Tai Chi Training may Reduce Dual Task Gait Variability, a Potential Mediator of Fall Risk, in Healthy Older Adults: Cross-Sectional and Randomized Trial Studies

The Science of Tai Chi and Qigong and Whole Person Health Part I: Rationale and State of the Science

The emerging paradigm of whole person health shares many core principles with traditional complementary and integrative health frameworks, including Tai Chi and qigong (TCQ). In the Fall of 2023, the Harvard Medical School Osher Center for Integrative Health hosted the inaugural international conference on The Science of Tai Chi for Whole Person Health: Advancing the Integration of Mind-Body Practices into Contemporary Health Care held at Harvard Medical School. A two-part white paper was written to summarize key conference topics, findings, and issues. Part I presented here summarizes the rationale for the conference and synthesizes the state of evidence for TCQ as rehabilitative and preventive tools for a range of clinical conditions, including falls and balance, cognition, mental health, sleep, cardiorespiratory health, musculoskeletal health, cancer, as well as translational evidence related to the neurophysiology, brain and immune function, and biomarkers of inflammation. The state of science of TCQ, viewed through the lens of traditional East Asian health constructs, is also discussed. Part II of this white paper outlines evidence gaps and opportunities and discusses strategies to address challenges in TCQ research, dissemination, and implementation.

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/.

The effects of mindful exercise on cognition in patients with schizophrenia: A systematic review and meta-analysis of randomized controlled trials

Cognitive impairment is a core symptom of schizophrenia. This study investigated the effects of mindful exercise on the cognitive performance of individuals with schizophrenia. A systematic review and meta-analysis were performed from inception to March 2023. The quality of included studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale. A random effects model was used to generate the pooled effect size. Ten randomized controlled trials met the inclusion criteria with fair-to-good methodological quality. The results showed that Mindful exercise significantly improved global cognition in patients with schizophrenia (g = 0.25, p = .002). There was a significant difference in mindful exercise compared with the passive control group (g = 0.34, p = .002), whereas no significant difference was found between the mindful exercise and exercise intervention group (g = 0.09, p = .371). These findings indicate that mindful exercise could be promising for improving cognition in patients with schizophrenia.

Uncorking the limitation-improving dual tasking using transcranial electrical stimulation and task training in the elderly: a systematic review

Introduction

With aging, dual task (DT) ability declines and is more cognitively demanding than single tasks. Rapidly declining DT performance is regarded as a predictor of neurodegenerative disease. Task training and non-invasive transcranial electrical stimulation (tES) are methods applied to optimize the DT ability of the elderly.

Methods

A systematic search was carried out in the PUBMED, TDCS (transcranial direct current stimulation) databases, as well as Web of Science, and a qualitative analysis was conducted in 56 included studies. Aiming to summarize the results of studies that implemented tES, task training, or the combination for improving DT ability and related performance changes in healthy elderly and geriatric patients. For different approaches, the training procedures, parameters, as well as outcomes were discussed.

Results

Task training, particularly cognitive-motor DT training, has more notable effects on improving DT performance in the elderly when compared to the neuromodulation method.

Discussion

Anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (L-DLPFC), or its combination with task training could be promising tools. However, additional evidence is required from aged healthy people and patients, as well as further exploration of electrode montage.

Long-term Tai Chi practice in older adults is associated with "younger" functional abilities

Age-related alterations in physiology lead to declines in physical function that are associated with numerous adverse outcomes among older adults. Utilizing a hybrid design, we aimed to understand whether both long-term and short-term Tai Chi (TC) training are associated with age-related decline in physical function in healthy older adults. We first conducted cross-sectional comparisons among TC-naïve older adults (n = 60, 64.2 ± 7.7 years), TC-expert older adults (n = 27, 62.8 ± 7.6 years, 24.5 ± 12 years experience), and TC-naïve younger adults (n = 15, 28.7 ± 3.2 years) to inform long-term effects of TC training on physical function, including single leg stance time with eyes closed, grip strength, Timed Up and Go, maximum walking speed, functional reach, and vertical jump for lower-extremity power. There were significant differences among the three groups on all the six tests. For most functional tests, TC-experts performed better than age-matched TC-naïve controls and were statistically indistinguishable from young healthy adult controls. Long-term TC training was associated with higher levels of physical function in older adults, suggesting a potential preventative healthy aging effect. In the randomized longitudinal trial, TC-naïve subjects were randomized (n = 31 to Tai Chi group, n = 29 to usual care control group) to evaluate the short-term effects of TC over 6 months on all outcomes. TC's short-term impacts on physical function were small and not statistically significant. The impact of short-term training in healthy adults is less clear. Both potential longer-term preventive effects and shorter-term restorative effects warrant further research with rigorous, adequately powered controlled clinical trials.

Wheelchair Tai Chi Ball Exercise for Improving Neuromuscular Functions of Older Adults With Disability

The purposes of this perspective article were to summarize Wheelchair or Seated Tai Chi studies related to neuromuscular functions of older adults with disability; to describe the development of Wheelchair Tai Chi Ball (WTCB) exercise — a concept to combine mind-body exercise with strength training; and to propose a new Telehealth WTCB exercise for improving neuromuscular functions of old adults with spinal cord injury (SCI) and disability. With reference to neuromuscular functions, WTC intervention may have positive effects on simple reaction time, range of motion at the shoulder and trunk, static and dynamic sitting balance, handgrip strength, vagal activity, and sympathetic activity among older adults with disability. The developed WTCB intervention is a feasible and safe exercise which combines the mind-body exercise and strength conditioning into one exercise which possesses aerobic, stretching and strength trainings and may facilitate neuromuscular functions of older adults with disability. The proposed Telehealth WTCB 12 forms (TWTCB12) exercise with a “Moving Shadow” method in the telehealth may enable the learner to superimpose learner’s image on an expert’s demonstrating model to enhance the learning and practice effects. Since wheelchair users will learn and practice TWTCB12 movements in a seated position or sitting on a wheelchair the “Moving shadow” method on Zoom would provide an ideal telehealth learning and practice environment for the wheelchair users to learn and practice TWTCB12 exercise from home more feasible and user friendly.

Effects of Exergaming-Based Tai Chi on Cognitive Function and Dual-Task Gait Performance in Older Adults With Mild Cognitive Impairment: A Randomized Control Trial

Background

Declined cognitive function interferes with dual-task walking ability and may result in falls in older adults with mild cognitive impairment (MCI). The mind-body exercise, Tai Chi (TC), improves cognition and dual-task ability. Exergaming is low-cost, safe, highly scalable, and feasible. Whether the effects of exergaming-based TC is beneficial than traditional TC has not been investigated yet.

Objectives

The objective of this study was to investigate effects of exergaming-based TC on cognitive function and dual-task walking among older adults with MCI.

Methods

Fifty patients with MCI were randomly assigned to an exergaming-based TC (EXER-TC) group, a traditional TC (TC) group, or a control group. The EXER-TC and TC groups received 36 training sessions (three, 50-min sessions per week) during a 12-week period. The control group received no intervention and were instructed to maintain their usual daily physical activities. The outcome variables measured included those related to cognitive function, dual-task cost (DTC), and gait performance.

