Tai Chi for improving balance and reducing falls: An overview of 14 systematic reviews

Multimodal respiratory muscle training and Tai Chi intervention with healthy older adults: A double-blind randomised placebo control trial

BACKGROUND

The World Health Organization reported that one of the major challenges for all countries in the next few years will be the development of preventive approaches to care for older adults. After COVID-19, multimodal interventions have been created to enhance older health, especially targeting respiratory muscles (e.g., inspiratory muscle training [IMT]). The following research aims to explore the combination of two interventions (IMT and Tai Chi) using a randomised, double-blind placebo approach.

METHODS

A total of 30 participants were recruited from the local community in Derby (UK) and underwent an experimental (IMT + Tai Chi) or placebo (sham-IMT + Tai Chi) training protocol. Measurements of balance (i.e., mini-BEST), inspiratory muscle strength (i.e., Maximal Inspiratory Pressure) and mobility (i.e., 6 Minutes Walking Test) were collected at baseline and after 8 weeks.

RESULTS

The results show that a combination of IMT and Tai Chi significantly improves dynamic balance (P < 0.01) and mobility (P < 0.05) when compared to Tai Chi alone, with an additional positive correlation between balance, mobility and inspiratory muscle strength (P < 0.05).

CONCLUSION

The manuscript is the first to report the combined effects of IMT and Tai Chi in older adults following rigorous methods. The results highlight the relationship between inspiratory muscle and balance, as the results demonstrate a potential link between metaboreflex and balance control, fostering multimodal practices for healthy ageing interventions.

Combined effects of Tai-Chi gait with mediolateral ground support perturbation on dynamic balance control

Tai-Chi (TC) is a broadly used exercise that appeared to decrease the risk of falls. However, biomechanical mechanisms underlying the reduced fall risks following TC exercise remain unclear and hinder the ability to optimize TC intervention to target specific balance deficit disorders. In addition, combining TC gait exercise with ground support perturbation may be a viable approach to further challenge balance control compared to TC gait alone. The purpose of this study was to compare dynamic stability and limb support force production during comfortable walking speed (CWS), TC gait, and TC gait with medial (MED) and lateral (LAT) ground support perturbations in older and younger adults. Ten older adults and ten younger adults performed CWS, TC gait, LAT, and MED. Conditions involving TC gait showed decreased margin of stability (MoS) (main effect of condition, p ​< ​0.01) and increased vertical force impulse compared to CWS (p ​< ​0.01). Medial ground support perturbation induced the smallest MoS among all conditions. Older adults showed increased MoS compared to younger adults (p ​< ​0.01). These findings provided insight into how key balance control characteristics are modulated during TC exercise and indicate that combining ground support perturbation with TC may further challenge dynamic stability.

The effects and optimal dosage of traditional Chinese exercises on patients with chronic ankle instability: A systematic review and meta-analysis

BACKGROUND

The effectiveness of Traditional Chinese exercises in promoting functional recovery in patients with chronic ankle instability, as well as the potential impact of variables such as intervention type, duration, frequency, and cycle on treatment outcomes, still requires further investigation.

METHODS

Literature searches were conducted in multiple databases including China National Knowledge Infrastructure (CNKI), VIP, Wanfang, China Biomedical Literature Database (CBM), PubMed, EBSCO(Medline、CINAHL、SPORTDiscus), Embase, Cochrane Library, ProQuest, and Web of Science for randomized controlled trials assessing the effects of Traditional Chinese Exercises interventions on patients with Chronic Ankle Instability. The publication timeframe spanned from the inception of each database until January 20, 2025. Meta-analysis was performed using STATA 15 software on the included studies.

RESULTS

Twelve randomized controlled trials (RCTs) involving 323 patients were included in this analysis. Compared with the control group, Traditional Chinese exercises showed the following improvements: CAIT: WMD = 4.02, 95 % CI [3.22, 4.81], z = 9.90, P < 0.001.Balance: ANT: SMD = 0.38, 95 % CI [0.18, 0.59], z = 3.71, P = 0.003.PM: SMD = 0.49, 95 % CI [0.26, 0.70], z = 4.73, P < 0.001.PL: SMD = 0.67, 95 % CI [0.46, 0.88], z = 6.35, P < 0.001.C: SMD = 0.80, 95 % CI [0.35, 1.25], z = 3.51, P < 0.001.JPS:Plantarflexion: SMD = -0.58, 95 % CI [-0.94, -0.21], z = 3.09, P = 0.002.Inversion: SMD = -0.46, 95 % CI [-0.86, -0.06], z = 2.23, P = 0.025.Muscle Strength: Plantarflexion: SMD = 0.81, 95 % CI [0.43, 1.18], z = 4.25, P < 0.001.Inversion: SMD = 0.66, 95 % CI [0.25, 1.07], z = 3.16, P = 0.002.Eversion: SMD = 1.04, 95 % CI [0.62, 1.46], z = 4.82, P < 0.001.Subgroup Analysis: Tai Chi training conducted twice weekly for a 12-week intervention period, with 60-minute sessions, demonstrated the most effective improvements.

LEVEL OF EVIDENCE

The evidence level for the effects of Traditional Chinese exercises on Balance-ANT, Balance-PM, and Balance-PL balance directions in CAI patients is rated as "moderate."

CONCLUSION

Traditional Chinese exercise has been shown to significantly improve balance, muscle strength, and joint position sense in CAI patients. Based on the current findings, Tai Chi training appears to provide greater benefits for CAI patients. It is recommended that CAI patients participate in Tai Chi training twice a week, with each session lasting 60 minutes, over a 12-week period.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO database, CRD42024613359.

Global research trends in mind body therapies: a bibliometric analysis

OBJECTIVES

Mind-body therapies are a group of treatments based on the theory of mind-body medicine, which are effective for a wide range of illnesses. However, there are no bibliometric papers that have examined the topic of mind-body therapies. Therefore, it is necessary to review and sort out the current status, hotspots and frontiers of mind-body therapies.

METHODS

Studies related to mind-body therapies during the period of Web of Science 1999-01/2024-07 were searched, and R language was applied to analyze the data and CiteSpace, Vosviewer software, was used to generate visualization maps.

RESULTS

A total of 29,710 relevant articles were included in the study. The country with the highest number of publications was the United States, followed by China and the United Kingdom, and the prolific author was Wang Yuan. Common keywords were acupuncture, quality of life, depression, and pain. The current study focuses on the promotion and application of mind-body therapies in various diseases, the main applicable diseases and the application in special groups.

CONCLUSION

This study presents the current status and trend of research on mind-body therapies, and inflammatory interventions and higher-level research assessment methods are potential hotspots, which can help researchers to clarify hotspots and explore new directions.

Effect of Tai Chi Softball on Health-Related Outcomes in Elderly Men

This study aimed to investigate the effects of Tai Chi Softball (TCSB) training on the physical health of older men, with a focus on improvements in muscle strength, flexibility, balance, and blood lipid profiles. A 12-week randomized controlled trial was conducted, recruiting 140 men aged 55-65 years. Participants were randomly assigned to either a Tai Chi Softball group (TCSBG, N = 70) or a control group (CG, N = 70). The TCSBG engaged in TCSB training sessions 4 to 5 times per week, with each session lasting 70 to 90 min, while the CG maintained their usual daily routines without any additional interventions. Measurements were taken before and after the intervention and included waist-to-hip ratio (WHR), handgrip strength (HS), sit-and-reach (SAR), single-leg stance (SLS), vital capacity (VC), heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol. The results revealed that after 12 weeks of TCSB training, participants in the TCSBG showed significant improvements (p < .05) in HS, SAR, and SLS, indicating enhanced muscle strength, flexibility, and balance, respectively. The VC also increased significantly, while both SBP and DBP decreased notably (p < .05). Moreover, significant reductions were observed in TC, TG, and LDL-C levels p < .05). In conclusion, TCSB training demonstrated efficacy in improving muscle strength, flexibility, balance, cardiorespiratory fitness, and blood lipid profiles in older men. These findings suggest that TCSB training can mitigate age-related declines in physical function and reduce cardiovascular risk in older men.

Complementary Therapies: Tai Chi in the Prevention and Management of Cardiovascular Disease

Cardiovascular disease has remained the top contributor to global mortality for decades, necessitating research into the most effective methods of its prevention and treatment. Simultaneous with an immense amount of discovery and innovation in the field of cardiology, certain therapies with traditional Chinese origins have become progressively more popular in the West in recent decades. Specifically, ancient meditative mind-body practices such as Qigong and Tai Chi may lower cardiovascular disease risk and severity through a focus on movement and meditation. Such practices are generally low-cost and modifiable, with few adverse effects. Studies have shown higher quality of life in patients with coronary artery disease and heart failure after participation in Tai Chi, as well as a positive impact on cardiovascular risk factors such as hypertension and waist circumference. Most studies in the field have various limitations, such as small sample size, lack of randomization, and inadequate control; however, these practices show potential as an adjunct in the prevention and treatment of cardiovascular disease. Patients unable or unwilling to partake in traditionally aerobic activities may benefit greatly from such mind-body therapies. Nonetheless, more studies are warranted for more definitive answers to the question of Tai Chi and Qigong's effectiveness. In this narrative review, we discuss the current evidence surrounding the effects of Qigong and Tai Chi on cardiovascular disease, in addition to the limitations and difficulties in conducting such studies.

Effects of Tai Chi on physical performance, sleep, and quality of life in older adults with mild to moderate cognitive impairment

BACKGROUND

Exercise is a promising nonpharmacological intervention to delay the progression of cognitive impairment and improve physical function and sleep quality in patients, but the evidence remains inconclusive.

AIMS

To compare the therapeutic efficacy of an exercise intervention on physical performance, sleep efficiency, and quality of life in older adults with cognitive impairment.

DESIGN

A three-arm randomized controlled trial.

METHODS

This study recruited 81 older adults with mild to moderate cognitive impairment at a nursing home from December 2020 to July 2021. Participants were screened and randomized into three groups: a tai chi intervention group (n = 27), a conventional exercise intervention group (n = 27), and a waitlist control group with no intervention (n = 27). The intervention groups underwent 12 weeks of exercise intervention. Participants were assessed at weeks 0, 6, and 12. The primary outcome was the Short Physical Performance Battery score, and the secondary outcomes were sleep efficiency and quality of life. Statistical analysis was conducted with generalized estimating equations (GEEs).

RESULTS

The mean age of the participants was 81.0 ± 7.4 years. The GEE analysis revealed that the Short Physical Performance Battery score, sleep efficiency, and quality of life were significantly higher in both intervention groups than in the control group at week 12, and physical performance improved significantly more in the tai chi group than in the conventional exercise group.

