Effectiveness of Tai Chi for Health Promotion of Older Adults: A Scoping Review of Meta-Analyses

Feasibility of a mat-based Pilates program for community dwelling seniors to improve balance and core strength

BACKGROUND

Popular programs to combat the increased rates of falls and improve overall balance and strength in the aging population are limited by accessibility or focus on distal movements, thereby limiting gains from the programs. The use of an age-appropriate, community-based Pilates program focusing on core strengthening for improved balance is proposed.

OBJECTIVE

The primary objective was to test the feasibility, acceptability, and appropriateness of a mat-based, core strengthening Pilates program (aka Pilates Gold). The secondary objective was to investigate changes in balance and core strength for participating seniors.

DESIGN

Prospective pre-post, observational study.

SETTING

Classes were on site at two retirement community centers.

PARTICIPANTS

Males and females (65 years old and older) were recruited from two different senior community centers on a first-come first-serve basis. Participants had to be (1) English speaking, (2) an existing resident at one of the retirement communities, and (3) considered healthy by common standards.

INTERVENTIONS

Mat-based Pilates program for 8 consecutive weeks. Movement difficulty and pace were slowly increased over the 8-week program, with a maximum of 17 different movements.

MAIN OUTCOME MEASURES

Primary outcomes for feasibility of the Pilates program were the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure. Secondary outcomes included the Sitting-Rising test, Activities Balance Confidence, and Patient Global Impression of Change.

RESULTS

The Pilates program was deemed appropriate, acceptable, and feasible by >80% of senior participants. Over 80% also reported some level of change in overall health due to the program. No significant differences were observed in balance outcomes, although there were individual improvements.

CONCLUSIONS

Community-based Pilates programs are highly desired, feasible, and acceptable. These results justify further studies, of longer training periods and perhaps increasing difficult levels, to determine if core strengthening mat-based Pilates is truly capable of improving balance, strength, and fall risks in seniors.

Effects of Tai Chi Versus General Aerobic Exercise on Depressive Symptoms and Serum Lipid Levels Among Older Persons With Depressive Symptoms: A Randomized Controlled Study

Tai Chi, a mindfulness-based aerobic exercise, may alleviate depressive symptoms and improve physiological markers in older adults. However, its distinct effects compared with general aerobic exercise remain unclear. To compare the effects of Tai Chi and general aerobic exercise on depressive symptoms and serum lipid levels in community-dwelling older adults with mild to moderate depression, a randomized controlled trial was conducted. Participants were randomly assigned to Tai Chi (n = 120) or general aerobic exercise (n = 120) for 3 months. Depressive symptoms and serum lipid levels were measured at baseline and postintervention. A generalized estimating equation was used to assess group differences over time. The Tai Chi group exhibited significantly greater reductions in depressive symptoms and improvements in serum lipid profiles compared with the general aerobic exercise group. Tai Chi's mind-body synergy may enhance its antidepressant effects, offering a promising approach to mental health and healthy aging.

S, R. B, P. JR, B. M. Evaluating the impact of tai chi therapy on stress reduction among older adults

This study investigates the effectiveness of Tai Chi therapy in reducing stress among older adults in selected community areas of Mehsana District. A quasi-experimental pre-test and post-test design was used with 60 participants aged 60-80, divided into experimental and control groups. The experimental group practiced Tai Chi therapy under supervision for 14 days, while the control group received no intervention. Stress levels were measured using the Perceived Stress Scale (PSS) before and after the intervention. Results showed a significant reduction in stress in the experimental group, with the mean pre-test score of 27.2 dropping to 10.1 post-intervention. In contrast, the control group showed no significant change. The t-test results confirmed Tai Chi's effectiveness in reducing stress (t = 10.43, p < 0.05) for the experimental group, with no significant association between stress reduction and demographic variables. These findings support Tai Chi as a beneficial intervention for managing stress among older adults.

Physical Activity Engagement After Tai Ji Quan Intervention Among Older Adults With Mild Cognitive Impairment or Memory Concerns: A Secondary Analysis of a Randomized Clinical Trial

Importance

The effect of exercise interventions on increasing and sustaining moderate to vigorous physical activity (MVPA) among older adults with mild cognitive impairment (MCI), who are at heightened risk of dementia, remains unclear.

Objective

To examine whether participation in a 6-month, supervised, home-based tai ji quan intervention increases MVPA among US community-dwelling older adults at 1 year.

Design, Setting, and Participants

This study was a secondary analysis of a parallel-group, outcome assessor-blinded, randomized clinical trial conducted virtually at participants' homes. Eligible participants were aged 65 years or older, lived independently, and had a baseline Clinical Dementia Rating (CDR) global score of 0.5 or less. Participants were enrolled between October 1, 2019, and June 30, 2022. Final follow-up occurred in May 2023.

