pilot study evaluated changes in flexibility, balance, sway, pain, and mood after a short slow-motion exercise. The program consisted of a series of movements involving turning, shifting weight, bending, and arm movements in combination with diaphragmatic breathing with slow movements. The measured effects included improved balance, sway, range of motion, decreased perceived pain, and lessened trait anxiety. Participants included 11 elderly females. Instruments consisted of standard goniometry, the Multiple Affect Adjective Check List, stopwatch measures of single-leg stance and a tandem walk (sway), and visual analog measurement of pain. Findings included significant improvement (p = .05) in trait anxiety and pain perception. Improvements in mood, flexibility, and balance may have a profound effect on the incidence of falls, injuries, resulting disability, and overall quality of life.
A randomized controlled trial of Kung Fu training for metabolic health in overweight/obese adolescents: the "martial fitness" study.
Tsang Tracey W,Kohn Michael,Chow Chin Moi,Singh Maria Fiatarone
Journal of pediatric endocrinology & metabolism : JPEM
Twenty overweight/obese adolescents underwent six months of Kung Fu or placebo (Tai Chi) training, 3x.wk(-1). Outcomes included fasting insulin and insulin resistance, lipids, glucose and HbA(1c), and C-reactive protein (CRP). CRP decreased significantly (p = 0.03) in both groups over time at six months. Although insulin sensitivity did not change, HbA(1c) tended to decrease over time (p = 0.09), again with no group difference (p = 0.60). Reduced CRP was related to increased upper body strength (p = 0.01). Increased lean body mass was related to reductions in HbA(1c), insulin resistance, triglycerides, and total cholesterol. Improvements in lean body mass appear to have a potential role in favorable metabolic outcomes, independent of changes in fat mass. Further research in this area is warranted before definite conclusions can be drawn about the efficacy of martial arts training for metabolic outcomes in this cohort.
The effect of physical exercise on bone density in middle-aged and older men: a systematic review.
Bolam K A,van Uffelen J G Z,Taaffe D R
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
Although trials have shown that exercise has positive effects on bone mineral density (BMD), the majority of exercise trials have been conducted in older women. The aim of this study was to systematically review trials examining the effect of weight-bearing and resistance-based exercise modalities on the BMD of hip and lumbar spine of middle-aged and older men. Eight electronic databases were searched in August 2012. Randomised controlled or controlled trials that assessed the effect of weight-bearing and resistance-based exercise interventions on BMD measured by dual-energy x-ray absorptiometry, and reported effects in middle-aged and older men were included. Eight trials detailed in nine papers were included. The interventions included walking (n = 2), resistance training (n = 3), walking + resistance training (n = 1), resistance training + impact-loading activities (n = 1) and resistance training + Tai Chi (n = 1). Five of the eight trials achieved a score of less than 50% on the modified Delphi quality rating scale. Further, there was heterogeneity in the type, intensity, frequency and duration of the exercise regimens. Effects of exercise varied greatly among studies, with six interventions having a positive effect on BMD and two interventions having no significant effect. It appears that resistance training alone or in combination with impact-loading activities are most osteogenic for this population, whereas the walking trials had limited effect on BMD. Therefore, regular resistance training and impact-loading activities should be considered as a strategy to prevent osteoporosis in middle-aged and older men. High quality randomised controlled trials are needed to establish the optimal exercise prescription.
Use of complementary and alternative therapies by overweight and obese adults.
Bertisch Suzanne M,Wee Christina C,McCarthy Ellen P
Obesity (Silver Spring, Md.)
OBJECTIVE:Obesity is associated with higher health-care costs due, in part, to higher use of traditional health care. Few data are available on the relationship between obesity and the use of complementary and alternative medicine (CAM). METHODS AND PROCEDURES:We analyzed data on CAM use from the 2002 National Health Interview Survey (NHIS) Alternative Medicine Supplement (n=31,044). We compared the use of CAM overall, within the past 12 months, between normal weight (BMI from 18 to <25), overweight (from 25 to <30), mildly obese (from 30 to <35), moderately obese (from 35 to <40), and extremely obese (>40) adults. For the primary analysis, our multivariable model was adjusted for sociodemographic factors, insurance status, medical conditions, and health behaviors. We performed additional analyses to explore the association of BMI and the use of seven CAM modalities. RESULTS:We found that adults with obesity have lower prevalence of use of yoga therapy, and similar prevalence of use of several CAM modalities, including relaxation techniques, natural herbs, massage, chiropractic medicine, tai chi, and acupuncture, compared to normal-weight individuals. After adjustment for sociodemographic factors, insurance status, medical conditions, and health behaviors, adults with obesity were generally less likely to use most individual CAM modalities, although the magnitude of these differences were quite modest in many cases. DISCUSSION:Even though adults with obesity have a greater illness burden and higher utilization of traditional medical care, adults with higher BMIs were no more likely to use each of the individual CAM therapies studied. Additional research is needed to improve our understanding of CAM use by adults with obesity.
The role of exercise in falls prevention for older patients.
Falls prevention is a key area of health promotion that is familiar to all nurses who work with older people. However, the suggestion that t'ai chi should be used as a prevention intervention may be new to many nurses. The evidence supporting t'ai chi and many other forms of exercise have been evaluated within the National Institute for Clinical Evidence (NICE) falls guidance. This should enable nurses to look at the prevention interventions that they currently recommend and question the evidence for or against their effectiveness. Nurses should also be able to identify factors that may present as barriers to participation.
Coordination exercise and postural stability in elderly people: Effect of Tai Chi Chuan.
Wong A M,Lin Y C,Chou S W,Tang F T,Wong P Y
Archives of physical medicine and rehabilitation
OBJECTIVE:To evaluate the effects of coordination exercise on postural stability in older individuals by Chinese shadow boxing, Tai Chi Chuan (TCC). DESIGN:Cross-sectional study. SETTING:Research project in a hospital-based biomechanical laboratory. PARTICIPANTS:The TCC group (n = 25) had been practicing TCC regularly for 2 to 35 years. The control group (n = 14) included healthy and active older subjects. INTERVENTION:Static postural stability test: progressively harder sequential tests with 6 combinations of vision (eyes open, eyes closed, sway-referenced) and support (fixed, sway-referenced); and dynamic balance test: 3 tests of weight shifting (left to right, forward-backward, multidirectional) at 3 speeds. MAIN OUTCOME MEASURES:Static and dynamic balance of Sensory Organization Testing (SOT) of the Smart Balance Master System. RESULTS:In static postural control, the results showed no differences between the TCC or control group in the more simple conditions, but in the more complicated SOT (eyes closed with sway surface, sway vision with sway surface), the TCC group had significantly better results than the control group. The TCC group also had significantly better results in the rhythmic forward-backward weight-shifting test. Duration of practice did not seem to affect the stability of elder people. CONCLUSION:The elderly people who regularly practiced TCC showed better postural stability in the more challenged conditions than those who do not (eg, the condition with simultaneous disturbance of vision and proprioception). TCC as a coordination exercise may reduce the risk of a fall through maintaining the ability of posture control.