CONCLUSIONS

Both exercise interventions improved physical performance, sleep efficiency, and quality of life in older adults with mild to moderate cognitive impairment. According to our results, tai chi may be a more effective therapeutic approach for cognitive impairment than conventional exercise.

TRIAL REGISTRATION

University Hospital Medical Information Network number UMIN000042051. Registered 01/12/2020.

Effects of Standard Tai Chi on Exercise Capacity and Mental Health in Exercise-Deprived Overweight/Obese Adults and Assessment of Participant Adherence

OBJECTIVE

To explore the effects of Tai Chi on body mass index (BMI), exercise capacity, and mental health of overweight/obese adults, and investigate factors influencing adherence to enhance adherence of Tai Chi as a sustainable exercise method.

METHODS

A randomized, controlled, exploratory clinical trial was conducted paired with a qualitative study of adherence management. A total of 20 overweight/obese participants were randomly assigned to a standard Tai Chi group (experimental) and a simplified Tai Chi group (control) for an 8-week intervention, 10 patients in each group, with a 12-month follow-up. BMI was calculated and exercise capacity including an isokinetic muscle strength and balance ability test were evaluated. Mental health was assessed using the General Well-Being Schedule (GWB), Pittsburgh Sleep Quality Index (PSQI), and Coping Self Efficacy Scale (CSES) at baseline, 4th week, and 8th week, respectively. The qualitative research included open-interviews with Tai Chi practitioners and semi-structured interviews with subjects.

RESULTS

The intervention was conducted in Haidian Park, Beijing, China from October 6, 2022, to January 1, 2023, without dropouts. After an 8-week intervention, the participants in the experimental group exhibited a significant decrease in BMI (P<0.05). Both groups demonstrated significant improvements in exercise capacity (P<0.05). The experimental group exhibited a significant enhancement in the GWB, PSQI and CSES (P<0.05). Only GWB had significant difference in the control group (P<0.05). The experimental group surpassed the control group in GWB and CSES (P<0.05). The adherence rate was 87.5% in the experimental group and 57.9% in the control group after 8 weeks intervention. Analysis on adherence identified 15 themes, the top 3 themes mentioned were as follows: mind-body effects, online and on-site guidance, training schedule (for subjects); mind-body effects, difficulties in practicing, and understanding of Tai Chi (for practitioners).

CONCLUSIONS

Both interventions were effective in improving exercise capacity. Tai Chi, integrating both physical and mental conditioning, reduced weight, improved exercise capacity and mental happiness, and increased adherence, providing a sustainable exercise program (ChiCTR2200063599).

Efficacy of traditional Chinese exercise on postmenopausal osteoporosis: a systematic review and meta-analysis

BACKGROUND

Traditional Chinese exercise (TCE) is used as a therapeutic method in patients with postmenopausal osteoporosis. A meta-analysis was performed to evaluate the efficacy of TCE and provide reliable clinical evidence.

METHODS

Eight databases, including the Cochrane Library, PubMed, Embase, Web of Science, Chinese Science Citation Database, Wanfang, China National Knowledge Infrastructure, and Chinese Medical Journal full-text databases, were searched for randomized controlled trials. Meta-analysis was performed using the RevMan (version 5.4) software.

RESULTS

Sixteen studies involving 1,288 patients were included. Compared with conventional treatment alone, TCE improved patients' bone mineral density, decreased pain, improved balance, improved quality of life, and decreased deoxypyridinoline levels. However, the intervention effects on the biochemical indexes of bone metabolism, including blood calcium, blood phosphorus, osteocalcin, and alkaline phosphatase levels, were not statistically significant.

CONCLUSION

TCE has a significant effect on postmenopausal patients with osteoporosis and can be used as a non-pharmacological treatment. The results of this study should be interpreted with caution because of the large heterogeneity for some indicators.

Tai chi improves balance performance in healthy older adults: a systematic review and meta-analysis

Background

Previous research has indicated that tai chi exercise can effectively enhance balance performance in patients; however, its impact on healthy individuals remains uncertain. Therefore, this meta-analysis aims to investigate the effects of different intensities and styles of tai chi exercise on the balance performance of healthy older adult individuals.

Methods

A targeted search method was employed to identify studies investigating the impact of tai chi exercise on balance in older adults across a range of databases, including Web of Science, PubMed, Cochrane Central, EBSCO, CHKI, and Embase. The studies were conducted in accordance with the PRISMA and PERSiST guidelines, and two independent reviewers were responsible for the search, screening of results, extraction of data, and assessment of study quality. A random-effects model was employed to calculate the weighted mean difference (WMD) and 95% confidence interval (CI).

Results

2000 participants who met inclusion criteria were included in analyses across 28 trials. The findings indicated that tai chi can enhance the balance performance of healthy older adults, as demonstrated by the Timed Up and Go test (WMD = -1.04, 95% CI: -1.36 to-0.72, p < 0.00001, I2 = 71%), functional Reach test (FR) (WMD = 2.81, 95% CI: 1.60 to 4.02, p < 0.00001, I2 = 56%), and Berg Balance Scale (WMD = 2.55, 95% CI: 1.19 to 3.91, p = 0.0002, I2 = 88%), as well as other balance tests such as SLS (WMD = 5.03, 95% CI: 3.08 to 6.97, p < 0.00001, I2 = 85), and GS (WMD = 0.09, 95% CI: 0.05 to 0.12, p < 0.00001, I2 = 54%). Subgroup analyses showed that tai chi exercise for both ≤12 and > 12 weeks was statistically significant (< 0.01, respectively) for balance performance in healthy older adults, especially for tai chi exercise performed more than twice a week (WMD = -1.03, 95% CI: -1.35 to -0.72, p < 0.00001) and for more than 45 min each time (WMD = -1.11, 95% CI: -1.58 to-0.63, p < 0.00001) tai chi exercise had greater benefits on TUG time, FR distance and BBS in healthy older adults. In addition, compared to Sun-style tai chi, Yang-style tai chi was more effective.

Conclusion

The tai chi exercise positively affects the balance performances of healthy older adults. Engaging in short-term (≤12 weeks) exercise for more than two 45-min sessions per week has been found to produce more pronounced effects. The effectiveness of Yang-style tai chi is superior to that of Sun-style tai chi.

Systematic review registration

PROSPERO ID is CRD42024532577 https://www.crd.york.ac.uk/prospero/.

Current Evidence of the Application of Music in Tai Chi Exercise: Scoping Review

BACKGROUND

Music has frequently been used in movement exercises to enhance health benefits. However, scientific evidence regarding the application of music to Tai Chi practice is limited.

OBJECTIVE

This scoping review aims to understand how music has been used in Tai Chi practice and whether music could be applied to Tai Chi practice to help optimize its benefits.

METHODS

PubMed, CINAHL, CNKI, and Weipu databases were searched. We included studies that compare Tai Chi practice experience or health outcomes between individuals practicing Tai Chi with music and those practicing Tai Chi without music. Studies published through September 2022 were identified. Two researchers (YD and YH) independently performed study selection and data extraction. Thematic analysis was used to summarize and categorize the findings of the included studies.

RESULTS

Seven studies were included in this review. All 7 included studies are experimental studies. Practicing Tai Chi with music might lead to positive perceptions of Tai Chi practice (eg, motivation, concentration, enjoyment, compliance, and performance) and higher evaluations of Tai Chi instructional quality, especially for Tai Chi beginners. The effects of incorporating music into Tai Chi practice on health outcomes are inconclusive due to the heterogeneities of the sample size, and the intervention components, lengths, and frequencies of the included studies.

CONCLUSIONS

Applying music to Tai Chi practice may result in positive Tai Chi practice experience and adherence, particularly for beginners, which could help improve the dissemination and implementation of Tai Chi interventions for public health. However, whether applying music to Tai Chi practice leads to synergetic effects on health outcomes needs further investigation.

The influence of traditional Chinese exercise on brain function compared with other sports: A meta-analysis on functional neuroimaging studies

Traditional Chinese Exercise (TCE) has been shown to improve quality of life, and functional magnetic resonance imaging (fMRI) is a highly used method for investigating its mechanism. However, there is currently a lack of systematic reviews and meta-analyses focusing on TCE-related brain changes. This study aims to fill this gap by conducting a meta-analysis on brain changes of TCE with fMRI technology. We searched relevant studies published until February 2024. Independent researchers conducted literature screening, quality assessment, and clinical and neuroimaging data extraction. Focis were filtered from eligible studies, and meta-analysis was performed using seed-based d mapping. Twenty-three studies involving 1182 participants were included in this study. The result found that longitudinal TCE increased brain activity in the left anterior cingulate gyri, right fusiform gyrus, right middle temporal gyrus, left middle occipital gyrus and left frontal superior compared with other exercises or healthcare. Subgroup analysis showed that the brain activity in the right superior frontal gyrus dorsolateral; right cortico-spinal projections; corpus callosum; right inferior network; right gyrus rectus; left middle occipital gyrus were decreased after TCE compared to other exercise among healthy participants. The right median cingulate gyri was increased after Baduanjin (one of the TCE) compared to other exercise; the left precentral gyrus activity was increased after Tai chi chuan (TCC) practice compared to other exercise. The brain activity in the right insula, right supplementary motor area, and left anterior thalamic were significantly increased after long-time TCC exercise. TCE effectively improved the cognitive level of the subjects. Among them, the MoCA score increased, but Memory Quotient was not improved. Research results indicate that TCE have specific neuromodulatory effects, and different TCE have different neuromodulatory patterns.

The effect of different traditional Chinese exercises on bone mineral density in menopausal women: a systematic review and network meta-analysis

Objective

To evaluate the optimal choice of traditional Chinese exercise (TCE) for improving bone mineral density in postmenopausal women through a network meta-analysis.

Methods

The Chinese and English databases were searched, including China National Knowledge Infrastructure, Chongqing VIP, PubMed, Web of Science and Cochrane Library. The outcomes included BMD of lumbar L2-L4, femoral neck, ward triangle, and greater trochanter. Standardized mean differences (SMD) and 95% confidence intervals (CI) were used to assess the correlation between each group of interventions, and surface under the cumulative ranking (SUCRA) was used to rank the best interventions.