Results

The EXER-TC and TC groups performed better than the control group on the Chinese version of the Stroop Color and Word Test, the Trail Making Test Parts A and B, the one-back test, gait speed, and DTC of gait speed in cognitive dual-task conditions after training. However, there were no significant differences between the EXER-TC and TC groups. Compared with the control group, only the EXER-TC group experienced beneficial effects for the Montreal Cognitive Assessment.

Conclusion

EXER-TC was comparable to traditional TC for enhancement of dual-task gait performance and executive function. These results suggested that the EXER-TC approach has potential therapeutic use in older adults with MCI.

An investigation to study the effects of Tai Chi on human gait dynamics using classical machine learning

Tai Chi has been proven effective in preventing falls in older adults, improving the joint function of knee osteoarthritis patients, and improving the balance of stroke survivors. However, the effect of Tai Chi on human gait dynamics is still less understood. Studies conducted in this domain only relied on statistical and clinical measurements on the time-series gait data. In recent years machine learning has proven its ability in recognizing complex patterns from time-series data. In this research work, we have evaluated the performance of several machine learning algorithms in classifying the walking gait of Tai Chi masters (people expert on Tai Chi) from the normal subjects. The study is designed in a longitudinal manner where the Tai Chi naive subjects received 6 months of Tai Chi training and the data was recorded during the initial and follow-up sessions. A total of 57 subjects participated in the experiment among which 27 were Tai Chi masters. We have introduced a gender, BMI-based scaling of the features to mitigate their effects from the gait parameters. A hybrid feature ranking technique has also been proposed for selecting the best features for classification. The research reports 88.17% accuracy and 93.10% ROC AUC values from subject-wise 5-fold cross-validation for the Tai Chi masters' vs normal subjects' walking gait classification for the "Single-task" walking scenarios. We have also got fairly good accuracy for the "Dual-task" walking scenarios (82.62% accuracy and 84.11% ROC AUC values). The results indicate that Tai Chi clearly has an effect on the walking gait dynamics. The findings and methodology of this study could provide preliminary guidance for applying machine learning-based approaches to similar gait kinematics analyses.

The effects of Baduanjin exercise vs. brisk walking on physical fitness and cognition in middle-aged patients with schizophrenia: A randomized controlled trial

OBJECTIVE

Patients with schizophrenia have deficits in physical and cognitive function that may become salient in their middle ages. These deficits need active intervention to prevent functional decline. Baduanjin and brisk walking show promise as interventions in patients with schizophrenia. This study investigated the effects of Baduanjin exercise vs. brisk walking in middle-aged patients with schizophrenia.

METHODS

In this single-blind, 2-arm, parallel, randomized controlled trial, 48 participants aged older than 40 years were enrolled and assigned to the intervention group (Baduanjin) or the control group (brisk walking). The training of both groups took place twice a week, 60 min per session, for 12 weeks. The participants were evaluated with physical, cognitive, and functional outcomes at baseline, postintervention, and 4 weeks after the intervention.

RESULTS

The results of the study demonstrated significant time effects in walking distance (p = 0.035, η² = 0.094) and lower extremity strength (p = 0.006, η² = 0.152). Post-hoc analysis revealed both groups had significant improvement in changes from baseline to the postintervention assessment (ps < 0.05) and follow-up (ps < 0.05). The results demonstrated a significant group-by-time interaction in change scores of global cognition (F = 7.01, p = 0.011, η² = 0.133). Post-hoc analysis revealed a significant improvement in the Baduanjin group from baseline to postintervention (p = 0.021), but the improvements were not maintained at the follow-up assessment (p = 0.070). The results also demonstrated significant group effects in balance function (p < 0.001, η² = 0.283), motor dual-task performance (p = 0.026, η² = 0.103), and cognitive dual-task performance (p < 0.001, η² = 0.307). Post-hoc analysis revealed that the Baduanjin group improved more than the brisk walking group in the above outcomes (ps < 0.05).

CONCLUSION

This study demonstrated the differential effects of Baduanjin exercise and brisk walking in middle-aged patients with schizophrenia. Baduanjin might be a beneficial regimen for improving physical and cognitive function in this population. Further research with a larger sample is warranted.

CLINICAL TRIAL REGISTRATION

[ClinicalTrials.gov], identifier [202000817B0C602].

Combining Transcranial Direct Current Stimulation With Tai Chi to Improve Dual-Task Gait Performance in Older Adults With Mild Cognitive Impairment: A Randomized Controlled Trial

Introduction: Engaging in a secondary task while walking increases motor-cognitive interference and exacerbates fall risk in older adults with mild cognitive impairment (MCI). Previous studies have demonstrated that Tai Chi (TC) may improve cognitive function and dual-task gait performance. Intriguingly, with emerging studies also indicating the potential of transcranial direct current stimulation (tDCS) in enhancing such motor-cognitive performance, whether combining tDCS with TC might be superior to TC alone is still unclear. The purpose of this study was to investigate the effects of combining tDCS with TC on dual-task gait in patients with MCI.

Materials and Methods: Twenty patients with MCI were randomly assigned to receive either anodal or sham tDCS, both combined with TC, for 36 sessions over 12 weeks. Subjects received 40 min of TC training in each session. During the first 20 min, they simultaneously received either anodal or sham tDCS over the left dorsolateral prefrontal cortex. Outcome measures included dual-task gait performance and other cognitive functions.

Results: There were significant interaction effects between groups on the cognitive dual task walking. Compared to sham, the anodal tDCS group demonstrated a greater improvement on cadence and dual task cost of speed.

Conclusion: Combining tDCS with TC may offer additional benefits over TC alone in enhancing dual-task gait performance in patients with MCI.

Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [TCTR20201201007].

The effect of video game-based training on postural control during gait initiation in community-dwelling older adults: a randomized controlled trial

PURPOSE

The aim was to investigate the effect of video game training as compared to dual-task training on gait initiation (GI) which is a sensitive indicator of balance deficiency in older adults.

METHOD

Sixty-six older adults were allocated to the video game-based training (intervention group) or the motor-cognitive dual-task training (active control group). The outcome measures were the mediolateral (ML)/anteroposterior (AP) displacement and velocity of COP during the phases of GI (anticipatory, weight transition, and locomotor).

RESULTS

The results indicated in the anticipatory phase, the ML & AP COP displacement were significantly increased at post-training relative to pre-training across both groups (p < 0.041). In the weight transition phase, the AP COP displacement & ML COP velocity were significantly increased at post-training than pre-training (p < 0.032). However, in the locomotor phase, within the intervention group, the ML COP displacement & ML COP velocity were significantly increased at follow-up as compared to pre-training (p < 0.05), while no such differences were observed within the control group.