Survey on Physical Fitness and Cardiovascular Function of the City Elderly in Different Regular Physical Activities in China.
Chen L,Wang S,Xu J C
The journal of nutrition, health & aging
OBJECTIVE:To explore the relationship between sports law project selection and physical health, cardiovascular function of the city elderly. DESIGN AND SETTING:To investigate the state of regular physical activity, physical health, and cardiovascular function. PARTICIPANTS:1,555 city elderly people aged 60-69 years in 10 cities of Shaanxi Province. MEASUREMENTS:Clinical and anthropometrics measurements included height, weight, waistline, blood pressure, heart rate, strength, balance, flexibility. RESULTS:The sports participation rate for the samples was 51.38%, which was with fitness walking (61.08%), Tai Chi (12.52%), fitness run (11.51%), dance(8.89%)as the main items; There were statistically significant difference in WHtR (F = 2.63), heart rate (F = 3.43), balance (F = 4.51), flexibility (F = 3.57), strength (F = 24.69) (all P < 0.05) for the two groups of elderly; Compared with the non-regular physical activity groups, these groups of fitness walking, Tai Chi and fitness running were statistically significant (all P<0.05). The systolic blood pressure (t = 4.18), diastolic blood pressure (t = 2.02), heart rate (t= -2.13), balance (t= 2.88) of fitness walking group were improved markedly. The balance (t = 4.42, P = .000) of Tai Chi group was significant. The strength (t = 2.48, P = .013) of fitness running group was significant. CONCLUSION:The project of regular physical activity can effectively improve the physical health level and heart vascular function of the elderly people. WHtR was suitable for evaluating physical fitness of elderly people in regular sports. Fitness walking, Tai Chi, fitness running can effectively improve the obese elderly obesity levels and reduce the risk of cardiovascular disease. Fitness walking program can improve heart rate and blood pressure levels, and it also can be recommended as an exercise for improving the level of cardiovascular function, with the flexibility exercise being added. Tai Chi helped the elderly to improve their balance level and prevent falls. Fitness running helped to improve the elderly power and slow down the process of muscle degradation. The choice of Regular sports activities for the elderly was single, not according to their own physical or chronic disease of the targeted exercise.
Effectiveness of diet and physical activity interventions among Chinese-origin populations living in high income countries: a systematic review.
Beasley Jeannette M,Wagnild Janelle M,Pollard Tessa M,Roberts Timothy R,Ahkter Nasima
BMC public health
BACKGROUND:This review examines the effectiveness of diet and physical activity interventions to reduce cardiometabolic risk among Chinese immigrants and their descendants living in high income countries. The objective of this review is to provide information to help build future interventions aimed at improving diet and increasing physical activity levels among Chinese immigrants. METHODS:Outcomes included BMI, weight, waist circumference (WC), waist-hip ratio (WHR), cholesterol (LDL, HDL), systolic and diastolic blood pressure (SBP, DBP), hemoglobin A1c (HgbA1c), fasting blood glucose (FBG), and HOMA-IR. Six databases were systematically searched from database inception to date of search (February 2020). Meta-analyses used random effect models to estimate pooled effects of outcomes with 95% confidence intervals. The outcomes assessed were changes in mean outcomes (post-intervention versus baseline) among the intervention group versus control groups. RESULTS:Twenty-one articles were included for synthesis, and eight of these were included in the meta-analysis. Among children/adolescents, there were no significant effects of intervention for any of the outcomes having sufficient data for meta-analysis (BMI, WHR, SBP, and DBP). Among adults, the pooled effect including three studies showed significant changes in BMI (effect size = - 1.14 kg/m; (95% CI: - 2.06, - 0.21), I = 31%). There were also significant effects of intervention among adults in terms of changes in SBP and DBP, as the pooled effect across three studies was - 6.08 mmHg (95% CI - 9.42, - 2.73), I = 0% and - 3.81 mmHg (95% CI: - 6.34, - 1.28), I = 0%, respectively. Among adults there were no other significant effects among the meta-analyses conducted (weight, WC, LDL, HgbA1c, and FBG). CONCLUSIONS:This review is the first to summarize the effectiveness of diet and physical activity interventions specifically designed for Chinese immigrants living in high income countries. There were clinically meaningful changes in BMI and blood pressure among adults, but evidence was weak for other cardiometabolic outcomes (weight, WC, LDL, HgbA1c, and FBG), and among children, there was no evidence of effect for any cardiometabolic outcomes. Given our mixed findings, more work is needed to support the design of successful interventions, particularly those targeting children and their families. TRIAL REGISTRATION:The systematic review protocol was registered in PROSPERO on December 17, 2018, the international prospective register of systematic reviews (registration number: CRD42018117842 ).
Effects of exercise on joint sense and balance in elderly men: Tai Chi versus golf.
Tsang William W N,Hui-Chan Christina W Y
Medicine and science in sports and exercise
PURPOSE:Our previous studies showed that experienced Tai Chi practitioners had better joint proprioception and balance control during weight shifting. The objective of the present study was to examine whether experienced golfers had attained similar improvement when compared with the Tai Chi practitioners, as well as healthy elderly subjects and young university students. METHODS:We compared 12 experienced elderly Tai Chi practitioners, with 11 experienced elderly golfers, 12 healthy elderly subjects, and 12 young university students, who were all males, using: 1) passive knee joint repositioning test to assess their joint proprioceptive acuity and 2) limits of stability test to assess their ability to voluntarily weight shift within their base of support. RESULTS:Both Tai Chi practitioners and golfers had better knee joint proprioceptive acuity than did the elderly control subjects (P < 0.05). Of special interest is that their performance was similar to that of the young subjects. In the limits of stability test, Tai Chi practitioners and golfers had faster reaction time, leaned further without losing stability, and showed better control of leaning trajectory than did elderly control subjects (all P < 0.05). The latter two outcome measures were also comparable to those of the young subjects. CONCLUSION:These results demonstrate that both experienced Tai Chi practitioners and golfers had improved knee joint proprioception and limits of stability, when compared with those of elderly control subjects similar in age, gender (male), and physical activity level. Such improved outcome measures were comparable to those of young male subjects. These findings suggest that experienced Tai Chi practitioners and golfers had improved joint proprioceptive acuity and dynamic standing balance control, despite the known aging effects in these specific sensorimotor functions.