Results

A total of 20 randomized controlled trials (RCTs) including 1933 subjects and six interventions: [Tai Chi (TC), Baduanjin (BDJ), Wuqinxi (WQX), Yijinjing (YJJ), TA (Tai chi plus calcium supplementation), BA (Baduanjin plus calcium supplementation)] and three control measures: [Calcium supplementation (CA), Aerobic exercise (AE), Not exercise intervention (NEI)] were analyzed. Regarding BMD of lumbar L2-L4: TC [SMD = 0.99 (0.62, 1.37)], BDJ [SMD = 2.12 (1.39, 2.85)], TA [SMD = 1.12(0.17, 2.07)], BA [SMD = 2.24 (1.16, 3.31)] were superior in increasing BMD of lumbar L2-L4 relative to NEI. Regarding BMD of femoral neck: TC [SMD = 1.24 (0.70, 1.78)], BA [SMD = 3.77 (1.98, 5.56)] were superior in increasing BMD of femoral neck relative to NEI. Regarding BMD of ward's triangle: TC [SMD = 1.63 (1.09, 2.17)] was superior in increasing BMD of ward's triangle relative to NEI. Regarding BMD of greater trochanter: TC [SMD = 0.98 (0.28, 1.68)] were superior in increasing BMD of greater trochanter relative to NEI. TC topped the SUCRA with BMD of lumbar L2-L4: 53.8, femoral neck: 74.9, ward's triangle: 86.9 and greater trochanter: 77.7.

Conclusion

Four TCE (TC, BDJ, TA and BA) are all effective in partially improving BMD indicators in postmenopausal women, while TC was effective on all four BMD indicators, which seems to be recommended as the most suitable exercise modality for postmenopausal women.

Systematic review registration

This research follows the PRISMA Network statement. The protocol for this study has been registered in the International Prospective Registry of Systematic Reviews (PROSPERO). CRD42023414944.

Prepandemic Feasibility of Tele-Exercise as an Alternative Delivery Mode for an Evidence-Based, Tai Ji Quan Fall-Prevention Intervention for Older Adults

There is a critical need for fall-prevention interventions to reach medically underserved, hard-to-reach, rural older adults. The evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program reduces falls in older adults. This pre-COVID-19 pandemic study assessed the feasibility and impact of a 16-week tele-TJQMBB intervention in older adults. Instructors led six tele-TJQMBB classes via Zoom for 52 older adults (mean age ± SD 68.5 ± 7.7 years) at one academic and four community sites. Nearly all (97%) planned sessions were delivered. Average attendance was 61%. There were no adverse events. Fidelity was fair to good (mean 67%). Forty-one percent of sessions experienced technical disruptions. Participants improved their gait speed, balance, lower-extremity strength, and body mass index. Tele-TJQMBB was feasible with a positive impact on outcomes. This study was the first step toward establishing an additional delivery mode that could potentially expand TJQMBB's reach and maintenance.

Fall status and risk factors in older Chinese adults: A cross-sectional study

AIM

To analyse the risk factors and incidence of falls in geriatric outpatients in a university hospital ward in Hangzhou, China.

METHODS

From May 2020 to August 2022, 1712 geriatric outpatients in a university hospital ward in Hangzhou, China, were screened using a socio-demographic questionnaire (e.g. gender, age, living arrangement, etc.) and assessment scales. The correlation between each factor and falls was preliminarily analysed by chi-squared tests. Finally, binary logistic regression analysis was conducted to further analyse the risk factors of falls. The STROBE checklist was used in reporting this study.

RESULTS

Of the 1712 geriatric outpatients recruited, 1626 participants (60-79 and ≥ 80 years old) with complete questionnaire and assessment data were included. The occurrence of falls for those in the 60-79 age group was 8.4%, and for those in the ≥80 age group it was 13.4%. Age (p = .007), use of a walking assistance device (p < .001), the Stay Independent Brochure Questionnaire (SIB) (OR = 7.751, 95% CI = 5.089-11.806, p < .001), living arrangement (p = .004), timed up and go test (TUGT) (p = .007) and three diseases or above (OR = 2.496, 95% CI = 1.358-11.4.586, p = .003) reached statistical significance.

CONCLUSIONS

Older people have a high incidence of falls. In this study, age, disease history, SIB scores (≥4 points), living arrangement, TUGT and walking assistance device increased the probability of falls in older Chinese adults. Personalised interventions should be carried out according to the specific situation of older people to effectively reduce their incidence of falls and improve their quality of life.

RELEVANCE TO CLINICAL PRACTICE

The basic characteristics and fall risk factors of the older can help nurses identify fall risk, and early intervention by caregivers can reduce fall-related injuries, which has practical significance for promoting healthy aging.

PATIENT OR PUBLIC CONTRIBUTION

The subjects of this study were older patients ≥60 years old, and the demographic characteristics and fall-related information of patients were obtained by questionnaire. The team worked closely with a team of experts in the field of health care. Some researchers collect data and rewrite them, while other researchers analyse the information and write a paper. All authors read and approved the final manuscript.

Implementing Tai Chi Exercise in Long-Term Care to Reduce Falls

BACKGROUND

Falls are a frequent occurrence in older adults in long-term care facilities.

LOCAL PROBLEM

At our long-term care facility, the percentage of patients who fell increased from 45% in 2021 to 68% in 2022, indicating a need for an evidence-based solution.

METHODS

We used an evidence-based quality improvement framework to pilot a tai chi exercise program.

INTERVENTIONS

Residents were invited to participate in the Tai Ji Quan: Moving for Better Balance program for 12 weeks. Classes were 30 minutes long and included a 5-minute warm-up and 5-minute cooldown.

RESULTS

Seventy-five residents participated in the tai chi program. There was a significant 32.3% reduction in falls ( P =.001). Residents' fall risk scores decreased 14% ( P < .001).

CONCLUSIONS

Implementing a tai chi exercise project may affect falls and decrease the overall fall risk.

Sodium-Glucose Transporter 2 Inhibitors in Heart Failure: An Overview of Systematic Reviews

Background: Several studies have shown that sodium-dependent glucose transporter 2 inhibitors can be used in the treatment of heart failure. This article summarized systematic reviews of sodium-dependent glucose transporter 2 inhibitors in the treatment of heart failure in order to evaluate efficacy and safety. Methods: We systematically searched eight electronic databases from inception to July 2023. We used Assessment of Multiple Systematic Reviews 2 to evaluate the methodological quality, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 to assess report quality, Risk of Bias in Systematic Review to assess the risk of bias, and Grading of Recommendations Assessment, Development, and Evaluation to rate the quality of evidence. Outcome: A total of 36 systematic reviews were included. Our results were classified as clear evidence of benefit: hospitalization for heart failure; possible benefit: cardiovascular death (mortality) and renal outcome composite; clear evidence of no effect or equivalence: atrial arrhythmias, ventricular arrhythmia, atrial fibrillation, and hypotension; possible harm: genital infection; insufficient evidence to draw a conclusion: atrial flutter, major adverse cardiovascular events, urinary tract infection, acute kidney injury, hypoglycemia, and bone fracture. Conclusions: Sodium-dependent glucose transporter 2 inhibitors are beneficial for the treatment of heart failure, especially in terms of heart failure hospitalization.

A 12-week Taijiquan practice improves balance control and functional fitness in fall-prone postmenopausal women

Purpose

Falls are the leading cause of accidental death among older persons, with postmenopausal women facing a greater hazard of falling due to osteoporosis. This study aimed to examine the effects of Taijiquan practice on balance control and functional fitness in at-risk females.

Methods

Chinese women who self-reported a tendency to fall and had a baseline one-leg stand test time (4.1 s in the Taijiquan group) below the national average for their age group (60-64 years: 10.9 s, 65-69 years: 9.9 s) were assigned to either a control group (n = 26, mean age = 63.9 years) or a Taijiquan group (n = 24, mean age = 63.9 years). The Taijiquan group participated in a 12-week supervised intervention, while the control group maintained their daily activities. The average duration of each exercise session was 52 min. Static balance and functional fitness were assessed at the beginning and end of the intervention.

Results

After 12 weeks, the Taijiquan group significantly outperformed the control group in terms of balance, flexibility, and muscular fitness (all p < 0.05). Participants in the Taijiquan group improved their one-leg stand by 61.0% (+2.5 s, Hedge's g = 0.85), arm curl by 8.3% (+1.7 repetitions, g = 0.53), handgrip strength by 8.3% (+1.9 kg, g = 0.65), and sit-and-reach by 163.2% (+6.2 cm, g = 1.17).

Conclusion

The improvement in balance, coupled with other functional fitness benefits, suggests that Taijiquan could serve as a useful exercise for older women with an elevated risk of falling.

The effect of Tai Chi exercise intervention on sleep quality in community residing older adults: a systematic review and meta-analysis

PURPOSE

While clinical research has shown that Tai Chi exercise may improve the sleep quality of older adults, there is a lack of robust evidence-based verification. Therefore, this study conducted a systematic review of published research on the effect of Tai Chi exercise on the sleep quality of community-dwelling older adults, aiming to provide solid evidence-based medicine to enhance their sleep quality.

METHODS

A systematic search was conducted on PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, VIP, and SinoMed databases from their inception to December 9, 2022. The Cochrane risk of bias assessment tool 2.0 was used to assess the risk of bias in the included studies.

RESULTS

This systematic review included 12 original articles, involving a total of 1,058 community-dwelling older adults, with 553 in the Tai Chi group and 505 in the control group. The meta-analysis results revealed a significant improvement in the sleep quality of community-dwelling older adults who practiced Tai Chi compared to the control group [WMD =  - 1.96 (95% CI: - 3.02 to - 0.90, z = 3.62, P < 0.001)]. Subgroup analysis showed that Tai Chi had significantly beneficial effects regardless of age, country/region, intervention time, and Tai Chi type.

CONCLUSIONS

Tai Chi exercise can serve as an effective non-medication approach for addressing sleep problems in this demographic. Among the various types of Tai Chi exercises, the 24-form Tai Chi exercise emerges as a preferred option. Moreover, Tai Chi exercise proves to be an excellent choice for older people in their later years, promoting their overall well-being and health.

Tai Chi counteracts age-related somatosensation and postural control declines among older adults

Objective

To investigate the effect of a 16-week Tai Chi practice on strength, tactile sensation, kinesthesia, and static postural control among older adults of different age groups.

Methods

This is a quasi-experimental study. Thirteen participants aged 60-69 years (60-69yr), 11 aged 70-79 years (70-79yr), and 13 aged 80-89 years (80-89yr) completed 16 weeks of 24-form Tai Chi practice. Their ankle and hip peak torque, tactile sensation, ankle and knee kinesthesia, and the root mean square of the center of pressure (Cop-RMS) were measured before (week 0) and after (week 17) practice.