Interventions

Participants were randomly assigned (1:1:1) to standard tai ji quan, cognitively enhanced tai ji quan, or stretching, and they exercised (via real-time videoconferencing) 1 hour semiweekly for 6 months.

Main Outcomes and Measures

The primary outcome was self-reported time engaged in MVPA (in minutes per week), assessed with the International Physical Activity Questionnaire at baseline and at 4, 6, and 12 months following randomization. The Physical Activity Guidelines for Americans recommend that older adults achieve at least 150 min/wk of MVPA, and the number of participants meeting this recommendation was also assessed. Analyses followed the intention-to-treat principle.

Results

Among the 318 participants enrolled, 107 were randomized to standard tai ji quan, 105 to cognitively enhanced tai ji quan, and 106 to stretching. Their mean (SD) age was 76 (5) years, 212 (66.7%) were women, and 247 (77.7%) had a CDR global score of 0.5. A total of 304 participants (95.6%) completed the trial, and 299 (94.0%) had complete data on the primary outcome at the 12-month follow-up. At 12 months, both tai ji quan groups had increased MVPA levels compared with the stretching control group, with mean differences from baseline of 66 min/wk (95% CI, 25-108 min/wk; P = .002) with standard tai ji quan and 65 min/wk (95% CI, 24-108 min/wk; P = .002) with cognitively enhanced tai ji quan. Odds ratios for meeting the recommended amount of MVPA (≥150 min/wk) were 3.11 (95% CI, 1.75-5.53; P < .001) for the standard tai ji quan group and 3.67 (95% CI, 2.02-6.65; P < .001) for the cognitively enhanced tai ji quan group compared with the stretching group.

Conclusion and Relevance

In this secondary analysis of a randomized clinical trial involving older adults with MCI or self-reported memory concerns, home-based tai ji quan training (delivered via videoconferencing) increased MVPA 6 months following cessation of the intervention compared with stretching. These findings suggest that tai ji quan may be promoted as an avenue to achieve physical activity guidelines for older adults with MCI or subjective memory concerns.

Trial Registration

ClinicalTrials.gov Identifier: NCT04070703.

The Relationship between Sleep and Physical Activity by Age, Race, and Gender

Cardiometabolic diseases remain the leading cause of death in the United States. Lifestyle factors contribute the majority of risk for these diseases. Although diet and exercise have been the primary focus of research on modifiable behaviors to target for interventions to prevent cardiometabolic disease, recent evidence suggests that sleep also plays an important role. Indeed, the updated American Heart Association campaign includes sleep as one of its "Essential Eight". This review details the reciprocally reinforcing positive relationship between sleep and daytime physical activity behaviors and explores how this relationship differs based on age, gender and race. For example, interventions to improve moderate intensity physical activity may be particularly beneficial to women, older adults, and Black Americans, who are at increased risk for sleep disturbances. Communicating to Americans the importance of managing their time to meet current physical activity and sleep recommendations is a challenge given that there are so many competing behaviors consuming large amounts of time (e.g., social media, gaming), but is critical given the importance of these behaviors for cardiometabolic health.

Effects of aerobic and resistance exercises on psychological and cognitive functions in patients with post-stroke migraine

OBJECTIVE

To investigate the impact of a combination of aerobic and resistance exercises on the psychological and cognitive functions of post-stroke migraine patients.

METHODS

This study recruited 100 patients suffering from post-stroke migraine pain who were admitted to the hospital, categorizing them into a control group (n = 50) and an intervention group (n = 50). The control group received conventional drug treatment, while the intervention group received the exercise-based intervention that combined aerobic exercise with resistance exercise.

RESULTS

Before treatment, both groups displayed similar Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Mini-mental State Examination (MMSE) and MoCA scores. However, after the intervention, the intervention group exhibited lower scores on these measures compared to the control group (all p < 0.05). Additionally, there were no discernible disparity in Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6) scores between the two cohorts of patients before treatment (p > 0.05), whereas the intervention group demonstrated significantly lower MIDAS and HIT-6 scores following the intervention (p < 0.05). Although there were no discernible distinctions in National Institute of Health stroke scale (NIHSS) and Stroke Specialized Quality of Life Scale (SS-QOL) measurements between the two patient groups before treatment (p > 0.05), the intervention group exhibited a significant decrease in NIHSS scores and a notable increase in SS-QOL scores after the intervention (p > 0.05). Moreover, the satisfaction rate and overall satisfaction rate were significantly higher in the intervention group (p < 0.05).

CONCLUSION

The combination of aerobic and resistance exercises demonstrated positive effects on the psychological well-being and overall quality of life for post-stroke migraine patients.