Effect of 4- and 8-wk intensive Tai Chi Training on balance control in the elderly.
Tsang William W N,Hui-Chan Christina W Y
Medicine and science in sports and exercise
PURPOSE:The objective of this study was to examine whether 4 and/or 8 wk of intensive Tai Chi practice could improve balance control in the healthy elderly subjects. METHODS:Forty-nine community-dwelling elderly subjects (aged 69.1 +/- SD 5.8 yr) voluntarily participated in an intervention program of either supervised Tai Chi or general education for 1.5 h, 6x wk for 8 wk. Two balance tests were administered using computerized dynamic posturography before, at 4 and 8 wk during training, and at 4 wk after training ended: 1) the sensory organization test measured subjects' abilities to use somatosensory, visual, and vestibular information to control their body sway during stance under six sensory conditions; and 2) the limits of stability test measured subjects' abilities to voluntarily weight shift to eight spatial positions within their base of support. These outcome measures were compared between the two intervention groups, and with those of experienced Tai Chi practitioners having means of 7.2 and 10.1 yr of practice from two previous studies. RESULTS:Statistical analysis demonstrated that, after 4 and 8 wk of intensive Tai Chi training, the elderly subjects achieved significantly better 1) vestibular ratio in the sensory organization test (P = 0.006) and 2) directional control of their leaning trajectory in the limits of stability test (P = 0.018), when compared with those of the control group. These improvements were maintained even at follow-up 4 wk afterward. Furthermore, the improved balance performance from week 4 on was comparable to that of experienced Tai Chi practitioners. CONCLUSIONS:The above findings indicated that even 4 wk of intensive Tai Chi training are sufficient to improve balance control in the elderly subjects.
Does different exercise have the same effect of health promotion for the elderly? Comparison of training-specific effect of Tai Chi and swimming on motor control.
Wong Alice M K,Chou Shih-Wei,Huang Shu-Chun,Lan Ching,Chen Hsieh-Ching,Hong Wei-Hsien,Chen Carl P C,Pei Yu-Cheng
Archives of gerontology and geriatrics
It remains unclear whether Tai Chi Chuan (TCC) instead of swimming yields a training-specific effect on dynamic balance. The objective of the present study is to test if the practice of TCC provides a distinctive benefit of balance in the elderly. The participants in TCC (n = 32) and swimming groups (n = 20) practiced regular swimming and TCC respectively for at least 3 years before the recruitment. Thirty-four healthy and active elderly volunteers were also recruited as the control group. To evaluate balance, we used SMART Balance Master that yields balance parameters including maximal stability, center-of-pressure velocity, and percentage ankle strategy obtained under six different balance conditions. We evaluated eye-hand coordination by measuring the movement time required to accurately point from one target to the next. In the most challenging balance conditions, the TCC group performed significantly better than the swimming and control groups. In eye-hand coordination tasks, both the TCC and swimming groups yielded significantly shorter movement time compared with the control group; however, no significant difference was observed between them. We concluded that both TCC and swimming improve eye-hand coordination in the elderly. However, TCC yields a better training effect on dynamic balance.
Tai Chi Chuan increases circulating myeloid dendritic cells.
Chiang Jasson,Chen Yu-Yawn,Akiko Takafuji,Huang Yu-Chuen,Hsu Ming-Ling,Jang Tsong-Rong,Chen Yu-Jen
Dendritic cells, the most potent antigen-presenting cells linking innate and adoptive immunity, are thought to be important targets of immune modulators such as exercise. We examined the effect of Tai Chi Chuan (TCC) on dendritic cells. TCC practitioners were further divided to high-level practitioners (TCC-H) and low-level practitioners (TCC-L). The quantities of myeloid and plasmacytoid dendritic cells were estimated by flow cytometry. We examined parameters including age, body weight, body length, body fat, and serum albumin level, in the controls, TCC-H and TCC-L, which did not differ significantly. The mean peak VO(2) (volume of O(2) utilization) of the TCC-H group was greater than that of the sedentary control group. White blood cell (WBC) count in the entire TCC group was greater than that of the controls. The quantity of myeloid dendritic cells was significantly greater in the TCC group, whereas the quantity of plasmacytoid dendritic cells was similar for both groups. Among the TCC subgroups, the quantity of myeloid dendritic cells, but not plasmacytoid dendritic cells, in the TCC-H group was greater than that of TCC-L practitioners. TCC could increase the number of circulating myeloid dendritic cells, but not plasmacytoid dendritic cells, in a performance level-dependent manner.
Body Composition Outcomes of Tai Chi and Qigong Practice: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Larkey Linda K,James Dara,Belyea Michael,Jeong Mihyun,Smith Lisa L
International journal of behavioral medicine
PURPOSE:Meditative movement (MM) practices are increasingly being studied, including examination of the potential for these modalities to contribute to weight management. METHODS:A search was conducted for randomized controlled trials testing one or both of two forms of MM, Tai Chi and Qigong, reporting effects on changes in body composition. Data from these studies were extracted and tabled, and a meta-analysis of studies with inactive control conditions was conducted. Risk of bias was assessed, and seven RCTs had a low risk of bias. Sources of bias include publication bias and selection of English only. RESULTS:Publications meeting inclusion criteria yielded 24 studies (N = 1621 participants). Significant improvements in body composition, primarily body mass index, were noted for 41.7% of studies. A synthesis table describes the distribution of design factors, including type of comparison condition (inactive vs. active) and baseline body composition status (whether or not overweight/obese). A meta-analysis was conducted on 12 studies with inactive controls (using a random effects model) finding a small-to-medium treatment effect (SMD = - 0.388, CI = [- 0.732, - 0.044], t = 2.48, p < 0.03) for TC or QG interventions with a high level of heterogeneity. CONCLUSIONS:Tai Chi and Qigong show demonstrable effects on body composition, when compared to inactive control conditions. Systematic evaluation and valid conclusions regarding the impact of Tai Chi and Qigong on body composition outcomes will require more targeted study designs and control of comparison conditions.