Results

80-89yr showed less ankle plantar/dorsiflexion and hip abduction peak torques (p = 0.003, p < 0.001, p = 0.001), and a greater ankle plantar/dorsiflexion kinesthesia (p < 0.001, p = 0.002) than 60-69yr and 70-79yr. Greater ankle plantar/dorsiflexion and hip abduction torques (p = 0.011, p < 0.001, p = 0.045), improved arch and heel tactile sensation (p = 0.040, p = 0.009), and lower knee flexion/extension kinesthesia (p < 0.001, p = 0.044) were observed at week 17. The significant group*practice interaction for the fifth metatarsal head tactile sensation (p = 0.027), ankle plantar/dorsiflexion kinesthesia (p < 0.001, p = 0.004), and the CoP-RMS in the mediolateral direction (p = 0.047) only in 80-89yr revealed greater improvement at week 17.

Conclusion

Tai Chi practice increased strength, tactile sensation, kinesthesia, and static postural control among older adults. Tai Chi practice improved tactile, kinesthesia sensations, and static postural control among older adults over 80, who presented with worse strength and kinesthesia than their younger counterparts. Tai Chi practice offers a safe exercise option for those aged over 80 to encourage improvements in sensorimotor control.

Lifestyle intervention Tai Chi for adult patients with type 2 diabetes mellitus: a PRIO-harms based overview of 17 systematic reviews

Objective

To systematically summarize current evidence and determine the clinical effectiveness and safety of Tai Chi for type 2 diabetes mellitus (T2DM) in adults by conducting an overview of systematic reviews (SRs).

Methods

A systematic search encompassing five electronic databases was conducted until July 30, 2023, to identify relevant systematic reviews (SRs) based on randomized controlled trials (RCTs) concerning Tai Chi for T2DM. The methodological quality of the included SRs was assessed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) and the Risk of Bias in Systematic Reviews (ROBIS) tool. The Preferred Reporting Items for Overview of Systematic Review (PRIO-harms) checklist was used to promote a more balanced reporting of benefits and harms in this overview. Corrected covered area (CCA) was used to calculate the degree of overlapping primary studies. Primary outcome measures were glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG), while secondary outcomes encompassed health-related quality measures. The GRADE (Grades of Recommendations, Assessment, Development, and Evaluation) framework was utilized to assess the quality of evidence for the outcome measures.

Results

A total of 17 eligible SRs were included in this overview. One SR reported negative conclusions, while the remaining 16 reported positive ones on different outcomes. A total of 4 SRs reported adverse events, either absent or minor. Most of the SRs exhibited critically low quality (15/17) and a high risk of bias (14/17), as indicated by AMSTAR2 and ROBIS, respectively. The CCA was 12.14%, indicating a high degree of primary study overlapping. Evidence from 135 results for 24 outcomes concerning Tai Chi for T2DM was evaluated using the GRADE approach, most of which were rated very low.

Conclusion

Tai Chi shows promise as a potentially effective and safe lifestyle intervention for adults with T2DM, particularly in improving HbA1c, FBG, BMI, and overall quality of life (QoL). However, these results should be cautiously interpreted due to methodological flaws observed in the current SRs and the low quality of the SRs based on GRADE. Furthermore, there is a compelling need for additional well-designed, high-quality RCTs and SRs to establish robust and conclusive evidence regarding the efficacy of Tai Chi for managing T2DM in the future.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD 42019140988.

The comparison between effects of Taichi and conventional exercise on functional mobility and balance in healthy older adults: a systematic literature review and meta-analysis

Background

Taichi is beneficial for functional mobility and balance in older adults. However, such benefits of Taichi when comparing to conventional exercise (CE) are not well understood due to large variance in study protocols and observations.

Methods

We reviewed publications in five databases. Eligible studies that examined the effects of Taichi on the outcomes of functional mobility and balance in healthy older adults as compared to CE were included. Subgroup analyses compared the effects of different types of CE (e.g., single and multiple-type exercise) and different intervention designs (e.g., Taichi types) on those outcomes (Registration number: CRD42022331956).

Results

Twelve studies consisting of 2,901 participants were included. Generally, compared to CE, Taichi induced greater improvements in the performance of Timed-Up-and-Go (SMD = -0.18, [-0.33 to -0.03], p = 0.040, I2 = 59.57%), 50-foot walking (MD = -1.84 s, [-2.62 to -1.07], p < 0.001, I2 = 0%), one-leg stance with eyes open (MD = 6.00s, [2.97 to 9.02], p < 0.001, I2 = 83.19%), one-leg stance with eyes closed (MD = 1.65 s, [1.35 to 1.96], p < 0.001, I2 = 36.2%), and functional reach (SMD = 0.7, [0.32 to 1.08], p < 0.001, I2 = 86.79%) tests. Subgroup analyses revealed that Taichi with relatively short duration (<20 weeks), low total time (≤24 h), and/or using Yang-style, can induce significantly greater benefits for functional mobility and balance as compared to CE. Uniquely, Taichi only induced significantly greater improvements in Timed-Up-and-Go compared to single- (SMD = -0.40, [-0.55 to -0.24], p < 0.001, I2 = 6.14%), but not multiple-type exercise. A significant difference between the effects of Taichi was observed on the performance of one-leg stance with eyes open when compared to CE without balance (MD = 3.63 s, [1.02 to 6.24], p = 0.006, I2 = 74.93%) and CE with balance (MD = 13.90s, [10.32 to 17.48], p < 0.001, I2 = 6.1%). No other significant difference was shown between the influences of different CE types on the observations.

Conclusion

Taichi can induce greater improvement in functional mobility and balance in older adults compared to CE in a more efficient fashion, especially compared to single-type CE. Future studies with more rigorous design are needed to confirm the observations here.

Effect of different types of Tai Chi exercise programs on the rate of change in bone mineral density in middle-aged adults at risk of osteoporosis: a randomized controlled trial

OBJECTIVE

To evaluate three Tai Chi (TC) exercise programs as intervention measures to compare their effects on improving rate of change in bone mineral density (BMD) in elderly individuals with osteoporosis (OP) and to propose the optimal exercise duration.

METHODS

A randomized controlled trial (RCT) was conducted to identify study participants based on inclusion and exclusion criteria. Due to subject attrition, the number of participants analyzed decreased from 60 to 49. These participants were divided into four groups: 24-style TC Chuan group (24TCCG) (n = 13, 7 males/6 females), TC Kung Fu Fan group (TCKFFG) (n = 12, 5 males/7 females), TC Softball group (TCSBG) (n = 11, 6 males/5 females), and a control group (CG) (n = 13, 6 males/7 females). Except for the control group, each group received different TC exercise programs four times a week for 60 min per session, lasting for 16 weeks. BMD was measured using dual-energy X-ray absorptiometry (DXA) at the L2-L4 lumbar vertebrae, Ward's triangle, femoral neck, and greater trochanter. The rate of change of BMD was calculated using the formula.

RESULTS

Compared with CG, all three TC groups showed significant improvements in BMD changes (P < 0.05), but their effects on the improvement of femoral neck and greater tuberosity BMD change rates were similar (P > 0.05). In addition, compared to the other exercise regimens, 24TCCG demonstrated more significant improvements in BMD at the L2-L4 lumbar vertebrae region and exhibited a more pronounced improvement in Ward's triangle BMD after only 8 weeks (P < 0.05). Short-term (≤ 4 weeks) TCKFFG was more effective than TCSBG in enhancing femoral neck BMD (P < 0.05). However, statistical significance was not found (P > 0.05) in all other cases.

CONCLUSION

These three TC exercise programs have similar positive effects on the BMD of the femoral neck and greater trochanter. However, compared with other exercise schemes, 24TCC showed a more significant improvement in BMD of the L2-L4 lumbar vertebrae region after just 8 weeks, as well as a more pronounced improvement in BMD of Ward's triangle. In terms of improving femoral neck BMD, TCKFF was found to be more effective than TCSB in less than 4 weeks. This study provides evidence for the effectiveness of TC exercise in improving BMD and preventing OP in the middle-aged and elderly high-risk population.

Traditional Chinese exercises on pain and disability in middle-aged and elderly patients with lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials

Background

Traditional Chinese exercises (TCEs) have played a significant role in treating various diseases. However, there is limited research assessing the efficacy of TCEs in treating Lumbar disc herniation (LDH). This study aimed to systematically evaluate the effects of four commonly used TCEs (Baduanjin, Yijinjing, Taichi, and Wuqinxi) on pain and disability in elderly patients with LDH.

Objectives

To assess the quality of relevant randomized controlled trials (RCTs) to provide evidence support for the treatment of LDH.

Methods

RCTs were identified through eight databases. Meta-analysis and trial sequence analysis (TSA) were conducted using RevMan 5.4, Stata 17.0, and TSA 0.9.

Results

A total of 22 RCTs, involving 1931 patients, were included in the analysis. TCEs exhibited a superior effectiveness in treating LDH compared to the control group. However, the TSA analysis suggested the possibility of false positives, indicating the need for more high-quality RCT evidence. Nevertheless, TCEs showed reliable results in significantly improving the VAS score and JOA score of LDH patients.

Conclusion

Current evidence indicates that the four TCEs have advantages in treating LDH in middle-aged and elderly individuals. However, considering the limitations of this study, we need to exercise caution in drawing conclusions, and further research is required to validate these findings.

Systematic Review Registration

http://www.crd.york.ac.uk/PROSPERO, identifier [CRD42023431633].

Effects of Tai chi in knee osteoarthritis patients: An overview of systematic reviews and meta-analyses

OBJECTIVE

Tai Chi (TC) is a complementary therapy for knee osteoarthritis (KOA). Although systematic reviews (SRs) and meta-analyses (Mas) of efficacy studies have been published, the results remain uncertain, and their quality has not yet been fully evaluated. Here, we summarize the existing SRs/Mas, evaluate their quality and level of evidence, and provide a reference for the effectiveness of TC.

METHODS

SRs/Mas of TC therapy for KOA published before February 2023 were retrieved from eight databases in Chinese and English. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, and the Risk of Bias in Systematic (ROBIS) scale were used to assess methodological quality, reporting quality, and risk of bias.

RESULTS

Seven SRs/Mas were finally included. One was deemed high quality by AMASTAR-2, while the rest were of critically low quality. In the PRISMA2020 assessment, the response rate of "Yes" for Q7, Q15, Q22, Q24, and Q27 was less than 50%. In the ROBIS assessment, three reports in Phase 3 were high risk and four were low risk. In the efficacy assessment, TC has shown varying degrees of improvement in physical function, pain, stiffness, 6-minute walk test, mental quality of life, TUG, and balance in patients with KOA.

CONCLUSION

TC effectively treats KOA-associated pain, stiffness, body function, and mental quality of life. However, the low methodological quality of the studies and the high risk of migration reduced their reliability. Therefore, these conclusions should be taken with caution. High-quality, large-sample research is needed to provide stronger and more scientific evidence.