The influence of tai chi on the death anxiety of elderly people living alone: the chain mediating effect of social support and psychological capital

Background

Population aging is a global trend, and the number of older adults living alone is increasing. Tai chi, a traditional Chinese exercise, has been shown to improve the physical and mental health of older adults.

Aim

To investigate the effects of tai chi on death anxiety in older adults living alone and the role of social support and psychological capital in this relationship.

Method

A cross-sectional study of 493 older adults living alone in four cities in southwestern China. Participants were assessed using questionnaires on tai chi practice, social support, psychological capital, and death anxiety.

Results

Tai chi practice significantly reduced death anxiety in older adults living alone. It also positively correlated with social support and psychological capital, both of which negatively correlated with death anxiety. Social support and psychological capital mediated the relationship between tai chi practice and death anxiety, suggesting that tai chi may reduce death anxiety through these factors. These findings encourage older adults living alone to practice tai chi, as it may improve their mental and physical health and reduce their risk of death anxiety.

Conclusion

Tai chi practice may reduce death anxiety in older adults living alone through the chain-mediated effects of social support and psychological capital. This suggests that tai chi may be a beneficial intervention for older adults living alone.

Association between Tai Chi Yuttari Exercise and Longevity and Prevention of Long-Term Care Need: Survival Analysis in Kitakata City, Japan

This study examined whether participation in Tai Chi Yuttari exercise is associated with a delay in the death and new certification for long-term care need of older adults. Individuals who participated in Tai Chi Yuttari exercise classes in 2011-2015 (participation group) were compared with individuals from the Basic Resident Register of Kitakata City (non-participation group). Death and new certification for long-term care need were selected to evaluate the effectiveness of participation in Tai Chi Yuttari exercise classes. The periods from the start date of the observation to each person's date of occurrence of events were calculated. The Kaplan-Meier method and log-rank test were used to compare survival curves between the groups. A total of 105 and 202 individuals in the participation and non-participation groups, respectively, were observed. Survival duration (χ2 = 8.782, p = 0.003) and the period before receiving certification for long-term care (χ2 = 5.354, p = 0.021) were longer in the participation group than in the non-participation group. In the stratified analysis by sex, survival duration was longer in the participation group in men only (χ2 = 7.875, p = 0.005). Participation in Tai Chi Yuttari exercise might be effective in delaying death, especially in men, and new certification for long-term care.

A Tai Chi Class Collaboratively Developed for Persons With Interstitial and Other Lung Diseases: An Ethnographic Investigation

Background

Participating in physical activity (PA) can be challenging for persons with chronic and significant lung disease due to the multifaceted disruptive effects of their symptoms and variable disease course.

Objectives

Our study investigates a novel approach to increasing PA by collaboratively and adaptively developing a Tai Chi (TC) class for and by persons with lung diseases and explores participants' perceptions of their experiences in the co-developed TC class.

Methods

We initiated a collaboration between the Interstitial Lung Disease (ILD) Collaborative and the Tai Chi Foundation to develop a TC class appropriate for persons with ILD and other lung diseases. The TC class was offered online, during the early phases of the COVID-19 pandemic, when pulmonary patients were isolated socially. TC class sessions were held twice weekly for 12 weeks with 12 participants. Ethnographic field methods were used to collect observations and conduct interviews with teachers and students. The Social Ecological Model (SEM) for understanding factors in intrapersonal, interpersonal, social, and organizational contexts was used to explore ways in which wellness practices, particularly those involving changes in health behaviors, can be collaboratively conceived, and developed by persons with the lived experience of illness and community organizations that are sensitive to their personal and social contexts. The constant comparative method was used for data analysis.

Results

Our findings include the importance of (1) creating a supportive class environment, characterized by interactive and reciprocal relationships among students and teachers; (2) alternating segments of movement and meditation to avoid fatigue and breathlessness; (3) cultivating sensory awareness and body trust, resting when needed and rejoining the movements when ready; (4) increasing the capacity to meditate through deepening presence and renewing the vital connection with inner and outer sources of energy; (5) reducing, through meditative movement, the persistent anxiety, isolation, and sense of loss that accompany chronic disease diagnosis and progression.

Conclusion

We documented a collaboration between the TC and pulmonary communities to design a TC class for persons with chronic and significant lung disease. We employed the SEM to provide insights into how teachers, informed by their students, can use effective pedagogical skills to create core curricula with modifications appropriate for a specific population.

Determining the safety and effectiveness of Tai Chi: a critical overview of 210 systematic reviews of controlled clinical trials

BACKGROUND

This overview summarizes the best available systematic review (SR) evidence on the health effects of Tai Chi.

METHODS

Nine databases (PubMed, Cochrane Library, EMBASE, Medline, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Sino-Med, and Wanfang Database) were searched for SRs of controlled clinical trials of Tai Chi interventions published between Jan 2010 and Dec 2020 in any language. Effect estimates were extracted from the most recent, comprehensive, highest-quality SR for each population, condition, and outcome. SR quality was appraised with AMSTAR 2 and overall certainty of effect estimates with the GRADE method.