Community-Based Mind-Body Meditative Tai Chi Program and Its Effects on Improvement of Blood Pressure, Weight, Renal Function, Serum Lipoprotein, and Quality of Life in Chinese Adults With Hypertension.
Sun Jing,Buys Nicholas
The American journal of cardiology
Obesity, metabolic syndrome, dyslipidemia, and poor quality of life are common conditions associated with hypertension, and incidence of hypertension is age dependent. However, an effective program to prevent hypertension and to improve biomedical factors and quality of life has not been adequately examined or evaluated in Chinese older adults. This study aims to examine the effectiveness of a Tai Chi program to improve health status in participants with hypertension and its related risk factors such as dyslipidemia, hyperglycemia, and quality of life in older adults in China. A randomized study design was used. At the conclusion of the intervention, 266 patients remained in the study. Blood pressure and biomedical factors were measured according to the World Diabetes Association standard 2002. A standardized quality-of-life measure was used to measure health-related quality of life. It was found that a Tai Chi program to improve hypertension in older adults is effective in reducing blood pressure and body mass index, maintaining normal renal function, and improving physical health of health-related quality of life. It did not improve existing metabolic syndrome levels, lipid level (dyslipidemia) or fasting glucose level (hyperglycemia), to prevent further deterioration of the biomedical risk factors. In conclusion, Tai Chi is effective in managing a number of risk factors associated with hypertension in Chinese older adults. Future research should examine a combination of Tai Chi and nutritional intervention to further reduce the level of biomedical risks.
Effects of Tai Chi or Conventional Exercise on Central Obesity in Middle-Aged and Older Adults : A Three-Group Randomized Controlled Trial.
Siu Parco M,Yu Angus P,Chin Edwin C,Yu Doris S,Hui Stanley S,Woo Jean,Fong Daniel Y,Wei Gao X,Irwin Michael R
Annals of internal medicine
BACKGROUND:Central obesity is a major manifestation of metabolic syndrome, which is a common health problem in middle-aged and older adults. OBJECTIVE:To examine the therapeutic efficacy of tai chi for management of central obesity. DESIGN:Randomized, controlled, assessor-blinded trial. (ClinicalTrials.gov: NCT03107741). SETTING:A single research site in Hong Kong between 27 February 2016 and 28 February 2019. PARTICIPANTS:Adults aged 50 years or older with central obesity. INTERVENTION:543 participants were randomly assigned in a 1:1:1 ratio to a control group with no exercise intervention ( = 181), conventional exercise consisting of aerobic exercise and strength training (EX group) ( = 181), and a tai chi group (TC group) ( = 181). Interventions lasted 12 weeks. MEASUREMENTS:Outcomes were assessed at baseline, week 12, and week 38. The primary outcome was waist circumference (WC). Secondary outcomes were body weight; body mass index; high-density lipoprotein cholesterol (HDL-C), triglyceride, and fasting plasma glucose levels; blood pressure; and incidence of remission of central obesity. RESULTS:The adjusted mean difference in WC from baseline to week 12 in the control group was 0.8 cm (95% CI, -4.1 to 5.7 cm). Both intervention groups showed reductions in WC relative to control (adjusted mean differences: TC group vs. control, -1.8 cm [CI, -2.3 to -1.4 cm]; < 0.001; EX group vs. control: -1.3 cm [CI, -1.8 to -0.9 cm]; < 0.001); both intervention groups also showed reductions in body weight ( < 0.05) and attenuation of the decrease in HDL-C level relative to the control group. The favorable changes in WC and body weight were maintained in both the TC and EX groups, whereas the beneficial effect on HDL-C was only maintained in the TC group at week 38. LIMITATIONS:High attrition and no dietary intervention. CONCLUSION:Tai chi is an effective approach to reduce WC in adults with central obesity aged 50 years or older. PRIMARY FUNDING SOURCE:Health and Medical Research Fund.
Tai Chi can prevent cardiovascular disease and improve cardiopulmonary function of adults with obesity aged 50 years and older: A long-term follow-up study.
To research the possible role of Tai Chi in preventing cardiovascular disease and improving cardiopulmonary function in adults with obesity aged 50 years and older.Between 2007 and 2012, 120 adults with obesity, aged 50 years and older, were divided into a Tai Chi group and a control group, with 60 participants in each group. The 2 groups were evaluated for weight, waist circumference, hip circumference, blood pressure (BP), body mass index, and incidence of chronic disease during follow-up monitoring.Two- and 6-year follow-up showed that the average BP in the Tai Chi group along with either the systolic or diastolic pressure decreased significantly compared to those in the control group (P < .001). Waist and hip circumference, weight, and body mass index in the Tai Chi group were significantly reduced compared to those in the control group (P < .001). The cardiopulmonary function of the control group and the Tai Chi group changed, with the cardiac index significantly higher in the Tai Chi group than in the control group (P < .05). The Tai Chi group had significantly higher levels of lung function, including vital capacity, maximal oxygen uptake, and total expiratory time, than the control group. The total incidence of complications and mortality in the Tai Chi group were much lower than those in the control group (P < .001). The incidence of cardiovascular and cerebrovascular disease in the Tai Chi group (16.67%) was lower than that in the control group (38.33%).Tai Chi is not only a suitable exercise for elderly people with obesity, but it can also help to regulate BP, improve heart and lung function in these individuals, as well as reduce the incidence of cardiovascular disease and other chronic diseases, helping to improve their quality of life.
The Atlanta FICSIT study: two exercise interventions to reduce frailty in elders.