Effectiveness of Tai Chi in Patients With Hypertension: An Overview of Meta-analyses

BACKGROUND

Hypertension affects more than 1 billion people worldwide. Hypertension management guidelines recommend regular exercise to control blood pressure. Tai Chi is a low-impact, low- to moderate-intensity exercise that has numerous health benefits.

OBJECTIVE

The aim of this study is to perform a review of meta-analyses and summarize the existing information on the health benefits of Tai Chi for patients with hypertension.

METHODS

This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Eight health-related databases were systematically searched from their inception to March 2021 to identify the relevant meta-analyses. Two reviewers independently assessed the methodological quality of the evidence.

RESULTS

A total of 6 relevant meta-analyses were included in this review: 3 were rated as critically low in quality, 2 were rated low, and 1 was rated high. In the included meta-analyses, Tai Chi showed many benefits for patients with hypertension. In addition to improving blood pressure, the blood lipid profile, blood sugar, body measurements, and quality of life of patients improved significantly after practicing Tai Chi.

CONCLUSION

Tai Chi may be considered an effective and safe alternative exercise for patients with hypertension.

The acceptability of homebased exercise snacking and Tai-chi snacking amongst high and low function UK and Taiwanese older adults

Introduction: Exercise "snacking" and Tai-chi 'snacking' protocols are designed to overcome typical barriers to older adults' participation in muscle strength and balance exercise, using short bouts of home-based exercise. This study aimed to investigate the acceptability of homebred exercise- and Tai-chi snacking in British and Taiwanese older adults of high and low physical function. Methods: Thirty-three British and Thirty Taiwanese older adults took part in semi-structured interviews, after trying 1-week of exercise- and Tai-chi snacking. The interview schedule and deductive framework analysis was based on the seven components of the Theoretical Framework of Acceptability (TFA). Differences between the Taiwanese and United Kingdom participants and those considered high versus low physical function were also analysed. Results: Both snacking regimes were found to be convenient and easy to implement. Participants reported that no activity had to be given up, and considered the programmes would be beneficial to their physical and mental health. Interestingly, more UK-based participants preferred the elegant and relaxing movements of Tai-chi snacking, yet participants with low physical function experienced difficulties when mastering Tai-chi movements. A few high physical function participants perceived exercise snacking to be tedious. Discussion: Overall, the snacking exercise was found to be acceptable and useful. Personal affective attitude and different cultural backgrounds may affect exercise participation. Nevertheless, it is important to consider individuals' physical function when designing exercise regime. The findings indicate that making Tai-chi snacking easier to master initially, building in progression and adding some upper body movements in the exercise snacking may further enhance acceptability.

Effect of a moderate-intensity comprehensive exercise program on body composition, muscle strength, and physical performance in elderly females with sarcopenia

Objective

This study aimed at examining an eight-week moderate-intensity comprehensive exercise training program on the parameters of sarcopenia in elderly females.

Methods

A total of 49 community-dwelling elderly females with sarcopenia (65.5 ± 2.5) were assigned randomly to an experiment group (EG, n = 25) and a control group (CG, n = 24). In the EG, an eight-week comprehensive exercise training program was implemented, in 1 h, 3 times per week, a total of 24 sessions. The CG only received health public education per two weeks, a total of 4 times. Subsequently, the differences between the two groups were tested through two-way repeated ANOVA.

Results

ASM, SMM, and SMI in the EG were significantly improved by 0.26 kg, 0.18 kg, and 0.10 kg/m2, respectively. Group-by-time interactions were significantly different on the ASM [F (1,47) = 6.25, η2 = 0.12] and SMI [F (1,47) = 6.77, η2 = 0.13]. Muscle strength was improved 0.8 kg in the EG. Significant group-by-time interaction differences were reported in the handgrip strength [F (1,47) = 6.8, η2 = 0.13] after the eight-week intervention. Compared with the baseline, gait speed was improved a 0.05 m/s and 5-time chair stand was decreased a 0.27 s in the EG. Group-by-time interactions were significantly different in 5-time chair stand [F (1, 47) = 6.35, η2 = 0.12].

Conclusions

The moderate-intensity comprehensive exercise was confirmed as a safe and convenient exercise program. Although a load of training intensity is not sufficient to improve the gait speed, this exercise protocol is promising in delaying overall results in community-dwelling sarcopenia elderly females and contributes to the improvement of muscle mass, handgrip strength, and 5TCS.

Is Tai Chi beneficial for multisite pain syndrome in older adults?

Chronic musculoskeletal pain is prevalent and undertreated in older adults. In particular, multisite pain is associated with serious functional consequences and falls and appears to be a novel geriatric syndrome. The causes of multisite pain are often multifactorial, and emerging evidence supports a complex pathway whereby multisite pain leads to cognitive problems, mobility decline, fear of falling, falls, and reduced participation in life roles. A few pharmacologic approaches are safe and effective for older adults with chronic multisite pain and evidence for effectiveness of non-pharmacologic treatments for this common condition is very limited. Compared to light physical exercise, mind-body exercise may prove to be more beneficial for older adults living with chronic pain. Tai Chi, as a movement-based mind-body exercise, can relieve pain symptoms, improve cognition and physical function, and lower risk for falls in older adults. However, little is known about the potential benefits of Tai Chi for older adults with multisite pain syndrome. Future large-scale randomized-controlled trials are needed to investigate the effectiveness of Tai Chi in alleviating pain and lowering fall risk in older adults with multisite pain, and the biological mechanisms that underlie its potential benefits to chronic pain, physical and cognitive functions, and falls in this at-risk population.

Are movement-based mindful exercises (QIGONG, TAI CHI, AND YOGA) beneficial for stroke and Parkinson's disease? A scoping review

OBJECTIVE

To synthesize evidence from systematic reviews on the effects of qigong, tai chi, and yoga in people with neurological diseases.

METHODS

A systematic search was conducted in PubMed, PsycINFO, Embase, CINAHL and Cochrane Library until September 2022. Methodological quality was assessed using the AMSTAR 2 tool. A qualitative synthesis of included reviews and meta-analyses was performed. Citation matrices and the corrected covered area were used to explore the overlap of randomized controlled trials among reviews.

RESULTS

Nineteen systematic reviews (containing 74 trials and 80 meta-analyses) in people with Parkinson's disease (PD) or stroke were included. The critical domains of the AMSTAR 2 were not satisfied in more than half of the reviews, and only 4 evaluated the certainty of the evidence. The overlap was very high (21.7%) and high (11%) for tai chi studies in PD and stroke, respectively. In people with PD, qigong, yoga, and tai chi can improve balance, with tai chi being beneficial to increase functional mobility. For stroke patients, tai chi was better than controls to enhance motor function and independence, but not for health-related quality of life and quality of sleep. Findings on balance, walking ability and depression were inconclusive in stroke population.

CONCLUSIONS

Qigong, tai chi, and yoga appear to be effective to improve balance performance in people with PD. Tai chi practice enhances motor function and independency in stroke patients.

Efficacy and safety of acupuncture for polycystic ovary syndrome: An overview of systematic reviews

BACKGROUND

Polycystic ovary syndrome (PCOS) is the primary cause of anovulatory infertility, bringing serious harm to women's physical and mental health. Acupuncture may be an effective treatment for PCOS. However, systematic reviews (SRs) on the efficacy and safety of acupuncture for PCOS have reported inconsistent results, and the quality of these studies has not been adequately assessed.

OBJECTIVE

To summarize and evaluate the current evidence on the efficacy and safety of acupuncture for PCOS, as well as to assess the quality and risks of bias of the available SRs.

SEARCH STRATEGY

Nine electronic databases (Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, Chinese National Knowledge Infrastructure, Wanfang Data, Chongqing VIP Chinese Science and Technology Periodical Database, and China Biology Medicine disc) were searched from their establishment to July 27, 2022. Based on the principle of combining subject words with text words, the search strategy was constructed around search terms for "acupuncture," "polycystic ovary syndrome," and "systematic review."

INCLUSION CRITERIA

SRs of randomized controlled trials that explored the efficacy and (or) safety of acupuncture for treating patients with PCOS were included.

DATA EXTRACTION AND ANALYSIS

Two authors independently extracted study data according to a predesigned form. Tools for evaluating the methodological quality, risk of bias, reporting quality, and confidence in study outcomes, including A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), Risk of Bias in Systematic Reviews (ROBIS), Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture (PRISMA-A), and the Grading of Recommendations Assessment, Development and Evaluation (GRADE), were used to score the included SRs.

RESULTS

A total of 885 studies were retrieved, and 11 eligible SRs were finally included in this review. The methodological quality of 2 SRs (18.18%) was low, while the other 9 SRs (81.82%) were scored as extremely low. Four SRs (36.36%) were considered to be of low risk of bias. As for reporting quality, the reporting completeness of 9 SRs (81.82%) was more than 70%. Concerning the confidence in study results, 2 study results were considered to have a high quality of evidence (3.13%), 14 (21.88%) a "moderate" quality, 28 (43.75%) a "low" quality, and 20 (31.24%) considered a "very low" quality. Descriptive analyses suggested that combining acupuncture with other medicines can effectively improve the clinical pregnancy rate (CPR) and ovulation rate, and reduce luteinizing hormone/follicle-stimulating hormone ratio, homeostasis model assessment of insulin resistance, and body mass index (BMI). When compared with medicine alone, acupuncture alone also can improve CPR. Further, when compared with no intervention, acupuncture had a better effect in promoting the recovery of menstrual cycle and reducing BMI. Acupuncture was reported to cause no adverse events or some adverse events without serious harm.

CONCLUSION

The efficacy and safety of acupuncture for PCOS remains uncertain due to the limitations and inconsistencies of current evidence. More high-quality studies are needed to support the use of acupuncture in PCOS.

Postural control of Parkinson's disease: A visualized analysis based on Citespace knowledge graph

Postural control impairment is one of the primary motor symptoms in patients with Parkinson's disease, leading to an increased risk of falling. Several studies have been conducted on postural control disorders in Parkinson's disease patients, but no relevant bibliometric analysis has been found. In this paper, the Web of Science Core Collection database was searched for 1,295 relevant papers on postural control in Parkinson's disease patients from December 2011 to December 2021. Based on the Citespace knowledge graph, these relevant papers over the last decade were analyzed from the perspectives of annual publication volume, countries and institutes cooperation, authors cooperation, dual-map overlay of journals, co-citation literature, and keywords. The purpose of this study was to explore the current research status, research hotspots, and frontiers in this field, and to provide a reference for further promoting the research on postural control in Parkinson's disease patients.