RESULTS

Of the 210 included SRs, 193 only included randomized controlled trials, one only included non-randomized studies of interventions, and 16 included both. Common conditions were neurological (18.6%), falls/balance (14.7%), cardiovascular (14.7%), musculoskeletal (11.0%), cancer (7.1%), and diabetes mellitus (6.7%). Except for stroke, no evidence for disease prevention was found; however, multiple proxy-outcomes/risks factors were evaluated. One hundred and fourteen effect estimates were extracted from 37 SRs (2 high, 6 moderate, 18 low, and 11 critically low quality), representing 59,306 adults. Compared to active and/or inactive controls, 66 of the 114 effect estimates reported clinically important benefits from Tai Chi, 53 reported an equivalent or marginal benefit, and 6 an equivalent risk of adverse events. Eight of the 114 effect estimates (7.0%) were rated as high, 43 (37.7%) moderate, 36 (31.6%) low, and 27 (23.7%) very low certainty evidence due to concerns with risk of bias (92/114, 80.7%), imprecision (43/114, 37.7%), inconsistency (37/114, 32.5%), and publication bias (3/114, 2.6%). SR quality was often limited by the search strategies, language bias, inadequate consideration of clinical, methodological, and statistical heterogeneity, poor reporting standards, and/or no registered SR protocol.

CONCLUSIONS

The findings suggest Tai Chi has multidimensional effects, including physical, psychological and quality of life benefits for a wide range of conditions, as well as multimorbidity. Clinically important benefits were most consistently reported for Parkinson's disease, falls risk, knee osteoarthritis, low back pain, cerebrovascular, and cardiovascular diseases including hypertension. For most conditions, higher-quality SRs with rigorous primary studies are required.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021225708.

Concepts and Application of Tai Ji in Stroke Rehabilitation: A Narrative Review

Stroke remains a leading cause of adult disability, and it decreases the health-related quality of life due to functional disability and poor functional recovery in stroke. Tai Ji has been recently introduced to overcome disabilities. This review aims to explain the effects of Tai Ji on functional recovery in stroke patients, linking it to current approaches, concepts and therapies such as Bobath and proprioceptive neuromuscular facilitation techniques. A compilation of recent literature on Tai Ji's use in stroke rehabilitation from Google scholar and PubMed Central (2018 to 2022). The benefits of Tai Ji in stroke functional recovery were studied and explained based on its similarity in concepts to current conventional stroke rehabilitation approaches. There were few randomized controlled trials on Tai Ji in functional recovery among stroke patients. However, all literature identified Tai Ji as beneficial in stroke rehabilitation. However, there was no literature on explaining the Tai Ji movement based on current conventional stroke rehabilitation approaches. Tai Ji carries similar theories to the current neurorehabilitation approach. Tai Ji can be modified and incorporated into stroke rehabilitation programs based on patients' needs to produce promising outcomes.

Relationship of Hardiness Components to General Health, Spiritual Health, and Burnout: The Path Analysis

Objective: Acknowledging the key role of hardiness, importance of health and its various dimensions, the present study aimed to investigate the simultaneous relationship between hardiness components and spiritual health, burnout, and general health, among Baqiyatallah University of Medical Sciences staff. Method : 307 Baqiyatallah University of Medical Sciences' staff in Tehran with at least five years work experience participated in this cross-sectional study using simple random sampling. Four questionnaires were used to evaluate the participants: the 28-item General Health Questionnaire (GHQ) to assess general mental problems with four subscales, 22-item Maslach Burnout Inventory (MBI) with two aspects (frequency and intensity) and three subscales of emotional exhaustion, depersonalization and personal accomplishment, the 20-item Spiritual Well Being Scale (SWBS) Questionnaire with two subscales of religious well-being and existential well-being and the 50-item Kobasa Hardiness Questionnaire to measure psychological hardiness with three subscales of control, commitment and challenge. At the end, two conceptual models which have shown effect of hardiness and its subscales on general health, Spiritual health and burnout were evaluated by path analysis. Results: According to the path analysis results, it was found that hardiness and its subscales, which were approved by univariable and multivariable analyses, had significant relationship with general health (direct effect: -0.525, P < 0.001), spiritual health (direct effect: 0.555, P < 0.001) and burnout (direct effect of frequency aspect: -0.523, P < 0.001). Thus, by increasing hardiness and its subscales, spiritual health increases while symptoms of illness and burnout decrease. Conclusion: Spiritual health increases as hardiness and its subscales increase as well; therefore, symptoms of illness and burnout decrease as hardiness and its subscales increase.