CONCLUSION

Both treatments were effective in improving COP trajectory during the phases of anticipatory and weight transition, while the intervention group was more effective during the phase of locomotor. So, these treatments can be recommended for clinical settings.Implications for rehabilitationThe video game and dual task training were effective in improving COP trajectory during the phases of anticipatory and weight transition.The video game-based training was more effective during the phase of locomotor.The study findings could have useful implications to further introduce cognition-based rehabilitation programs such as video games for older adults.Rehabilitation professionals could use the video game to improve the postural control of older adults.

A Randomized Trial of Tai Chi on Preventing Hypertension and Hyperlipidemia in Middle-Aged and Elderly Patients

In our randomized controlled trial, we investigated whether Wu-style Tai Chi (Tai Chi combined with Daoyin) as a potential exercise prescription is more effective than simplified Tai Chi in the prevention and treatment of hypertension and hyperlipidemia in the middle-aged and elderly. We randomly assigned 66 patients with hypertension and hyperlipidemia to one of the two groups: the Wu-style Tai Chi group or the simplified Tai Chi group; the simplified Tai Chi group only exercised simplified Tai Chi three times a week for 6 weeks. The Wu-style Tai Chi group participated in 60 min of Wu-style Tai Chi three times a week for 6 weeks. Serum biochemical tests were conducted at baseline and at the end of the study. Measurements of blood pressure were performed at the same time. Primary outcomes were compared within and between groups at baseline and at 6 weeks. The participants in the Wu-style Tai Chi group performed, at 6 weeks, significantly better than baseline on all of the primary outcomes (p value ≤ 0.05). The results also show significant difference within the simplified Tai Chi group from baseline to 6 weeks in TCHO (mmol/L), SBP (mmHg), and LDL-C (mmol/L) (p value < 0.05). From baseline to 6 weeks, the Wu-style Tai Chi group had significant differences at more test indexes in serum and blood pressure than the simplified Tai Chi group. At 6 weeks, the Wu-style Tai Chi group had a significantly greater mean improvement in the SBP (mmHg) than did the simplified Tai Chi group (mean between-group difference, -5.80 (mmHg) [95% CI, -14.01 to 2.41]; p = 0.007). The results showed that, compared with simplified Tai Chi, Wu-style Tai Chi had a better effect on hypertension in the middle-aged and elderly. At 6 weeks in LDL-C (mmol/L), the Wu-style Tai Chi group had significantly greater improvement between the two groups (means between-group difference, -0.45 (mmol/L) [95% CI, -0.89 to -0.17]; p = 0.03). The results showed that Wu-style Tai Chi protected the cardiovascular system of the middle-aged and elderly in improving LDL-C (mmol/L), and was more significant than simplified Tai Chi. After 6 weeks of exercise, Wu-style Tai Chi could effectively improve hyperlipidemia and hypertension. The total effective rate of cardiovascular disease was 90.00%. There was significant difference in the treatment effect of hypertension and hyperlipidemia between the two groups during 6 weeks (p = 0.039), showing that, in a small population of middle-aged and elderly subjects, Wu style Tai Chi could be useful in managing important CV risk factors, such as hypertension and hyperlipidemia.

The Effect of Tai Chi Chuan on Emotional Health: Potential Mechanisms and Prefrontal Cortex Hypothesis

Deep involvement in the negative mood over long periods of time likely results in emotional disturbances/disorders and poor mental health. Tai Chi Chuan (TCC) is regarded as a typical mind-body practice combining aerobic exercise and meditation to prevent and treat negative mood. Although there are an increasing number of TCC studies examining anxiety, depression, and mental stress, the mechanisms underlying these negative emotions are not fully understood. This review study examined TCC studies related to emotional health from both clinical patients and healthy individuals. Next, several potential mechanisms from physiological, psychological, and neurological perspectives were evaluated based on direct and indirect research evidence. We reviewed recent functional magnetic resonance imaging studies, which demonstrated changes in brain anatomy and function, mainly in the prefrontal cortex, following TCC practice. Finally, the effects of TCC on emotion/mental health is depicted with a prefrontal cortex hypothesis that proposed “an immune system of the mind” indicating the role of the prefrontal cortex as a flexible hub in regulating an individual's mental health. The prefrontal cortex is likely a key biomarker among the multiple complex neural correlates to help an individual manage negative emotions/mental health. Future research is needed to examine TCC effects on mental health by examining the relationship between the executive control system (mainly prefrontal cortex) and limbic network (including amygdala, insula, and hippocampal gyrus).

Tai Chi practitioners have lower fall risks under dual-task conditions during stair descending

Stairs are among the most hazardous locations, and stair descending contributes to a high risk of falls among the elderly under dual-task (DT) conditions. The purpose of this study was to determine whether the practitioners of Tai Chi (TC), one type of mind-body exercise, have lower fall risks under DT conditions during stair descending, compared with their no-exercise (NE) counterparts. Fifteen TC practitioners with at least 10 years of experience in TC and fifteen NE participants were recruited in this study. They were asked to descend a six-step staircase under single-task (ST) and DT conditions. An eight-camera motion analysis system and two force plates were used for data collection. Results showed group by DT interactions in walking velocity (p = 0.016) and center of mass–center of pressure inclination angle (COM–COP IA) in the anteroposterior directions (p = 0.026). Group effects observed with foot clearance (p = 0.031), trunk (p = 0.041) and head (p = 0.002) tilt angles, and COM–COP IA in the mediolateral (p = 0.006) directions. Significant DT effects only detected in foot clearance (p = 0.004). Although both groups of participants adopted a more cautious gait strategy under the dual-task condition, the TC practitioners were less influenced by the DT paradigm than their NE counterparts. Our observations indicated that TC practitioners have lower fall risks under DT conditions during stair descending.

Tai Chi training's effect on lower extremity muscle co-contraction during single- and dual-task gait: Cross-sectional and randomized trial studies

BACKGROUND

Tai Chi (TC) mind-body exercise has been shown to reduce falls and improve balance and gait, however, few studies have evaluated the role of lower extremity muscle activation patterns in the observed benefits of TC on mobility.

PURPOSE

To perform an exploratory analysis of the association between TC training and levels of lower extremity muscle co-contraction in healthy adults during walking under single-task (ST) and cognitive dual-task (DT) conditions.

METHODS

Surface electromyography of the anterior tibialis and lateral gastrocnemius muscles was recorded during 90 sec trials of overground ST (walking normally) and DT (walking with verbalized serial subtractions) walking. A mean co-contraction index (CCI), across all strides, was calculated based on the percentage of total muscle activity when antagonist muscles were simultaneously activated. A hybrid study design investigated long-term effects of TC via a cross-sectional comparison of 27 TC experts and 60 age-matched TC-naïve older adults. A longitudinal comparison assessed the shorter-term effects of TC; TC-naïve participants were randomly allocated to either 6 months of TC training or to usual care.

RESULTS

Across all participants at baseline, greater CCI was correlated with slower gait speed under DT (β(95% CI) = -26.1(-48.6, -3.7)) but not ST (β(95% CI) = -15.4(-38.2, 7.4)) walking. Linear models adjusting for age, gender, BMI and other factors that differed at baseline indicated that TC experts exhibited lower CCI compared to TC naives under DT, but not ST conditions (ST: mean difference (95% CI) = -7.1(-15.2, 0.97); DT: mean difference (95% CI) = -10.1(-18.1, -2.4)). No differences were observed in CCI for TC-naive adults randomly assigned to 6 months of TC vs. usual care.