Effectiveness and safety of manual therapy for knee osteoarthritis: An overview of systematic reviews and meta-analyses

Background

Manual therapy has been used as an alternative approach to treat knee osteoarthritis (KOA) for many years. Numerous systematic reviews (SRs) or meta-analyses (MAs) were published to evaluate its effectiveness and safety. Nevertheless, the conclusions of SRs/MAs are inconsistent, and the uneven quality needs to be critically appraised.

Objectives

To conduct a comprehensive overview of the effectiveness and safety of manual therapy for KOA and the quality of relevant SRs/MAs, thus providing critical evidence and valuable direction for future researchers to promote the generation of advanced evidence.

Methods

The pre-defined search strategies were applied to eight electronic databases from inception to September 2022. Suitable SRs/MAs were included in accordance with the inclusion and exclusion criteria. The methodological quality, risk of bias, reporting quality, and evidence quality were assessed by two independent reviewers who used respectively the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic Reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Version (PRISMA 2020), and Grades of Recommendations, Assessment, Development and Evaluation (GRADE) based on the method of narrative synthesis. We excluded the overlapping randomized controlled trials (RCTs) and performed a re-meta-analysis of the total effective rate.

Results

A total of eleven relevant SRs/MAs were included: nine SRs/MAs were rated critically low quality, and two were rated low quality by AMSTAR-2. According to ROBIS, all SRs/MAs were rated low risk in Phase 1 (assessing relevance) and Domain 1 (study eligibility criteria) of Phase 2. Three SRs/MAs (27.27%) were rated low risk in Domain 2 (identification and selection of studies). Ten SRs/MAs (90.91%) were rated low risk in Domain 3 (data collection and study appraisal). Five SRs/MAs (45.45%) were rated low risk in Domain 4 (synthesis and findings). And five SRs/MAs (45.45%) were rated low risk in Phase 3 (risk of bias in the review). By PRISMA 2020, there were some reporting deficiencies in the aspects of abstract (2/11, 18.18%), search strategy (0/11, 0%), preprocessing of merging data (0/11, 0%), heterogeneity exploration (6/11, 54.55%), sensitivity analysis (4/11, 36.36%), publication bias (5/11, 45.45%), evidence quality (3/11, 27.27%), the list of excluded references (3/11, 27.27%), protocol and registration (1/11, 9.09%), funding (1/11, 9.09%), conflict of interest (3/11, 27.27%), and approach to relevant information (0/11, 0%). In GRADE, the evidence quality was defined as moderate quality (8 items, 21.05%), low quality (16 items, 42.11%), and critically low quality (14 items, 36.84%). Among the downgraded factors, risk of bias, inconsistency, imprecision, and publication bias were the main factors. A re-meta-analysis revealed that manual therapy can increase the total effective rate in KOA patients (risk ratio = 1.15, 95% confidence interval [1.12, 1.18], p < 0.00001; I² = 0, p = 0.84). There are four reviews that narratively report adverse effects, and no severe adverse reactions occurred in the manual therapy group.

Conclusions

Manual therapy may be clinically effective and safe for patients with KOA. However, this conclusion must be interpreted with caution because of the generally unsatisfactory study quality and inconsistent conclusions of the included SRs/MAs. Further rigorous and normative SRs/MAs are expected to be carried out to provide robust evidence for definitive conclusions.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: CRD42022364672.

Tai chi-muscle power training for children with developmental coordination disorder: a randomized controlled trial

This study compared the effectiveness of tai chi (TC) muscle power training (MPT), TC alone, MPT alone, and no training for improving the limits of stability (LOS) and motor and leg muscular performance and decreasing falls in children with developmental coordination disorder (DCD). One hundred and twenty-one children with DCD were randomly assigned to the TC-MPT, TC, MPT, or control group. The three intervention groups received TC-MPT, TC, or MPT three times per week for 3 months. Measurements were taken before and after the intervention period. The primary outcomes were the LOS completion time and dynamic LOS scores. The secondary outcomes included the Movement Assessment Battery for Children-Second Edition total test score and percentile rank, knee muscle peak force and time to peak force, and the number of falls. None of the interventions affected the LOS test scores. Improvements in the peak forces of the knee extensors and flexors were demonstrated in the TC (p = 0.006) and MPT groups (p = 0.032), respectively. The number of falls also decreased in these two groups (p < 0.001). Thus, clinicians may prescribe TC or MPT for children with DCD to increase their knee muscle strength and reduce their risk of falls.

The effect of Tai Chi in elderly individuals with sarcopenia and frailty: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The potential role of Tai Chi in improving sarcopenia and frailty has been shown in randomized controlled trials (RCTs). This systematic review and meta-analysis aimed to examine the effect of Tai Chi on muscle mass, muscle strength, physical function, and other geriatric syndromes in elderly individuals with sarcopenia and frailty.

METHODS

Systematic searches of the PubMed, Cochrane Library, PEDro, EMBASE, Web of Science, CINAHL, and Medline databases for RCTs published between 1989 and 2022 were conducted; the database searchers were supplemented with manual reference searches. The inclusion criteria were as follows: (1) the study was designed as a RCT; (2) Tai Chi was one of the intervention arms; (3) the participants had a minimum age of ≥ 60 years and were diagnosed with frailty or sarcopenia, and the diagnostic guidelines or criteria were mentioned; (4) the number of participants in each arm was ≥ 10; and (5) the outcome reports included ≥ 1 item from the following primary or secondary outcomes. The exclusion criteria were as follows: (1) non-RCT studies; (2) nonhuman subjects; (3) participants aged < 60 years; (4) no description of the diagnostic guidelines or criteria for frailty or sarcopenia in the text; and (5) reported outcomes not among the following primary or secondary outcomes. The primary outcomes were muscle mass, grip strength and muscle performance (gait speed, 30-second chair stand test (30CST), sit-to-stand test (SST), Timed up and go test (TUGT), balance, and the Short Physical Performance Battery (SPPB)). The secondary outcomes included the number of falls and fear of falling (FOF), diastolic blood pressure (DBP), Mini-Mental State Examination (MMSE) score, and depression and quality of life (QOL) assessments.

RESULTS

Eleven RCTs were conducted from 1996 to 2022 in 5 countries that investigated 1676 sarcopenic or frail elderly individuals were included in the review. There were 804 participants in the Tai Chi exercise cohort and 872 participants in the control cohort (nonexercised (n = 5)/ exercise (n = 8)). The mean age of participants was 70-89.5 years and the numbers of participants from each arm in each study were 10-158. The majority of the participants practiced Yang-style Tai Chi (n = 9), and the numbers of movement ranged from 6 to 24. The prescriptions of training were 8-48 weeks, 2-7 sessions per weeks, and 30-90 min per session. Most studies used Tai Chi expert as instructor (n = 8). The lengths of follow-up period were 8-48 weeks. The results from our meta-analysis revealed significant improvements for Tai Chi compared to control group (nonexercise/ exercise) on measures of the 30CST (weighted mean difference (WMD): 2.36, 95% confidence interval (CI) 1.50-3.21, p < 0.00001, I² = 87%), the TUGT (WMD: -0.72, 95% CI -1.10 to -0.34, p = 0.0002, I² =0%), numbers of fall (WMD: -0.41, 95% CI -0.64 to -0.17, p = 0.0006, I² =0%) and FOF (standardized MD (SMD): -0.50, 95% CI -0.79 to -0.22, p = 0.0006, I² = 57%); and for Tai Chi compared to 'nonexercise' controls on measures of SST (WMD: -2.20, 95% CI -2.22 to -2.18, p < 0.00001), balance (SMD: 9.85, 95% CI 8.88-10.82, p < 0.00001), DBP (WMD: -7.00, 95% CI -7.35 to -6.65, p < 0.00001), MMSE (WMD: 1.91, 95% CI 1.73-2.09, p < 0.00001, I² =0%), depression (SMD: -1.37, 95% CI -1.91 to -0.83, p < 0.00001) and QOL (SMD: 10.72, 95% CI 9.38-12.07, p < 0.00001). There were no significant differences between Tai Chi and control groups on any of the remaining 4 comparisons: body muscle mass (WMD: 0.53, 95% CI -0.18 to 1.24; P = 0.14; I² =0%), grip strength (WMD: -0.06, 95% CI -1.98 to 1.86; P = 0.95; I² =0%), gait speed (WMD: 0.05, 95% CI -0.11 to 0.20; P = 0.55; I² =99%), and SPPB (WMD: 0.55, 95% CI -0.04 to 1.14; P = 0.07). The variables of bias summary, Tai Chi instructor, Tai Chi movements, and Tai Chi training duration without significant association with the 30CST or the TUGT through meta-regression analyses.

CONCLUSIONS

Our results demonstrated that patients with frailty or sarcopenia who practiced Tai Chi exhibited improved physical performance in the 30-second chair stand test, the Timed up and go test, number of falls and fear of falling. However, there was no difference in muscle mass, grip strength, gait speed, or Short Physical Performance Battery score between the Tai Chi and control groups. Improvements in the sit-to-stand test, balance, diastolic blood pressure, Mini-Mental State Examination score, and depression and quality of life assessments were found when comparing the Tai Chi cohort to the nonexercise control cohort rather than the exercise control cohort. To explore the effectiveness of Tai Chi in sarcopenic and frail elderly individuals more comprehensively, a standardized Tai Chi training prescription and a detailed description of the study design are suggested for future studies.

Trends and characteristics of Tai Chi and Qi Gong use among U.S. adults: Results from the 2007-2017 National Health Interview Survey

OBJECTIVE

To provide updated information about the prevalence, patterns, and predicting factors of Tai Chi and Qigong (TCQ) use among U.S. adults to better inform the future directions of TCQ application and research.

METHODS

Using 2007, 2012, and 2017 National Health Interview Survey, we examined the trends and characteristics of TCQ use by descriptive analysis, Wald F chi-square test, and multivariable logistic regression models among U.S. adults (n = 85,360), adjusting for the complex sampling design.

RESULTS

The prevalence use of TCQ among U.S. adults use was 1.17% in 2007, 1.27% in 2012, and 1.70% in 2017, which presents a 64% increase from 2007 to 2017 (p < 0.0001). Correlates of TCQ use are older adults (≥ 65 years old), Asians, having higher education levels, having lower income, and being more physically active (p < 0.001). The greater prevalence of TCQ use in 2017 than in 2012 occurred in some vulnerable demographic subgroups, including older adults, people with income less than $35,000/year, and those who were physically inactive. Those with delayed access to the conventional medical care system (e.g., had difficulty getting through on phone; couldn't get an appointment soon enough; had to wait too long to see doctor;)were also more likely to use TCQ (p < 0.001).

CONCLUSIONS

The use of TCQ has significantly increased among U.S. adults from 2007 to 2017. Given that the greatest increases in use of TCQ were among older adults, females, low-income individuals, and people who were physically inactive, TCQ may serve as age-appropriate, cost-effective, mind-body exercises for these groups of populations to help ameliorate health disparities.

