An Intervention Study for Preventing Falls

Falls have a major impact on the overall health of seniors, and physical activity can help lower the risk of falls. In a case-control study of individuals older than 65 years of age, subjects who practiced vigorous physical activity and had no limitations to their activities of daily living (ADL) had an adjusted odds ratio of 0.6 for fall compared with that for sedentary adults.^[1] However, active adults with a limitation in ADL actually experienced an increased risk of fall compared with inactive seniors (adjusted odds ratio = 3.2). Meanwhile, mild physical activity alone had little impact on the risk of falls.

Physical activity and disability are certainly not the only variables increasing the risk of fall. In a prospective study of 528 participants with a mean age of 77 years, participants who judged themselves to be at higher risk of falls had an adjusted relative risk of falling of 2.09 compared with subjects who reported a lower self-assessed risk of falls.^[2] Moreover, subjects reporting a higher risk for falls had lower scores in the performance of ADL and overall health, and they were more likely to be placed in a care facility. The reduction in ADL was not related to a higher rate of falls among these subjects.

Based on these studies, it is clear that improving older patients’ physical function as well as their fear of falling may reduce negative outcomes. Tai chi may offer a low-cost, low-impact solution toward both of these goals. In this study, one-leg balance and trunk flexion were improved with a practical program of only 8 weeks of Tai Chi. While walking velocity was not improved with exercise, the perceived risk of falling fell in the Tai Chi vs control groups.

Other research has also supported the physical and even cardiovascular benefits of Tai Chi for older adults. In a group of community-dwelling seniors who were randomized to Tai Chi or no treatment, Tai Chi improved all measures of physical function.^[3] In this longer trial of Tai Chi, this program improved the ability of participants to perform both walking and more vigorous activities such as running. In a cross-sectional study comparing Tai Chi practitioners with an average of 13.2 years of experience with a control group of sedentary older adults, Tai Chi was associated with a reduced resting heart rate and reduced post-exercise heart rate.^[4] In this same study, Tai Chi improved the ability to sit and reach, total body rotation, and standing on one leg with eyes closed.

Physicians in Western countries might question whether older adults will accept Tai Chi as a form of exercise. A study of 130 seniors in the Southern United States found that older adults derived similar balance and movement benefits after randomization to programs of Tai Chi or individualized balance training, but only participants performing Tai Chi reported that their ADL and overall life was improved with the training program.^[5] Many subjects in the Tai Chi group continued their exercise program after the study had concluded.

The main fault with the current study is that it failed to measure the rate of falling, instead using surrogates of fall risk. However, a longer trial period with more patients would have been necessary to demonstrate a difference in this outcome. Although the researchers used a validated instrument to measure fear of falling, they could not be sure that its validity could be maintained after being translated into Chinese. Finally, other factors, including increased social contact through Tai Chi classes, could have also contributed to a decreased fear of falling.

This study is made stronger through its selection of participants. The authors focused on older adults with problems with balance and no prior experience with Tai Chi. This study helps reinforce other research regarding the value of Tai Chi in older adults. Whether performed alone or in a group environment, it appears that Tai Chi can provide important physical and psychological benefits for older adults. Physicians should keep this in mind when counseling older adults at risk of falling.

References

Stevens JA, Powell KE, Smith SM, Wingo PA, Sattin RW. Physical activity, functional limitations, and the risk of fall-related fractures in community-dwelling elderly. Ann Epidemiol. 1997;7:54-61.
Cumming RG, Salkeld G, Thomas M, Szonyi G. Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. J Gerontol A Biol Sci Med Sci. 2000;55:M299-M305.
Li F, Harmer P, McAuley E, Duncan TE, et al. An evaluation of the effects of Tai Chi exercise on physical function among older persons: a randomized controlled trial. Ann Behav Med. 2001;23:139-146.
Hong Y, Li JX, Robinson PD. Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners. Br J Sports Med. 2000;34:29-34.
Kutner NG, Barnhart H, Wolf SL, McNeely E, Xu T. Self-report benefits of Tai Chi practice by older adults. J Gerontol B Psychol Sci Soc Sci. 1997;52:P242-P246.