Wolf S L,Kutner N G,Green R C,McNeely E
Journal of the American Geriatrics Society
This study examines the effect of two different exercise approaches on balance and frailty measures among more than 200 community-dwelling individuals greater than 70 years of age. Exercises are provided for 15 weekly sessions on an individual basis for participants randomly assigned to a Balance Training group. Training consists of center-of-mass feedback displayed on a motor under static conditions, or, in later sessions, as the floor surface is moved, with eyes open or closed. This high technology interface provides instantaneous information about displacement of body weight in space so that balance can be enhanced. An alternative procedure is comparatively simple and requires little expense or space. Tai Chi Quan was originally developed as a martial arts form but has been used for centuries in China as an exercise among elderly citizens. Participants randomly assigned to this intervention meet twice weekly for 15 weeks to learn a condensation of 108 Tai Chi forms into 10 that emphasize movement components often restricted or absent with aging. A third group serves as a control for exercise interventions by meeting weekly for 15 sessions to discuss topics of interest such as memory loss, drug management, and nutrition. All subjects are screened prior to assignment, and a host of physical, behavioral, and functional measures are assessed before and after the intervention as well as 4 months later. Measurements unique to the Atlanta site include: balance with eyes closed, programmed force-distribution changes when stance is perturbed, cardiovascular assessments, WAIS, Affects Balance Scale, and a survey of home environment.
The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients.
Benedetti Maria Grazia,Furlini Giulia,Zati Alessandro,Letizia Mauro Giulia
BioMed research international
Physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients. The authors reviewed the current literature to define the most appropriate features of exercise for increasing bone density in osteoporotic patients. Two types emerged: (1) , i.e., walking, stair climbing, jogging, and Tai Chi. Walking alone did not appear to improve bone mass; however it is able to limit its progressive loss. In fact, in order for the weight-bearing exercises to be effective, they must reach the mechanical intensity useful to determine an important ground reaction force. (2) : these are carried out with loading (lifting weights) or without (swimming, cycling). For this type of exercise to be effective a joint reaction force superior to common daily activity with sensitive muscle strengthening must be determined. These exercises appear extremely site-specific, able to increase muscle mass and BMD only in the stimulated body regions. Other suggested protocols are multicomponent exercises and whole body vibration. consist of a combination of different methods (aerobics, strengthening, progressive resistance, balancing, and dancing) aimed at increasing or preserving bone mass. These exercises seem particularly indicated in deteriorating elderly patients, often not able to perform exercises of pure reinforcement. However, for these protocols to be effective they must always contain a proportion of strengthening and resistance exercises. Given the variability of the protocols and outcome measures, the results of these methods are difficult to quantify. Training with these exercises are performed with dedicated devices, and while it seems they have effect on enhancing muscle strength, controversial findings on improvement of BMD were reported. WBV seems to provide good results, especially in improving balance and reducing the risk of falling; in this, WBV appears more efficient than simply walking. Nevertheless, contraindications typical of senility should be taken into account.
The Beneficial Effect of Traditional Chinese Exercises on the Management of Obesity.
Qin Yuan,Xia Weiyi,Huang Wei,Zhang Jing,Zhao Yi,Fang Min
Evidence-based complementary and alternative medicine : eCAM
This paper systematically reviewed the clinical update of traditional Chinese exercises in the treatment of simple obesity in recent years and discussed their specific advantages in this aspect. This review focused on several typical traditional Chinese exercises, namely, Tai Chi, Ba Duan Jin, Yi Jin Jing, Wu Qin Xi, Shaolin Neigong, and Liu Zi Jue, which all showed clinical beneficial effect on the treatment of simple obesity with their own characteristics. To optimize the clinical therapeutic effect of these traditional Chinese exercises, we need to seek the most appropriate exercise or the combo exercise based on the characteristics of different obese population, to improve the efficiency of weight loss, reduce sports injury, and consolidate the therapeutic effect. In the future, we need to further evaluate the efficacy of sitting exercise, lying exercise, and static training in the treatment of simple obesity, subdivide the treatment population, and explore the working mechanism of these traditional Chinese exercises.
Effectiveness of martial arts exercise on anthropometric and body composition parameters of overweight and obese subjects: a systematic review and meta-analysis.
de Souza Fabricio,Lanzendorf Felipe Nunes,de Souza Márcia Mendonça Marcos,Schuelter-Trevisol Fabiana,Trevisol Daisson José
BMC public health
BACKGROUND:Obesity is considered a top public health concern, and its prevalence is growing every day. Thus, interventions to address this problem should be encouraged and further studied. In this regard, the aim of this review was to summarize the evidence of martial arts interventions to evaluate their effectiveness on the anthropometric and body composition parameters of overweight and obese subjects. METHODS:A systematic literature search was conducted on January 26, 2020 using the PubMed, Medline, Lilacs, Cochrane, and Scielo databases. Reference lists of eligible articles and relevant reviews have also been examined. All randomized clinical trials on martial arts that evaluated the anthropometric and body composition parameters of overweight and obese subjects were included, and a narrative synthesis of eligible studies was conducted in accordance with PRISMA guidelines. The Downs & Black checklist was used to assess the quality of the studies. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42018086116). RESULTS:A total of 82 articles were identified from the initial search strategy. A further 2 articles were identified from the review of relevant bibliographies. Six studies encompassing 258 participants who were overweight or obese were included. Four studies reported Tai Chi practice, one study reported Kung Fu exercise, and another study reported martial arts exercise. The examined meta-analyses did not reveal significant benefits from martial arts practice over control groups after the experiment period for body mass index (- 1.34 kg/m; 95% CI: - 2.72, 0.05), waist circumference (1.41 cm; 95% CI: - 0.72, 3.54) and percentage of body fat (- 0.75%; 95% CI: - 5.58, 4.08). CONCLUSION:The scarcity, heterogeneity, short intervention time, small sample size, and significant methodological limitations of the available studies do not allow to conclude whether martial arts are effective in the anthropometric and body composition parameters of overweight and obese individuals. This study highlights the need for more research to assess the benefits of martial arts for overweight and obese individuals.
Effects of the addition of t'ai chi to a dietary weight loss program on lipoprotein atherogenicity in obese older women.
Beebe Nowen,Magnanti Steve,Katkowski Lynn,Benson Marisa,Xu Furong,Delmonico Matthew J,Lofgren Ingrid E
Journal of alternative and complementary medicine (New York, N.Y.)