Benefits of Tai Chi Quan on neurodegenerative diseases: A systematic review

BACKGROUND

Neurodegenerative diseases have become an important concern with the accelerated aging process. Tai Chi Quan (TCQ) has positive benefits for brain health and chronic diseases. The aim of this study was to summarize the protective effects of TCQ for motor function, cognition, quality of life, and mood in patients with neurodegenerative diseases.

METHODS

A systematic search was conducted via PubMed database and the Web of Science core collection database until August 20, 2021. The available English systematic reviews, meta-analyses, and clinical trials were included. Two reviewers completed the screening and assessment process independently.

RESULTS

A total of 28 studies on Parkinson's disease, 21 on cognitive impairment, and 9 on multiple sclerosis met the included criteria. The study found that TCQ remarkably improved general motor function and balance, and prevented falls for Parkinson's disease. TCQ significantly improved global cognitive function for cognitive impairment. TCQ was likely safe and beneficial for multiple sclerosis as result of heterogeneous outcomes and small samples.

CONCLUSION

TCQ exercise can effectively improve the motor function, global cognitive function, and falls in patients with neurodegenerative diseases. However, the positive effects of TCQ on the quality of life and mood of patients with neurodegenerative diseases need further evidence.

Effectiveness of Tai Chi on older adults: A systematic review of systematic reviews with re-meta-analysis

This overview study examined and synthesized the effect of Tai Chi (TC) on the physical conditions, psychological conditions, cognitive abilities, and quality of life (QoL) of older adults. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Using Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, PubMed, Scopus, and Web of Science, English-language systematic reviews (SRs) published within the latest decade (2010-2020) were included. SRs with meta-analysis were selected if TC was the examined intervention and older adults was the targeted population. A total of 16 SRs covering 89 original studies were included. A number of the pooled results of the included SRs were inconclusive. Taking into consideration of the new meta-analyses of this study, TC significantly improved most outcomes, including the mobility, pain level, physical function, psychological distress, depressive symptoms, anxiety, global cognitive function, mental speed and attention, learning ability, verbal fluency, executive function, and QoL of older adults. TC can be an effective intervention for older adults for improving physical and psychological conditions, cognitive abilities, and QoL. Additional high-quality studies with larger samples investigating the effectiveness of TC in older adults are warranted.

The effect and safety of Tai Chi on bone health in postmenopausal women: A meta-analysis and trial sequential analysis

Background

Tai Chi may be a promising exercise to prevent and control bone loss in postmenopausal women. This meta-analysis and trial sequential analysis aimed to evaluate the effect and safety of Tai Chi on bone health in postmenopausal women.

Method

Seven databases were searched from their inceptions to 11 May 2022 to collect randomized controlled trials (RCTs) investigating the effect and safety of Tai Chi on bone health in postmenopausal women. Two independent reviewers identified the eligible studies, extracted data, and assessed the risk of bias of included studies using the revised Cochrane risk-of-bias tool for randomized trials. The primary outcome was the bone mineral density (BMD), and secondary outcomes included bone turnover markers and calcaneus quantitative ultrasound. Subgroup analyses were conducted based on the duration of Tai Chi. Sensitivity analyses and publication bias assessment were performed. RevMan software (version 5.4.1) and R software (version 3.6.1) were used for data synthesis. The certainty of evidence was rated with the Grading of recommendations assessment, development, and evaluation (GRADE) system. We also performed the trial sequential analysis to evaluate the reliability of the evidence.

Results

A total of 25 reports involving 24 studies were included. Four studies were considered as high overall risk of bias, and the rest were some concerns. Among included studies, there were three comparisons including Tai Chi vs. non-intervention, Tai Chi vs. other exercises, and Tai Chi plus nutraceutical vs. nutraceutical. Compared with non-intervention, Tai Chi was more effective to improve BMD of lumbar spine (MD = 0.04, 95% CI 0.02 to 0.07, I2 = 0%, low certainty), femoral neck (MD = 0.04, 95% CI 0.02 to 0.06, I2 = 0%, low certainty), and trochanter (MD = 0.02, 95% CI 0.00 to 0.03, I2 = 0%, very low certainty), but there was no significant difference in increasing the BMD of Ward's triangle (MD = 0.02, 95% CI −0.01 to 0.04, I2 = 0%, very low certainty). Trial sequential analysis showed that the effect of Tai Chi vs. non-intervention on the BMD of lumbar spine and femoral neck was reliable, but the effect on the BMD of trochanter and Ward's triangle needed further verification. The subgroup analyses suggested that Tai Chi training for over 6 months had greater improvement in BMD of the lumbar spine, femoral neck, and trochanter than non-intervention. No significant differences were observed in the above outcomes of Tai Chi vs. other exercises, and Tai Chi plus nutraceutical vs. nutraceutical. There was insufficient evidence to support the effect of Tai Chi on bone turnover markers and calcaneus quantitative ultrasound. Few Tai Chi relevant adverse events occurred.

Conclusion

Tai Chi may be an optional and safe exercise for improving BMD loss in postmenopausal women, and practicing Tai Chi for more than 6 months may yield greater benefits. However, more rigorously designed RCTs are required to verify the benefits and to explore the optimal protocol of Tai Chi exercise for bone health.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309148, identifier: CRD42022309148.

Health-Related Physical Fitness as a Risk Factor for Falls in Elderly People Living in the Community: A Prospective Study in China

Objectives

Health-related physical-fitness (HRPF) involves multi-components of physical functional tests and is reported to be associated with the risk of fall. The study sought to determine whether specific physical fitness components were stronger predictors of falls among elderly people.

Methods

This prospective cohort study involved 299 community residents age ≥60 years from Shanghai, China. The baseline data included comprehensive assessment of sociodemographic, clinical, and HRPF test. Subjects were followed for 1 year and were contacted by telephone to report falls. LASSO regression and Multivariate regression analysis were used to identify risk predictors of fall. In addition, we used receiver operating characteristic (ROC) curve analyses to determine whether the predictors have diagnostic.

Results

During the 1-year prospective fall assessment, 11.7% of these subjects experienced one or frequent falls. LASSO models revealed that age (=0.01) and 8-ft up-and-go test score (=0.06) were positively associated with falls, while activity-specific balance confidence (ABC; = −0.007) and 2-min step test score (= −0.005) were inversely related. The Area Under roc Curve (AUC) for a linear combination of age, ABC scale score, 2-min step test and 8-ft up-and-go test was 0.778 (95% confidence interval: 0. 700–0.857), which was superior to any of the variables taken alone.

Conclusion

Age, activity-specific balance confidence and fitness abnormalities were determined to contribute to the incident of falls. The value of 2-min step test score, and 8-ft up-and-go test score were the key HRPF components in predicting falls among elderly people.

Cumulative additional information does not improve the neuromuscular control during postural responses to perturbations in postural instability/gait disorders subtype of Parkinson's disease

BACKGROUND

Postural response impairments in postural instability and gait disorders (PIGD) subtype patients may be attributed to Parkinson's disease (PD)-deterioration in central-set (programing/modulating of central outputs during motor responses). Although additional information improves some PD motor impairments, an unanswered question is whether additional information can benefit postural response in PIGD subtype.

OBJECTIVE

To analyze the effect of cumulative additional information on postural responses after perturbation in PIGD and neurologically healthy older adults (CG).

METHODS

Perturbations were applied in 16 PIGD and 19 CG by the support-base translation. Participants performed 3 blocks of 5 trials without additional information (B1-B3, Day 1) and 5 trials of each cumulative additional information (C1-C4, Day 2): information about perturbation (C1), visual (C2), verbal (C3), and somatosensory information (C4). Electromyography and center of pressure (CoP) parameters were analyzed by ANOVAs with Group (PIGD × CG) and Block (B1 × B2 × B3) and with Group (PIGD × CG) and Condition (B3 × C1 × C2 × C3 × C4).

RESULTS

PIGD decreased the range of CoP in B3 while CG decreased both range of CoP and the integral of antagonist's muscle activity (iEMG) in B2. Also, PIGD decreased the recovery time in C4 while CG increased the iEMG of agonist's muscle in C2 and antagonist's muscle in all conditions except C2.

CONCLUSION

Additional information provided before postural control assessment influences the postural response in PIGD and CG differently. PIGD demonstrated inflexibility of central-set in modulating the neuromuscular control regardless of additional information. CG presents a flexible system evidenced by the increase of agonist muscle iEMG when provided visual information.

Functional Capacity of Tai Chi-Practicing Elderly People

Research shows that ageing is modifiable or modulable, attending to external modifications and lifestyle factors: physical activity has a unique contribution to functional health and energy balance. Extensive research shows Tai Chi (TC) produced a major physical condition. To determine the impact of lifestyle on functional capacity, comparing the impact of continued long-life practice. 113 individuals (±71.53 years old): (a) PTC (n = 27); senior competitors, life-long training; (b) TC (n = 27); ±4 years; (c) Keep-Fit (KF n = 36); ±4 years; and the control group (d) sedentary individuals (SI n = 23). Five tests from the Senior Fitness Test (SFT) were used to assess the physical condition. The TC group showed significantly better results than the KF group: 30-s chair stand (23.22 ± 3.08 * rep vs. 17.17 ± 2.96 rep), chair sit-and-reach (2.19 ± 4.85 * cm vs. −1.93 ± 5.46 cm) and back scratch (1.02 ± 4.46 * cm vs. −2.43 ± 5.78 cm). The TCP group showed better results than the TC group: 30-s chair stand (27.70 ± 4.98 * rep vs. 23.22 ± 3.08 rep), 30-s arm curl (30.22 ± 4.36 * rep vs. 23.48 ± 3.42 rep), chair sit-and-reach (13.07 ± 4.00 * cm vs. 2.19 ± 4.85 cm) and back scratch (5.48 ± 3.51 * cm vs. 1.02 ± 4.46 cm). Among the different activities analysed, TC showed better results in SFT tests; in particular considering the long-life training of this martial art.

Effectiveness of Olympic Combat Sports on Balance, Fall Risk or Falls in Older Adults: A Systematic Review

Simple Summary

The regular practice of physical activity has achieved greater diffusion in recent years as a strategy for fall prevention and improving or maintaining the general health status of older adults, which contributes to an active and healthy lifestyle. The strategies to promote active and healthy aging need to be reassessed due to the COVID-19 pandemic to promote the safe practice of physical activity among older adults, considering, among other measures, practicing social distancing or training at home. Such a scenario could provide the opportunity to promote physical activity that requires a limited number of participants in reduced spaces for its practice, such as Olympic combat sports. In this review, an overview of the effects of Olympic combat sports on balance, fall risk, or falls in older adults is presented. From 1496 records, eight studies were included, involving 322 older adults (64% female; mean age = 71.1 years). The available evidence does not allow a definitive recommendation for or against Olympic combat sports interventions as an effective strategy to improve balance and reduce the fall risk or falls in older adults. Therefore, more high-quality studies are required to draw definitive conclusions.