CONCLUSION

Lower extremity muscle co-contraction may play a role in the observed benefit of longer-term TC training on gait and postural control. Longer-duration and adequately powered randomized trials are needed to evaluate the effect of TC on neuromuscular coordination and its impact on postural control.

TRIAL REGISTRATION

The randomized trial component of this study was registered at ClinicalTrials.gov (NCT01340365).

Medical Qigong for Mobility and Balance Self-Confidence in Older Adults

Background/Objectives: Physical inactivity, sedentary lifestyle, and impaired neuromuscular function increases fall risk and fractures in our aging population. Mind-body modalities, improve strength, balance and coordination, mitigating these risks. This study examined whether a manualized Medical Qigong protocol measurably improves balance, gait, and health self-confidence among older adults. Design: Randomized prospective cohort pre-post study with wait time control. Setting: Two martial arts centers in Massachusetts and Arizona. Participants: Ninety-five adults age ≥ 50 (mean age 68.6 y.o., range 51-96) were randomly assigned to an immediate start group (N = 53) or 4-week delayed start group (N = 43). Intervention: A 10 form qigong protocol taught over 12 weekly classes. Measurments: Primary outcome measures were the Community Balance and Mobility Scale (CBMS) and Activities-Specific Balance Confidence (ABC) Scale. Data was collected at baseline, 1-month and 4-months. Results: Both groups at both sites demonstrated improved balance and gait (CBMS + 11.9 points, p < 0.001). This effect was strongest in patients in their 60 s (CBMS +12.9 p < 0.01) and 70 s (CBMS + 14.3, p < 0.001), was equal across genders and socioeconomic status. Balance self-confidence did not significantly change (ABC + 0.9, p = 0.48), though several elements within ABC trended toward improvement [e.g., walk up/down ramp (p = 0.07), bend over/pick up (p = 0.09)]. Falls in the past year was inversely correlated with balance self-confidence (p = 0.01). Conclusion: A 12-week manualized Medical Qigong protocol significantly improved balance and gait and modestly improved balance self-confidence among older adults. Medical Qigong may be a useful clinical intervention for older adults at heightened risk for falls and related injuries. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04430751.

Effects of wheelchair Tai Chi ball exercise on physical and mental health and functional abilities among elderly with physical disability

The purpose of this study was to examine the effect of a 12-week Wheelchair Tai Chi Ball (WTCB) intervention, a combination of mind-body exercise with strength training, on physical and mental health and functional abilities among elderly with disability. Twenty-six elderly persons participated in the study, nine WTCB group participants and ten control group participants completed the study. The WTCB group practised WTCB12 twice/week for one hour each time. The control group did their daily routine without WTCB intervention. The outcomes measures were: Pain Self-Efficacy Questionnaire (PSEQ), SF-36v2 for physical and mental health, heart rate, blood pressure, range of motion and muscle strength of the dominant arm at the shoulder, elbow and wrist joints. The Mixed Model ANOVA was employed to examine the differences between and within the two groups using pre-test and post-test scores. The results demonstrated the WTCB group had significant improvements on PSEQ, general physical health and had positive effects on maintaining muscle strength at the shoulder, elbow and wrist joints as compared to the control group. The WTCB12 exercise had positive effects on self-efficacy for pain management, general physical health, and maintain upper extremity muscle strength and is a feasible exercise for elderly with disability.

Effects of a Dual-Task Paradigm and Gait Velocity on Dynamic Gait Stability during Stair Descent

Falls during stair negotiation have become one of the leading causes of accidental death. The effects of a concurrent cognitive or manual dual-task paradigm on dynamic gait stability remain uncertain. How much dynamic gait stability is influenced by gait velocity is also not clear. A total of 16 healthy young females descended a staircase under three different walking conditions: descend stairs only (single task), descend stairs while performing subtraction (cognitive dual-task), and descend stairs while carrying a glass of water (manual dual-task). An eight-camera Vicon motion analysis system and a Kistler force plate embedded into the third step of the staircase were used synchronously to collect kinematic and kinetic data. Gait velocity decreased and dynamic gait stability increased with both cognitive and manual dual-task conditions. The center of mass–center of pressure inclination angle increased with gait velocity but decreased with the manual dual-task condition compared to the single-task condition. Changes in gait velocity caused by the dual-task paradigm can partially explain the effects of dual-task dynamic gait stability. The influence of gait velocity should be considered in the assessment of dual-task effects.

Effects of tai chi on postural control during dual-task stair negotiation in knee osteoarthritis: a randomised controlled trial protocol

INTRODUCTION

Stair ascent and descent require complex integration between sensory and motor systems; individuals with knee osteoarthritis (KOA) have an elevated risk for falls and fall injuries, which may be in part due to poor dynamic postural control during locomotion. Tai chi exercise has been shown to reduce fall risks in the ageing population and is recommended as one of the non-pharmocological therapies for people with KOA. However, neuromuscular mechanisms underlying the benefits of tai chi for persons with KOA are not clearly understood. Postural control deficits in performing a primary motor task may be more pronounced when required to simultaneously attend to a cognitive task. This single-blind, parallel design randomised controlled trial (RCT) aims to evaluate the effects of a 12-week tai chi programme versus balance and postural control training on neuromechanical characteristics during dual-task stair negotiation.

METHODS AND ANALYSIS

Sixty-six participants with KOA will be randomised into either tai chi or balance and postural control training, each at 60 min per session, twice weekly for 12 weeks. Assessed at baseline and 12 weeks (ie, postintervention), the primary outcomes are attention cost and dynamic postural stability during dual-task stair negotiation. Secondary outcomes include balance and proprioception, foot clearances, self-reported symptoms and function. A telephone follow-up to assess symptoms and function will be conducted at 20 weeks. The findings will help determine whether tai chi is beneficial on dynamic stability and in reducing fall risks in older adults with KOA patients in community.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee of the Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine (#2018KY-006-1). Study findings will be disseminated through presentations at scientific conferences or publications in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ChiCTR1800018028.

Long-term Tai Chi Training Is Associated With Better Dual-task Postural Control and Cognition in Aging Adults

OBJECTIVE

Many activities within our daily lives require us to stand upright while concurrently performing a cognitive task (ie, dual tasking). The "costs" of dual tasking can present as a detriment to either task, or even both. Evidence supports that tai chi (TC), a mind-body exercise, improves both postural control and cognition. The purpose of this study was to (1) determine whether long-term TC training reduces dual-task costs to standing postural control, and (2) determine whether it characterizes the relationship between these costs and cognition in aging adults with and without long-term TC training.