OBJECTIVE:To examine the additive effect of t'ai chi (TC) to diet education on the traditional coronary heart disease (CHD) risk factor low-density lipoprotein cholesterol (LDL-C) and on emerging CHD risk factors (apolipoprotein B and LDL particle size) in older obese women. DESIGN:Ancillary study of a randomized clinical trial. SETTING:University of Rhode Island. PARTICIPANTS:26 obese women (mean age±standard deviation, 61.5±6.0 years; mean body mass index, 34.3±4.0 kg/m(2)) were enrolled and randomly assigned to the diet education group (n=13) or the diet education plus TC group (n=13). INTERVENTION:All participants received 45 minutes of diet education per week. The diet education plus TC group also received 45 minutes of TC three times per week for 16 weeks. OUTCOME MEASURES:Anthropometrics (height, weight, BMI, waist circumference, and hip circumference), clinical variables (blood pressure), and biochemical variables (standard lipid profile, apolipoprotein B, LDL particle size) were measured. The primary outcome was LDL-C, and the secondary outcomes were apolipoprotein B and LDL particle size. RESULTS:Neither LDL-C nor apolipoprotein B improved in either group. Percentage of large LDL particles after the intervention was increased in the diet education plus TC group compared with the diet education group. Weight, waist circumference, and high-density lipoprotein cholesterol decreased in both groups from baseline to post-intervention. Triacylglycerol and dietary screening tool scores increased in both groups. Additional improvements were seen in the diet education plus TC group, including a significant increase in Dietary Approaches to Stop Hypertension score from baseline to post-intervention. CONCLUSION:The addition of TC to diet education is more effective than diet education alone at improving diet quality and emerging CHD risk factors, such as LDL particle size, in obese older women.
Pilot study of a 10-week multidisciplinary Tai Chi intervention in sedentary obese women.
Dechamps Arnaud,Gatta Blandine,Bourdel-Marchasson Isabelle,Tabarin Antoine,Roger Patrick
Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine
OBJECTIVE:Alternative approaches to weight control and physical activity are increasingly needed. Numerous factors influence weight management, including the choice of physical exercise. No study has previously examined the therapeutic effect of a multidisciplinary weight management program incorporating Tai Chi (TC) exercises among sedentary obese women. DESIGN:Randomized intervention trial with blinded medical provider. SETTING:In day hospital consultations. PARTICIPANTS:Twenty-one obese women. INTERVENTION:All subjects participated in a 10-week weight management program that was part of usual care and included a hypocaloric balanced diet, a weekly physician/psychologist/dietician group session, and an exercise program. For the exercise component, subjects were randomized to either a 2-hour weekly session of TC or a conventional structured exercise program. MAIN OUTCOME MEASURES:Changes in weight, body composition, heart rate, blood pressure, mobility scores, mood, Three Factor Eating Questionnaire scores, and General Self-Efficacy. RESULTS:The TC arm improved in resting systolic blood pressure, chair rise test, mood, and reduced percent of fat at week 10 and at 6 months follow-up. General self-efficacy was enhanced in both groups and maintained at 30 weeks. CONCLUSION:The observed benefits over a 30-week period of a multidisciplinary weight management program incorporating TC exercises on physical functioning mood and dietary restraint need further understanding of how sedentary obese women adhere to physical activity like TC or other alternative exercises.
Effects of Tai Chi and Walking Exercises on Weight Loss, Metabolic Syndrome Parameters, and Bone Mineral Density: A Cluster Randomized Controlled Trial.
Hui Stanley Sai-Chuen,Xie Yao Jie,Woo Jean,Kwok Timothy Chi-Yui
Evidence-based complementary and alternative medicine : eCAM
Tai Chi and walking are both moderate-intensity physical activity (PA) that can be easily practiced in daily life. The objective of the study was to determine the effects of these two PAs on weight loss, metabolic syndrome parameters, and bone mineral density (BMD) in Chinese adults. We randomized 374 middle-aged subjects (45.8 ± 5.3 years) into 12-week training (45 minutes per day, 5 days per week) of Tai Chi (n = 124) or self-paced walking (n = 121) or control group (n = 129). On average, Tai Chi and walking groups lost 0.50 and 0.76 kg of body weight and 0.47 and 0.59 kg of fat mass after intervention, respectively. The between-group difference of waist circumference (WC) and fasting blood glucose (FBG) was -3.7 cm and -0.18 mmol/L for Tai Chi versus control and -4.1 cm and -0.22 mmol/L for walking versus control. No significant differences were observed regarding lean mass, blood pressure, triglycerides, total cholesterol, high-density and low-density lipoprotein cholesterol, and BMD compared to control. Change in lean mass, not fat mass or total weight loss, was significantly correlated to the change in BMD. Our results suggest that both of these two PAs can produce moderate weight loss and significantly improve the WC and FBG in Hong Kong Chinese adults, with no additional effects on BMD.
Tai chi for primary prevention of cardiovascular disease.