Abstract

This systematic review and meta-analysis aimed to assess the available body of published peer-reviewed articles related to the effects of Olympic combat sports (OCS), compared with active/passive controls, on balance, fall risk, or falls in older adults. The TESTEX and GRADE scales assessed the methodological quality and certainty of the evidence. The protocol was registered in PROSPERO (code: CRD42020204034). From 1496 records, eight studies were included, involving 322 older adults (64% female; mean age = 71.1 years). The TESTEX scale revealed all studies with a score ≥ 60% (moderate-high quality). The GRADE scale indicated all studies with at least some concerns, up to a high risk of bias (i.e., was rated very low). Meta-analyses were planned, although the reduced number of studies precluded its incorporation in the final manuscript. Only two from six studies that assessed balance found improvements after OCS compared to controls. No differences were found between OCS vs. control groups for fall risk or falls. The available evidence does not allow a definitive recommendation for or against OCS interventions as an effective strategy to improve balance and reduce the fall risk or falls in older adults. Therefore, more high-quality studies are required to draw definitive conclusions.

Effectiveness and safety of acupuncture for treating functional constipation: An overview of systematic reviews

BACKGROUND

Functional constipation (FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews (SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.

OBJECTIVE

In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.

SEARCH STRATEGY

The search strategy was structured by medical subject headings and search terms such as "acupuncture therapy" and "functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.

INCLUSION CRITERIA

SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.

DATA EXTRACTION AND ANALYSIS

Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools: (1) A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2); (2) Risk of Bias in Systematic Reviews (ROBIS); (3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture (PRISMA-A); and (4) the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). A κ index was used to score the level of agreement between the 2 reviewers.

RESULTS

Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified. Using the AMSTAR 2 tool, we rated 92.3% (12/13) of the SRs as "critically low" confidence and one study as "low" confidence. Using the ROBIS criteria, 38.5% (5/13) of the SRs were considered to have "low risk" of bias. Based on PRISMA-A, 76.9% (10/13) of the SRs had over 70% compliance with reporting standards. The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5% (9/40) of the measured outcomes as "moderate" quality, 57.5% (23/40) as "low" quality, and 20.0% (8/40) as "very low" quality. The inter-rater agreement was moderate when using GRADE. Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements (CSBMs) and for raising the Bristol Stool Form Scale (BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.

CONCLUSION

Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020189173.

Lian gong as a Therapeutic Treatment Option in Primary Care for Patients with Dizziness: A Randomized Controlled Trial

Introduction  Dizziness is one of the most common reasons for seeking primary health care. Vestibular rehabilitation (VR) is a conventional treatment method for peripheral balance disorders that effectively decreases symptoms. Lian gong [LG] is believed to benefit patients with dizziness and to reduce the impact of the condition on quality of life by stimulating visual fixation, attention, body balance, and neuroplasticity. Objective  The present study aimed to evaluate the effects of LG on the impact of dizziness on quality of life and fear of falling in primary health care patients. Methods  This was a two-arm, parallel randomized clinical trial that included 36 patients with dizziness not caused by central changes. After specific medical evaluations and indications for treatment, the participants were randomly assigned to 3 groups: the LG group ( n  = 11), the VR group ( n  = 11), and the control group ( n  = 14). The interventions were conducted collectively over a period of 12 weeks. Results  Lian gong reduced the influence of dizziness on quality of life in physical (1.8 points, 95% confidence interval [CI]: 0.2-3.4), functional (4.0 points, 95% CI: 2.1-5.9), and emotional domains of quality of life (4.4 points, 95% CI: 1.7-7.2), with no differences compared with VR. There were similar concerns among the groups about the risk of falling. Conclusion  Lian gong was shown to be an effective balance rehabilitation strategy to reduce the impact of dizziness on quality of life, with similar results to those of VR.

Self-Efficacy of Older People Using Technology to Self-Manage COPD, Hypertension, Heart Failure, or Dementia at Home: An Overview of Systematic Reviews

BACKGROUND AND OBJECTIVES

Although telehealth research among the general population is voluminous, the quality of studies is low and results are mixed. Little is known specifically concerning older people and their self-efficacy to engage with and benefit from such technologies. This article reviews the evidence for which self-care telehealth technology supports the self-efficacy of older people with long-term conditions (LTCs) living at home.

RESEARCH DESIGN AND METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA) guidelines, this overview of systematic reviews focused on four LTCs and the concept of "self-efficacy." Quality was appraised using R-AMSTAR and study evaluation was guided by the PRISMS taxonomy for reporting of self-management support. Heterogeneous data evidencing technology-enhanced self-efficacy were narratively synthesized.

RESULTS

Five included articles contained 74 primary studies involving 9,004 participants with chronic obstructive pulmonary disease, hypertension, heart failure, or dementia. Evidence for self-care telehealth technology supporting the self-efficacy of older people with LTCs living at home was limited. Self-efficacy was rarely an outcome, also attrition and dropout rates and mediators of support or education. The pathway from telehealth to self-efficacy depended on telehealth modes and techniques promoting healthy lifestyles. Increased self-care and self-monitoring empowered self-efficacy, patient activation, or mastery.

DISCUSSION AND IMPLICATIONS

Future research needs to focus on the process by which the intervention works and the effects of mediating variables and mechanisms through which self-management is achieved. Self-efficacy, patient activation, and motivation are critical components to telehealth's adoption by the patient and hence to the success of self-care in self-management of LTCs. Their invisibility as outcomes is a limitation.

Effects of Tai Chi on the Executive Function and Physical Fitness of Female Methamphetamine Dependents: A Randomized Controlled Trial

Purpose: Exercise improves the health and mental status of drug dependents. The way by which Tai Chi (TC) as a special exercise treatment affects executive functions (EFs) of methamphetamine (MA) dependents is yet to be established. This study aimed to explore the effects of TC on the EFs and physical fitness of MA dependents. Methods: A total of 76 female MA dependents were randomly assigned to the exercise and control groups. The exercise group underwent three 60-min sessions of TC training per week for 12 weeks. The control group was trained with conventional exercises including the 9th Guang Bo Ti Cao and square dance. Physical fitness and EF assessments that evaluated inhibitory control (IC, go/no-go task), working memory (3-back task) and cognitive flexibility (switching task) were performed at baseline and at 12 weeks. A repeated-measures ANOVA was applied to analyze the differences of group and time. Results: The exercise group showed decreased response time (RT) with a significant main effect of time on the go/no-go task [F (1, 68) = 9.6, p < 0.05]. The interaction effect between time and group was significant on accuracy [F (1, 61) = 4.73, p < 0.05], and the main effect of time was significant on RT [F (1, 61) = 4.66, p < 0.05] in the 3-back task of the exercise group. Significant changes in BMI [F (1, 68) = 19.57, p < 0.05], vital capacity [F (1, 68) = 6.00, p < 0.05], and systolic blood pressure [F (1, 68) = 6.11, p < 0.05] were observed in the exercise group. Conclusion: These findings showed that 3 months of TC training can improve the IC and maintain the working memory and cognitive flexibility of MA dependents. Other data implied that TC may improve the physical fitness of MA dependents. Clinical Trial Registration: http://www.chictr.org.cn/, ChiCTR1900022091.

Procalcitonin-guided antibiotic therapy in AECOPD patients: Overview of systematic reviews

BACKGROUND

Procalcitonin (PCT)-guided antibiotic therapy has emerged as mainstream treatment for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and has been studied in many systematic reviews (SRs), but robust conclusion has not been drawn. Thus, this overview aims to summarize and critically evaluate the methodological and evidence quality of SRs on this topic.

METHODS

PubMed, EMBASE, Cochrane library, and Web of science were searched for SRs regarding on PCT-guided antibiotic therapy on AECOPD. Two reviewers assessed the quality of SRs in line with AMSTAR-2 tool and evaluated the strength of evidence quality with the grading of recommendations, assessment, development, and evaluation (GRADE) system for concerned outcomes independently.

RESULTS

Six SRs were published from Jun 2011 to Aug 2019, with from 4 (556 patients) to 15 (2571 patients) randomized controlled trials (RCTs) and retrospective studies. All the included SRs were classified as critical low methodology quality according to A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) tool. Most of SRs were absented a list of excluded studies (item 7), and adequate investigation of publication bias and discuss its likely impact on the results (item 15). The PCT-guided antibiotic therapy may reduce antibiotic exposure days and antibiotic prescription rate in patients with AECOPD without affecting treatment success rate or causing adverse events (all-cause mortality, re-admission, re-exacerbation), but the results should be study deeper for the low or moderate evidence quality.

CONCLUSION

Current SRs show that PCT-guided antibiotic therapy could be employed by clinicians in treatment of AECOPD. However, the high-quality evidence of outcomes is lacking, further intensive exploration should be carried out on the precise role of PCT-guided antibiotic therapy on AECOPD.

The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing

BACKGROUND/OBJECTIVES

This study was designed to test the impact of Tai Chi (TC) on healthcare utilization and cost in older adults living in low-income senior housing. We hypothesized that TC would improve overall health enough to reduce the use of emergency department (ED) and inpatient services.

DESIGN

Cluster randomized controlled trial with randomization at the housing site level.

SETTING

Greater Boston, Massachusetts.

PARTICIPANTS

The study includes 6 sites with 75 individuals in the TC treatment condition and 6 sites with 67 individuals in the health education control condition.

INTERVENTION

Members of the treatment group received up to a year-long intervention with twice weekly, in-person TC exercise sessions along with video-directed exercises that could be done independently at home. The comparison group received monthly, in-person healthy aging education classes (HE). Study recruitment took place between August, 2015 and October, 2017. Key outcomes included acute care utilization (inpatient stays, observation stays and emergency department visits). In addition, the cost of utilization was estimated using the age, sex and race adjusted allowed amount from Medicare claims for a geographically similar population aged ≥ 65.

RESULTS

The results suggested a possible reduction in the rate of ED visits in the TC group vs. controls (rate ratio = 0.476, p-value = 0.06), but no findings achieved statistical significance. Adjusted estimates of imputed costs of ED and hospital care were similar between TC and HE, averaging approximately $3,000 in each group.

CONCLUSION

ED utilization tended to be lower over 6 to 12 months of TC exercises compared to HE in older adults living in low-income housing, although estimated costs of care were similar.