METHODS

Twenty-six TC experts (age 63 ± 8 y, TC experience 24 ± 11 y) and 60 controls (TC naïve: age 64 ± 8 y) were studied. Center-of-pressure sway speed and elliptical area were recorded during quiet and dual-task standing. In addition, postural sway speed and range were analyzed in the anterior-posterior and medial-lateral direction. Dual-task cost was calculated as the percent change in center-of-pressure outcomes from quiet to dual-task conditions. Cognition was assessed with the digit span (verbal memory), trail making test (working memory and task switching ability), category naming (semantic verbal fluency), and F-A-S test (phonemic verbal fluency).

RESULTS

TC experts had significantly lower dual-task costs to postural control in elliptical area (16.1 vs 110.4%, 95% confidence interval [CI], -94.27 to -0.07) compared with TC-naïves. TC experts also performed better on the digit span (23.5 vs 19.2; 95% CI, 0.68 to 3.59), trail making test A (28.5 vs 32.6 s; 95% CI, -3.83 to -0.21), and category naming (46.2 vs 41.3, 95%, CI 0.80 to 4.09), compared with TC naïves. There was not a clear significant association between better cognitive functioning and lower dual-task costs for either groups. These group differences and associations were independent of age, body mass index, education, and physical activity level.

CONCLUSIONS

These observations suggest cognitive-motor benefits from TC and the need for future controlled trials.

Complexity-Based Measures of Heart Rate Dynamics in Older Adults Following Long- and Short-Term Tai Chi Training: Cross-sectional and Randomized Trial Studies

Measures characterizing the complexity of heart rate (HR) dynamics have been informative in predicting age- and disease-related decline in cardiovascular health, but few studies have evaluated whether mind-body exercise can impact HR complexity. This study evaluated the effects of long-term Tai Chi (TC) practice on the complexity of HR dynamics using an observational comparison of TC experts and age- and gender-matched TC-naïve individuals. Shorter-term effects of TC were assessed by randomly assigning TC-naïve participants to either TC group to receive six months of TC training or to a waitlist control group. 23 TC experts (age = 63.3 ± 8.0 y; 24.6 ± 12.0 y TC experience) and 52 TC-naïve (age = 64.3 ± 7.7 y) were enrolled. In cross-sectional analyses, TC experts had a higher overall complexity index (CI, p = 0.004) and higher entropy at multiple individual time scales (p < 0.05); these findings persisted in models accounting for age, gender, body mass index (BMI), and physical activity levels. Longitudinal changes in complexity index did not differ significantly following random assignment to six months of TC vs. a waitlist control; however, within the TC group, complexity at select time scales showed statistically non-significant trends toward increases. Our study supports that longer-term TC mind-body training may be associated with increased complexity of HR dynamics.

Trends in Yoga, Tai Chi, and Qigong Use Among US Adults, 2002-2017

OBJECTIVES

To examine the characteristics and temporal trends of yoga, tai chi, and qigong (YTQ) use among US adults.

METHODS

Using the 2002, 2007, 2012, and 2017 National Health Interview Surveys, we examined the prevalence, patterns, and predicting factors of YTQ use by Taylor series linear regression, the Wald F χ² test, and multivariable logistic regression models (n = 116 404).

RESULTS

YTQ use increased from 5.8% in 2002 to 14.5% in 2017 (P ≤ .001). Only 6.6% of YTQ users were referred by their medical doctors, and approximately one third disclosed their use of YTQ to medical professionals. Reasons for using YTQ included (1) YTQ was beneficial, (2) YTQ focused on the whole person, and (3) YTQ was natural. Acute and chronic pain, arthritis, and depression were the top 3 medical conditions for which people used YTQ the most.

CONCLUSIONS

YTQ use is increasing substantially, mainly because of its natural and holistic healing approach toward health and chronic diseases. Future studies aiming to explore how to best integrate YTQ into the current health care system are warranted.

Long-term Tai Chi practitioners have superior body stability under dual task condition during stair ascent

BACKGROUND

Stair walking contributed to 26% of self-reported falls and become the leading cause of accidental death for the elderly. The risk of fall increases while performing a cognitive task, like talking and/or reasoning.

RESEARCH QUESTION

Our work aimed to found out whether body stability under physical-cognitive dual task(DT) condition during stair ascent is superior among long-term Tai Chi (TC) practitioners.

METHODS

Fifteen healthy, elderly long-term TC practitioners and fifteen no exercise(NE) practitioners were asked to walking ascent the stairs under single task(ST) and DT conditions in this cross-sectional study. Vicon motion analysis system and Kistler force plates were used synchronously to collect data. Ninety-five% confidence intervals, effect size and statistical power were calculated for each dependent variable to confirm significant difference.

RESULTS

Compared with NE practitioners, TC practitioners had a lower head inclination angle, trunk inclination angle, hip angle, laterial impulse and center of mass-center of pressure(COM-COP)ap/ml separation, a higher ankle angle and loading rate under DT condition; TC practitioners had a lower head inclination angle, trunk inclination angle, higher ankle angle, loading rate and COM-COPml separation under ST condition. Compared with under ST condition, TC practitioners increased in minimum foot clearance, NE practitioners increased in laterial impulse and COM-COPml separation under DT condition. Under DT condition, body stability decreased among NE practitioners, while TC practitioners remained unchanged.

SIGNIFICANCE

At present, there is no drug therapy proven to delay preclinical cognitive deterioration, it would be great helpful for the elderly if TC was been proved to improve their performance under cognitive related conditions.

The effect of Tai Chi training on the dual-tasking performance of stroke survivors: a randomized controlled trial

Objective:

To compare the effect of Tai Chi training with conventional exercise on dual-tasking performance among stroke survivors.

Design:

An assessor-blinded, randomized controlled trial.

Subjects:

Community-dwelling stroke survivors.

Setting:

Community centers and university.

Interventions:

Subjects in the Tai Chi group and the conventional exercise group were trained with the corresponding exercises for 12 weeks (1 hour/session, 2/week). No training was given to the controls.

Main measures:

An auditory Stroop test, a turning-while-walking test, and a dual-tasking condition that combined the two tests were conducted at baseline, after the intervention, and one month later.

Results:

Forty-seven subjects were randomized into Tai Chi group ( n = 15), conventional exercise group ( n = 17), or control group ( n = 15). There was no significant difference in the outcome measures among the three groups after the intervention and at the one month follow-up assessment. Within-group comparisons showed improvements in dual-tasking performance after Tai Chi training and further improvement during the follow-up period (composite score on the auditory Stroop test: pre-assessment: 73.1 ± 27.6, post-assessment: 89.9 ± 23.4, follow-up assessment: 91.7 ± 26.9; completion time of the turning-while-walking test: pre-assessment: 17.7 ± 6.9 seconds, post-assessment: 15.6 ± 5.2 seconds, follow-up assessment: 14.9 ± 4.9 seconds).

Conclusion:

Tai Chi training does not have superior effect on dual-tasking performance compared with conventional exercise among stroke survivors. Further studies with larger sample size, longer training, and follow-up periods are needed.

Tai Chi for Reducing Dual-task Gait Variability, a Potential Mediator of Fall Risk in Parkinson's Disease: A Pilot Randomized Controlled Trial

Objectives

To assess the feasibility and inform design features of a fully powered randomized controlled trial (RCT) evaluating the effects of Tai Chi (TC) in Parkinson’s disease (PD) and to select outcomes most responsive to TC assessed during off-medication states.