Hartley Louise,Flowers Nadine,Lee Myeong Soo,Ernst Edzard,Rees Karen
The Cochrane database of systematic reviews
BACKGROUND:Stress and a sedentary lifestyle are major determinants of cardiovascular disease (CVD). As tai chi involves exercise and can help in stress reduction, it may be effective in the primary prevention of CVD. OBJECTIVES:To determine the effectiveness of tai chi for the primary prevention of CVD. SEARCH METHODS:We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 11, 2013); MEDLINE (Ovid) (1946 to November week 3, 2013); EMBASE Classic + EMBASE (Ovid) (1947 to 6 December 2013); Web of Science (Thomson Reuters) (1970 to 6 December 2013); PsycINFO (Ovid) (1806 to December week 1, 2013); Database of Abstracts of Reviews of Effects (DARE); Health Technology Assessment Database and Health Economics Evaluations Database (Issue 4, 2013). We also searched the Allied and complementary Medicine Database (AMED) and OpenGrey (inception to October 2012) and several Asian databases. We searched trial registers and reference lists of reviews for further studies. We applied no language restrictions. SELECTION CRITERIA:Randomised controlled trials of tai chi lasting at least three months involving healthy adults or adults at high risk of CVD. The comparison group was no intervention or minimal intervention. The outcomes of interest were CVD clinical events and CVD risk factors. We excluded trials involving multifactorial lifestyle interventions or focusing on weight loss to avoid confounding. DATA COLLECTION AND ANALYSIS:Two review authors independently selected trials for inclusion, abstracted the data and assessed the risk of bias. MAIN RESULTS:We identified 13 small trials (1520 participants randomised) and three ongoing trials. All studies had at least one domain with unclear risk of bias, and some studies were at high risk of bias for allocation concealment (one study) and selective reporting (two studies). Duration and style of tai chi differed between trials. Seven studies recruited 903 healthy participants, the other studies recruited people with borderline hypertension or hypertension, elderly people at high risk of falling, and people with hypertension with liver and kidney yin deficiency syndrome.No studies reported on cardiovascular mortality, all-cause mortality or non-fatal events as most studies were short term (all studies had follow-up of one year or less). There was also considerable heterogeneity between studies, which meant that it was not possible to combine studies statistically for cardiovascular risk (I(2) statistic for systolic blood pressure (SBP) was 96%, for diastolic blood pressure (DBP) 96%, for total cholesterol 96%, low-density lipoprotein-cholesterol (LDL-C) 95%, high-density lipoprotein-cholesterol (HDL-C) 98%, triglycerides 75%). Nine trials measured blood pressure, six individual trials found reductions in SBP (reductions ranged from -22.0 mmHg (95% confidence interval (CI) -26.3 to -17.7) to -11.5 mmHg (95% CI -21.5 to -1.46)), two trials found no clear evidence of a difference (however, CIs were wide and an increase or decrease in SBP cannot be ruled out), and one trial found an increase in SBP with tai chi (increase 5.2 mmHg, 95% CI 3.73 to 6.67). A similar pattern was seen for DBP: three trials found a reduction in DBP (reductions ranged from -12.2 mmHg (95% CI -15.8 to -8.7) to -4.43 mmHg (95% CI -7.14 to -1.72)) and three trials found no clear evidence of a difference, however again with wide CIs. Three trials reported lipid levels and two found reductions in total cholesterol, LDL-C and triglycerides (total cholesterol reductions ranged from -1.30 mmol/L (95% CI -1.57 to -1.03) to -0.50 mmol/L (95% CI -0.74 to -0.26): LDL-C reductions ranged from -0.76 mmol/L (95% CI -0.93 to -0.59) to -0.59 mmol/L (95% CI -0.80 to -0.38): triglyceride reductions ranged from -0.46 mmol/L (95% CI -0.62 to -0.30) to -0.37 mmol/L (95% CI -0.67 to-0.07)) and increased HDL-C with the intervention (HDL-C increases ranged from 0.61 mmol/L (95% CI 0.51 to 0.71) to 0.16 mmol/L (95% CI 0.02 to 0.30)), while the third study found no clear evidence of a difference between groups on lipid levels. Quality of life was measured in one trial: tai chi improved quality of life at three months. None of the included trials reported on adverse events, costs or occurrence of type 2 diabetes. AUTHORS' CONCLUSIONS:There are currently no long-term trials examining tai chi for the primary prevention of CVD. Due to the limited evidence available currently no conclusions can be drawn as to the effectiveness of tai chi on CVD risk factors. There was some suggestion of beneficial effects of tai chi on CVD risk factors but this was not consistent across all studies. There was considerable heterogeneity between the studies included in this review and studies were small and at some risk of bias. Results of the ongoing trials will add to the evidence base but additional longer-term, high-quality trials are needed.
Tai Chi Is a Promising Exercise Option for Patients With Coronary Heart Disease Declining Cardiac Rehabilitation.
Salmoirago-Blotcher Elena,Wayne Peter M,Dunsiger Shira,Krol Julie,Breault Christopher,Bock Beth C,Wu Wen-Chih,Yeh Gloria Y
Journal of the American Heart Association
BACKGROUND:More than 60% of patients decline participation in cardiac rehabilitation after a myocardial infarction. Options to improve physical activity (PA) and other risk factors in these high-risk individuals are limited. We conducted a phase 2 randomized controlled trial to determine feasibility, safety, acceptability, and estimates of effect of tai chi on PA, fitness, weight, and quality of life. METHODS AND RESULTS:Patients with coronary heart disease declining cardiac rehabilitation enrollment were randomized to a "LITE" (2 sessions/week for 12 weeks) or to a "PLUS" (3 sessions/week for 12 weeks, then maintenance classes for 12 additional weeks) condition. PA (accelerometry), weight, and quality of life (Health Survey Short Form) were measured at baseline and 3, 6, and 9 months after baseline; aerobic fitness (stress test) was measured at 3 months. Twenty-nine participants (13 PLUS and 16 LITE) were enrolled. Retention at 9 months was 90% (LITE) and 88% (PLUS). No serious tai chi-related adverse events occurred. Significant mean between group differences in favor of the PLUS group were observed at 3 and 6 months for moderate-to-vigorous PA (100.33 min/week [95% confidence interval, 15.70-184.95 min/week] and 111.62 min/week; [95% confidence interval, 26.17-197.07 min/week], respectively, with a trend toward significance at 9 months), percentage change in weight, and quality of life. No changes in aerobic fitness were observed within and between groups. CONCLUSIONS:In this community sample of patients with coronary heart disease declining enrollment in cardiac rehabilitation, a 6-month tai chi program was safe and improved PA, weight, and quality of life compared with a 3-month intervention. Tai chi could be an effective option to improve PA in this high-risk population. CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT02165254.
Tai Chi is an effective form of exercise to reduce markers of frailty in older age.
Kasim Nor Fadila,Veldhuijzen van Zanten Jet,Aldred Sarah
Frailty affects the quality of life of older age adults by limiting mobility, reducing physiological reserve and reducing independence. The frailty phenotype is typically characterised by exhaustion, loss or lack of physical activity, weight loss and weakness, although more recently there have been proposals to extend the frailty criteria to include physiological characteristics such as inflammation, oxidative stress and vascular function. Exercise has the potential to prevent, delay or even reverse frailty, but not all exercise is perceived as suitable for an older age population. The purpose of this study was to test Tai Chi and Zumba Gold® as exercise interventions in older age adults (65 to 75 years old) to improve characteristics related to the frailty phenotype. Muscle strength and flexibility (functional fitness as a measure of weakness), cardiorespiratory fitness, blood pressure, vascular function (FMD), markers of oxidative stress (total antioxidant capacity, malondialdehyde, 8-isoprostane, protein carbonyl), inflammation (CRP) and aspects of wellbeing related to exhaustion were assessed at baseline (pre-), 6 weeks (mid-) and 12 weeks (post-intervention). Both Tai Chi and Zumba Gold® improved systolic blood pressure, vascular function, and functional fitness following the 12 week intervention to a similar extent. Furthermore Antioxidant capacity was significantly increased (303 ± 15.56 vs. 336 ± 18.82 μm; p = 0.0028) and lipid oxidation significantly reduced (36.41 ± 6.4 vs 13.49 ± 2.5 pg/ml; p = 0.0042) after 12 weeks of Tai Chi compared to baseline. Anxiety, physical and mental fatigue decreased in both groups, with a greater decrease in mental fatigue in the Tai Chi group. Taken together, these changes suggest that Tai Chi has the potential to reduce outcomes related to the extended frailty phenotype in older age adults.