Design

Two-arm, wait-list controlled RCT.

Settings

Tertiary care hospital.

Subjects

Thirty-two subjects aged 40–75 diagnosed with idiopathic PD within 10 years.

Interventions

Six-month TC intervention added to usual care (UC) versus UC alone.

Outcome Measures

Primary outcomes were feasibility-related (recruitment rate, adherence, and compliance). Change in dual-task (DT) gait stride-time variability (STV) from baseline to 6 months was defined, a priori, as the clinical outcome measure of primary interest. Other outcomes included: PD motor symptom progression (Unified Parkinson’s Disease Rating Scale [UPDRS]), PD-related quality of life (PDQ-39), executive function (Trail Making Test), balance confidence (Activity-Specific Balance Confidence Scale, ABC), and Timed Up and Go test (TUG). All clinical assessments were made in the off-state for PD medications.

Results

Thirty-two subjects were enrolled into 3 sequential cohorts over 417 days at an average rate of 0.08 subjects per day. Seventy-five percent (12/16) in the TC group vs 94% (15/16) in the UC group completed the primary 6-month follow-up assessment. Mean TC exposure hours overall: 52. No AEs occurred during or as a direct result of TC exercise. Statistically nonsignificant improvements were observed in the TC group at 6 months in DT gait STV (TC [20.1%] vs UC [−0.1%] group [effect size 0.49; P = .47]), ABC, TUG, and PDQ-39. UPDRS progression was modest and very similar in TC and UC groups.

Conclusions

Conducting an RCT of TC for PD is feasible, though measures to improve recruitment and adherence rates are needed. DT gait STV is a sensitive and logical outcome for evaluating the combined cognitive-motor effects of TC in PD.

Can Tai Chi and Qigong Postures Shape Our Mood? Toward an Embodied Cognition Framework for Mind-Body Research

Dynamic and static body postures are a defining characteristic of mind-body practices such as Tai Chi and Qigong (TCQ). A growing body of evidence supports the hypothesis that TCQ may be beneficial for psychological health, including management and prevention of depression and anxiety. Although a variety of causal factors have been identified as potential mediators of such health benefits, physical posture, despite its visible prominence, has been largely overlooked. We hypothesize that body posture while standing and/or moving may be a key therapeutic element mediating the influence of TCQ on psychological health. In the present paper, we summarize existing experimental and observational evidence that suggests a bi-directional relationship between body posture and mental states. Drawing from embodied cognitive science, we provide a theoretical framework for further investigation into this interrelationship. We discuss the challenges involved in such an investigation and propose suggestions for future studies. Despite theoretical and practical challenges, we propose that the role of posture in mind-body exercises such as TCQ should be considered in future research.

Effect of Tai Chi Training on Dual-Tasking Performance That Involves Stepping Down among Stroke Survivors: A Pilot Study

Descending stairs demands attention and neuromuscular control, especially with dual-tasking. Studies have demonstrated that stroke often degrades a survivor's ability to descend stairs. Tai Chi has been shown to improve dual-tasking performance of healthy older adults, but no such study has been conducted in stroke survivors. This study investigated the effect of Tai Chi training on dual-tasking performance that involved stepping down and compared it with that of conventional exercise among stroke survivors. Subjects were randomized into Tai Chi (n = 9), conventional exercise (n = 8), and control (n = 9) groups. Those in the former two groups received 12-week training. Assessments included auditory Stroop test, stepping down test, and dual-tasking test involving both simultaneously. They were evaluated before training (time-1), after training (time-2), and one month after training (time-3). Tai Chi group showed significant improvement in the auditory Stroop test from time-1 to time-3 and the performance was significantly better than that of the conventional exercise group in time-3. No significant effect was found in the stepping down task or dual-tasking in the control group. These results suggest a beneficial effect of Tai Chi training on cognition among stroke survivors without compromising physical task performance in dual-tasking. The effect was better than the conventional exercise group. Nevertheless, further research with a larger sample is warranted.

Can Tai Chi training impact fractal stride time dynamics, an index of gait health, in older adults? Cross-sectional and randomized trial studies

Purpose

To determine if Tai Chi (TC) has an impact on long-range correlations and fractal-like scaling in gait stride time dynamics, previously shown to be associated with aging, neurodegenerative disease, and fall risk.

Methods

Using Detrended Fluctuation Analysis (DFA), this study evaluated the impact of TC mind-body exercise training on stride time dynamics assessed during 10 minute bouts of overground walking. A hybrid study design investigated long-term effects of TC via a cross-sectional comparison of 27 TC experts (24.5 ± 11.8 yrs experience) and 60 age- and gender matched TC-naïve older adults (50–70 yrs). Shorter-term effects of TC were assessed by randomly allocating TC-naïve participants to either 6 months of TC training or to a waitlist control. The alpha (α) long-range scaling coefficient derived from DFA and gait speed were evaluated as outcomes.

Results

Cross-sectional comparisons using confounder adjusted linear models suggest that TC experts exhibited significantly greater long-range scaling of gait stride time dynamics compared with TC-naïve adults. Longitudinal random-slopes with shared baseline models accounting for multiple confounders suggest that the effects of shorter-term TC training on gait dynamics were not statistically significant, but trended in the same direction as longer-term effects although effect sizes were very small. In contrast, gait speed was unaffected in both cross-sectional and longitudinal comparisons.

Conclusion

These preliminary findings suggest that fractal-like measures of gait health may be sufficiently precise to capture the positive effects of exercise in the form of Tai Chi, thus warranting further investigation. These results motivate larger and longer-duration trials, in both healthy and health-challenged populations, to further evaluate the potential of Tai Chi to restore age-related declines in gait dynamics.

Trial registration

The randomized trial component of this study was registered at ClinicalTrials.gov (NCT01340365).

Meditative Movement, Energetic, and Physical Analyses of Three Qigong Exercises: Unification of Eastern and Western Mechanistic Exercise Theory

Qigong is the meditative movement and therapeutic exercise of Eastern medicine. A growing body of evidence is validating its health benefits leading to mechanistic questions of how it works. The purpose of this article is to explore mechanisms of action related to Qigong, with the intent of unifying Eastern and Western exercise theory and to present a model for Qigong exercise analysis. Three exercises from a standardized Qigong form: ‘Plucking the Stars’, ‘Lotus Leaves Rustle in the Wind’, and ‘Pacing Forwards and Backwards’ were selected for meditative, energetic, and physical analyses. Meditative aspects include relaxation response, interoception and exteroception. Energetic aspects include stimulation of meridians through mental intent, acupressure, and self-massage. Physical aspects include flexibility, strength, articular stimulation, neuro-integration, respiratory effect, fascial stretch, visceral massage, balance challenge CranioSacral pump, lymphatic and venous return and glandular stimulation, and physiologic response to relaxation. Knowledge of mechanisms of action for specific Qigong exercises can guide operational definition of Qigong, selection of outcomes assessment in future research, inform prescriptive practice addressing clinical health issues, and advance adoption of Qigong practice within integrative health care. The model of analysis demonstrated in this discussion may assist in these endeavors.

The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study: Design and rationale of a cluster randomized controlled trial of Tai Chi in senior housing

Supporting the health of growing numbers of frail older adults living in subsidized housing requires interventions that can combat frailty, improve residents' functional abilities, and reduce their health care costs. Tai Chi is an increasingly popular multimodal mind-body exercise that incorporates physical, cognitive, social, and meditative components in the same activity and offers a promising intervention for ameliorating many of the conditions that lead to poor health and excessive health care utilization. The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study is an ongoing two-arm cluster randomized, attention-controlled trial designed to examine the impact of Tai Chi on functional indicators of health and health care utilization. We are enrolling participants from 16 urban subsidized housing facilities (n=320 participants), conducting the Tai Chi intervention or education classes and social calls (attention control) in consenting subjects within the facilities for one year, and assessing these subjects at baseline, 6months, and 1year. Physical function (quantified by the Short Physical Performance Battery), and health care utilization (emergency visits, hospitalizations, skilled nursing and nursing home admissions), assessed at 12months are co-primary outcomes. Our discussion highlights our strategy to balance pragmatic and explanatory features into the study design, describes efforts to enhance site recruitment and participant adherence, and summarizes our broader goal of post study dissemination if effectiveness and cost-effectiveness are demonstrated, by preparing training and protocol manuals for use in housing facilities across the U.S.

Effect of Yang-Style Tai Chi on Gait Parameters and Musculoskeletal Flexibility in Healthy Chinese Older Women

The purpose of the present study was to examine the effect of Yang-style Tai chi (TC) on gait parameters and musculoskeletal flexibility in healthy Chinese female adults. Sixty-six female adults aged >65 years were randomly assigned to either an experimental group (67.9 ± 3.2 years of age) receiving three 90-min simplified 24-form TC sessions for eight weeks, or a control group (67.4 ± 2.9 years of age) who maintained their daily lifestyles. All study participants were instructed to perform a selected pace walking for recording gait parameters (stride length, gait speed, swing cycle time, stance phase, and double support times) at both baseline and after the experiment. Low-limb flexibility and range of motion at specific musculoskeletal regions (hip flexion, hip extension, and plantar flexion, as well as anterior and lateral pelvic tilts, pelvic rotation, and joint range of motion (hip, knee, and ankle)) were also assessed in the present study. Multiple separate 2 × 2 Factorial Analysis of Variance (ANOVA) with repeated measures were used to examine the effects of TC on the abovementioned outcomes between baseline and posttest in the two groups. When compared to those in the control group, older female adults who experienced the 8-week Tai chi intervention demonstrated significant improvements in most of the outcome measures. More specifically, positive changes in the TC group were found, including gait parameter (p < 0.001 for all; stride length (1.12 to 1.24, +8.6%), gait speed (1.06 to 1.21, +13.9%), stance phase (66.3 to 61.8, −5.5%), swing phase (33.7 to 38.4, +10.1%), double support time (0.33 to 0.26, −21.1%)), flexibility-related outcomes (hip flexion (90.0 to 91.9, 22.6%, p < 0.0001), single hip flexor (6.0 to 2.0, −61.5%, p = 0.0386), and plantar flexion (41.6 to 49.7, +17.5%, p < 0.0001)), and range of motion (anterior pelvic tilt (9.5 to 6.2, −34.7%, p < 0.0001), lateral pelvic tilt (6.6 to 8.3, +23.8%, p = 0.0102), pelvic rotation (10.3 to 14.7, 28.2%, p < 0.0001), hip range of motion (29.8 to 32.9, +13.5%, p = 0.001), and ankle range of motion (28.0 to 32.6, +11.1%, p < 0.0001)). The present study supports the notion that the practice of TC has a positive effect on healthy older female adults in improving gait parameters and flexibility, counteracting the normal functional degeneration due to age.

The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: A systematic review and meta-analysis

PURPOSE

To systematically evaluate and quantify the effects of Tai Chi/Qigong (TCQ) on motor (UPDRS III, balance, falls, Timed-Up-and-Go, and 6-Minute Walk) and non-motor (depression and cognition) function, and quality of life (QOL) in patients with Parkinson's disease (PD).

METHODS

A systematic search in 7 electronic databases targeted clinical studies evaluating TCQ for individuals with PD published through August 2016. Meta-analysis was used to estimate effect sizes (Hedges's g) and publication bias for randomized controlled trials (RCTs). Methodological bias in RCTs was assessed by two raters.

RESULTS

Our search identified 21 studies, 15 of which were RCTs with a total of 735 subjects. For RCTs, comparison groups included no treatment (n = 7, 47%) and active interventions (n = 8, 53%). Duration of TCQ ranged from 2 to 6 months. Methodological bias was low in 6 studies, moderate in 7, and high in 2. Fixed-effect models showed that TCQ was associated with significant improvement on most motor outcomes (UPDRS III [ES = -0.444, p < 0.001], balance [ES = 0.544, p < 0.001], Timed-Up-and-Go [ES = -0.341, p = 0.005], 6 MW [ES = -0.293, p = 0.06], falls [ES = -0.403, p = 0.004], as well as depression [ES = -0.457, p = 0.008] and QOL [ES = -0.393, p < 0.001], but not cognition [ES = -0.225, p = 0.477]). I² indicated limited heterogeneity. Funnel plots suggested some degree of publication bias.

CONCLUSION

Evidence to date supports a potential benefit of TCQ for improving motor function, depression and QOL for individuals with PD, and validates the need for additional large-scale trials.

Bienfaits du tai-chi sur la santé

Objectif

Résumer les données probantes sur les bienfaits du tai-chi sur la santé.

Sources d’information

Une revue de la littérature sur les bienfaits du tai-chi sur 25 affections différentes, de même que sur la santé en général et sur la forme physique, a été effectuée afin d’actualiser une revue des revues systématiques effectuée en 2014. Les revues systématiques et les essais cliniques récents ont été évalués et organisés en 5 groupes : données excellentes, bonnes, acceptables ou préliminaires, étayant un bienfait ou n’étayant aucun bienfait direct.