Impact of a program of Tai Chi plus behaviorally based dietary weight loss on physical functioning and coronary heart disease risk factors: a community-based study in obese older women.
Xu Furong,Letendre Jonathan,Bekke Jillian,Beebe Nowen,Mahler Leslie,Lofgren Ingrid E,Delmonico Matthew J
Journal of nutrition in gerontology and geriatrics
This study employed a quasi-experimental design in a community-based study translating the results of our recent findings on the combined effects of Tai Chi and weight loss on physical function and coronary heart disease (CHD) risk factors. A 16-week intervention was conducted to assess the impact of Tai Chi plus a behavioral weight loss program (TCWL, n = 29) on obese (body mass index [BMI] = 35.4 ± 0.8 kg/m²) older (68.2 ± 1.5 yr.) women compared to a control group (CON, n = 9, BMI = 38.0 ± 1.5 kg/m², 65.6 ± 2.7 yr.), which was asked to maintain their normal lifestyle. The TCWL group lost weight (1.6 ± 2.9 kg, P = 0.006) while the CON group did not (1.2 ± 1.9 kg, P = 0.106). Physical functioning as measured by the short physical performance battery improved in TCWL when compared to the CON group (β = 1.94, 95% Confidence Interval [CI]: 1.12, 2.76, P < 0.001). TCWL also improved in sit-and-reach flexibility (β = -2.27, 95% CI: -4.09, -0.46, P = 0.016), body fat mass (BMI, β = -0.65, 95% CI: -1.03, -0.26, P = 0.002), waist circumference (β = -1.78, 95% CI: -2.83, -0.72, P = 0.002), systolic blood pressure (β = -16.41, 95% CI: -21.35, -11.48, P < 0.001), and diastolic blood pressure (β = -9.52, 95% CI: -12.65, -6.39, P < 0.001). Thus, TCWL intervention may represent an effective strategy to improve physical function and ameliorate CHD risk in the older adult population.
Tai chi for overweight/obese adolescent and young women with polycystic ovary syndrome: study protocol for a randomized controlled trial.
Li Yan,Peng Changle,Cao Guangying,Li Wei,Hou Lihui
BACKGROUND:Tai Chi is a moderately intense exercise that dates back to ancient China. It has been reported that Tai Chi not only has beneficial effects on metabolic disorders, such as diabetes, cardiovascular diseases and obesity, but also has favorable effects on psychological well-being. Since these conditions are quite closely associated with polycystic ovary syndrome (PCOS), we hypothesis that Tai Chi could be a potential treatment option for PCOS patients. We aim to determine the feasibility and effectiveness of Tai Chi on overweight/obese adolescent and young women with PCOS. METHODS:A total of 50 patients will be randomized into two arms: (1) Tai Chi or (2) self-monitored exercise. Both groups will exercise for 3 months. The primary hypothesis is that Tai Chi results in a significantly lower Body Mass Index (BMI) than self-monitored exercise. The study was approved by the Ethics Committee of the First Affiliated Hospital of Heilongjiang University of Chinese Medicine. DISCUSSION:This is the first study to determine the feasibility and effectiveness of Tai Chi in treating overweight/obese adolescent and young women with PCOS. The trial will provide evidence to assess the feasibility of a future multicenter, randomized controlled trial. TRIAL REGISTRATION:ClinicalTrials.gov, ID: NCT02608554 . Registered on 17 November 2015.
The effects of sitting Tai Chi on physical and psychosocial health outcomes among individuals with impaired physical mobility: A systematic review and meta-analysis.
Zhao Jie,Chau Janita Pak Chun,Lo Suzanne Hoi Shan,Choi Kai Chow,Liang Surui
International journal of nursing studies
BACKGROUND:Impaired physical mobility refers to a limitation in independent and purposeful physical movement of the body or one or more extremities. Physical restrictions result in negative consequences on an individual's physical and psychosocial functions. Sitting Tai Chi, a derivative form of traditional Tai Chi, has been found to increase the flexibility of all joints involved and enhance the ability to perform physical activity. However, the evidence of sitting Tai Chi on physical and psychosocial health outcomes on individuals with impaired physical mobility is limited. OBJECTIVES:To critically synthesize evidence that evaluates the effects of sitting Tai Chi on health outcomes among individuals with impaired physical mobility and to identify implementation strategies for the sitting Tai Chi intervention. METHODS:Searches were performed across 11 English and two Chinese databases systematically from inception to January 2020. Randomised controlled trials and non-randomised controlled trials, written in English or Chinese were included. Two independent reviewers screened all eligible studies, appraised risk of bias, and extracted the data. Meta-analyses were conducted using Review Manager 5.4 and narrative syntheses were performed where meta-analysis was inappropriate. The certainty of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation profiler Guideline Development Tool. This study was registered in PROSPERO. RESULTS:A total of 1,446 records were generated and 11 studies were eligible for inclusion. Meta-analysis reported a statistically significant effect size favouring sitting Tai Chi on depressive symptoms (SMD: -1.53, 95% CI: -2.81 to -0.21, 2 studies; very low quality), heart rate (MD: -5.72, 95% CI: -11.16 to -0.29, 2 studies; low quality) and social domain of quality of life (MD: 1.42, 95% CI: 0.66 to 2.19, 3 studies; low quality). CONCLUSIONS:Sitting Tai Chi was found to have favourable effects on depressive symptoms, heart rate, and social domain of quality of life of individuals with impaired physical mobility. Very low to low quality evidence does not support the effectiveness of sitting Tai Chi on dynamic sitting balance, handgrip strength, and the physical and psychological domains of quality of life. There was limited evidence to suggest the best implementation strategies for the sitting Tai Chi intervention. It is anticipated that more well-designed studies will continue developing high quality evidence in this field.