Message principal

Au cours des 45 dernières années, plus de 500 essais et 120 revues systématiques ont été publiés sur les bienfaits du tai-chi sur la santé. Les revues systématiques sur le tai-chi pour différentes affections ont donné lieu à d’excellentes données étayant un bienfait pour la prévention des chutes, l’arthrose, la maladie de Parkinson, la réadaptation dans les cas de maladie pulmonaire obstructive chronique et l’amélioration de la capacité cognitive chez les personnes âgées. Il existe de bonnes données étayant un bienfait pour la dépression, la réadaptation cardiaque et après un AVC et la démence. Les données étayant un bienfait pour l’amélioration de la qualité de vie des patients atteints de cancer, de fibromyalgie, d’hypertension et d’ostéoporose sont acceptables. Les données actuelles étayent l’absence d’un bienfait direct pour le diabète, la polyarthrite rhumatoïde ou l’insuffisance cardiaque chronique. Les revues systématiques portant sur les bienfaits sur la santé en général et la forme physique font état d’excellentes données étayant un bienfait pour l’amélioration de l’équilibre et de la capacité aérobique chez les personnes en mauvaise forme physique. Les données étayant une plus grande force dans les membres inférieurs sont bonnes. Les données étayant une amélioration du bien-être et du sommeil sont acceptables. Aucune étude n’a révélé que le tai-chi aggravait une affection. Une récente revue systématique sur l’innocuité du tai-chi a révélé que les événements indésirables étaient habituellement mineurs et principalement de nature musculosquelettique; aucun événement indésirable grave lié au tai-chi n’a été rapporté.

Conclusion

Il existe d’abondantes données étayant les effets du tai-chi sur la santé et la forme physique. En s’appuyant sur ces données, les médecins peuvent maintenant faire des recommandations éclairées à leurs patients, en précisant que le tai-chi fait toujours l’objet de recherches. Aussi, toute affection clinique doit faire l’objet d’un suivi médical continu.

Health benefits of tai chi: What is the evidence?

OBJECTIVE

To summarize the evidence on the health benefits of tai chi.

SOURCES OF INFORMATION

A literature review was conducted on the benefits of tai chi for 25 specific conditions, as well as for general health and fitness, to update a 2014 review of systematic reviews. Systematic reviews and recent clinical trials were assessed and organized into 5 different groups: evidence of benefit as excellent, good, fair, or preliminary, or evidence of no direct benefit.

MAIN MESSAGE

During the past 45 years more than 500 trials and 120 systematic reviews have been published on the health benefits of tai chi. Systematic reviews of tai chi for specific conditions indicate excellent evidence of benefit for preventing falls, osteoarthritis, Parkinson disease, rehabilitation for chronic obstructive pulmonary disease, and improving cognitive capacity in older adults. There is good evidence of benefit for depression, cardiac and stroke rehabilitation, and dementia. There is fair evidence of benefit for improving quality of life for cancer patients, fibromyalgia, hypertension, and osteoporosis. Current evidence indicates no direct benefit for diabetes, rheumatoid arthritis, or chronic heart failure. Systematic reviews of general health and fitness benefits show excellent evidence of benefit for improving balance and aerobic capacity in those with poor fitness. There is good evidence for increased strength in the lower limbs. There is fair evidence for increased well-being and improved sleep. There were no studies that found tai chi worsened a condition. A recent systematic review on the safety of tai chi found adverse events were typically minor and primarily musculoskeletal; no intervention-related serious adverse events have been reported.

CONCLUSION

There is abundant evidence on the health and fitness effects of tai chi. Based on this, physicians can now offer evidence-based recommendations to their patients, noting that tai chi is still an area of active research, and patients should continue to receive medical follow-up for any clinical conditions.

The Effect of Tai Chi on Reducing the Risk of Falling: A Systematic Review and Meta-Analysis

Tai Chi has frequently been used as a preventive measure against falling in at-risk populations. However, studies have yielded contradictory results, and literature reviews have considered only a small number of trials and have not addressed some key aspects, such as sources of heterogeneity and publication bias. This study includes 13 controlled trials published before June 2015 that analyzed the effectiveness of Tai Chi in fall prevention in populations of frail and at-risk adults. The effect measure used in this meta-analysis was absolute risk reduction (ARR) with a 95% confidence interval (CI). According to our findings, practice of Tai Chi significantly prevents the risk of falling (ARR, [Formula: see text]; 95% CI: [Formula: see text], [Formula: see text]). The heterogeneity of results across the trials was low, with a reduced risk of publication bias, and no significant effect differences were observed between studies comparing Tai Chi with other interventions or non-treatment. We therefore conclude that Tai Chi is more effective than other measures, or no intervention, for fall prevention in at-risk populations. Further research is warranted to analyze the consequences of falls and to study the episodes rather than the cases of falls.

Prevalence, Patterns, and Predictors of T'ai Chi and Qigong Use in the United States: Results of a Nationally Representative Survey

OBJECTIVE

This study examined the prevalence, patterns, and predictors of t'ai chi and qigong use in the U.S. general population.

DESIGN

Cross-sectional survey.

METHODS

Data from the 2012 National Health Interview Survey (n = 34,525). Weighted frequencies were used to analyze lifetime and 12-month prevalence and patterns of use. Independent predictors of practice were analyzed by using logistic regression models. Analyzes were conducted in 2015.

RESULTS

The lifetime and 12-month prevalence of t'ai chi/qigong practice were 3.1% and 1.2%, respectively. The 12-month prevalence was associated with age older than 30 years; being African American, Asian, or other ethnic origin; living in the West; being college educated and single; and being a light to heavy alcohol consumer. Almost 39% of users attended formal classes. T'ai chi/qigong was practiced for wellness/disease prevention and to improve energy, immune function, athletic performance, or memory/concentration. Stress, arthritis, and joint problems were the most frequent specific health problems for practice.

CONCLUSIONS

Despite an only marginal increase of t'ai chi/qigong practice in the United States over the past 10 years, the proportion of minorities among practitioners has increased significantly. Gaps between clinical application and research are discussed.

Impact of Short- and Long-term Tai Chi Mind-Body Exercise Training on Cognitive Function in Healthy Adults: Results From a Hybrid Observational Study and Randomized Trial

BACKGROUND

Cognitive decline amongst older adults is a significant public health concern. There is growing interest in behavioral interventions, including exercise, for improving cognition. Studies to date suggest tai chi (TC) may be a safe and potentially effective exercise for preserving cognitive function with aging; however, its short-term and potential long-term impact on physically active, healthy adults is unclear.

OBJECTIVE

To compare differences in cognitive function among long-term TC expert practitioners and age-matched and gender-matched TC-naïve adults and to determine the effects of short-term TC training on measures of cognitive function in healthy, nonsedentary adults.

DESIGN

A hybrid design including an observational comparison and a 2-arm randomized clinical trial (RCT).

PARTICIPANTS

Healthy, nonsedentary, TC-naive adults (50 y-79 y) and age-matched and gender-matched long-term TC experts.

METHODS

A cross-sectional comparison of cognitive function in healthy TC-naïve (n=60) and TC expert (24.5 y ÷ 12 y experience; n=27) adults: TC-naïve adults then completed a 6-month, 2-arm, wait-list randomized clinical trial of TC training. Six measures of cognitive function were assessed for both cross-sectional and longitudinal comparisons.

RESULTS

TC experts exhibited trends towards better scores on all cognitive measures, significantly so for category fluency (P=.01), as well as a composite z score summarizing all 6 cognitive assessments (P=.03). In contrast, random assignment to 6 months of TC training in TC-naïve adults did not significantly improve any measures of cognitive function.

CONCLUSIONS

In healthy nonsedentary adults, long-term TC training may help preserve cognitive function; however, the effect of short-term TC training in healthy adults remains unclear.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01340365.