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Is a fall prevention–specific tai ji quan intervention clinically more effective in reducing falls among older adults at high risk of falling than a stretching intervention (control) or a standard multimodal exercise intervention?
In a randomized clinical trial involving 670 adults 70 years or older with a history of falls or impaired mobility, the therapeutic tai ji quan intervention effectively reduced falls by 58% compared with the stretching exercise (control intervention) and by 31% compared with a multimodal exercise intervention.
For older adults at high risk of falling, a therapeutically tailored tai ji quan intervention was more effective than stretching or multimodal exercises in reducing the incidence of falls.
Falls in older adults are a serious public health problem associated with irreversible health consequences and responsible for a substantial economic burden on health care systems. However, identifying optimal choices from among evidence-based fall prevention interventions is challenging as few comparative data for effectiveness are available.
To determine the effectiveness of a therapeutically tailored tai ji quan intervention, Tai Ji Quan: Moving for Better Balance (TJQMBB), developed on the classic concept of tai ji (also known as tai chi), and a multimodal exercise (MME) program relative to stretching exercise in reducing falls among older adults at high risk of falling.
Design, Setting, and Participants
A single-blind, 3-arm, parallel design, randomized clinical trial (February 20, 2015, to January 30, 2018), in 7 urban and suburban cities in Oregon. From 1147 community-dwelling adults 70 years or older screened for eligibility, 670 who had fallen in the preceding year or had impaired mobility consented and were enrolled. All analyses used intention-to-treat assignment.
One of 3 exercise interventions: two 60-minute classes weekly for 24 weeks of TJQMBB, entailing modified forms and therapeutic movement exercises; MME, integrating balance, aerobics, strength, and flexibility activities; or stretching exercises.
Main Outcomes and Measures
The primary measure at 6 months was incidence of falls.
Among 670 participants randomized, mean (SD) age was 77.7 (5.6) years, 436 (65%) were women, 617 (92.1%) were white, 31 (4.6%) were African American. During the trial, there were 152 falls (85 individuals) in the TJQMBB group, 218 (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. At 6 months, the incidence rate ratio (IRR) was significantly lower in the TJQMBB (IRR, 0.42; 95% CI, 0.31-0.56; P < .001) and MME groups (IRR, 0.60; 95% CI, 0.45-0.80; P = .001) compared with the stretching group. Falls were reduced by 31% for the TJQMBB group compared with the MME group (IRR, 0.69; 95% CI, 0.52-0.94; P = .01).
Conclusions and Relevance
Among community-dwelling older adults at high risk for falls, a therapeutically tailored tai ji quan balance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls.
ClinicalTrials.gov identifier: NCT02287740
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Accepted for Publication: June 21, 2018.
Published Online: September 10, 2018. doi:10.1001/jamainternmed.2018.3915
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2018 Li F et al. JAMA Internal Medicine.
Corresponding Author: Fuzhong Li, PhD, School of Kinesiology, Shanghai University of Sport, 200 Changhai Rd, Shanghai, China, 200438 (firstname.lastname@example.org).
Author Contributions: Drs Li and Harmer had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Li, Harmer, Voit.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Li, Harmer.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Li, Akers.
Obtained funding: Li, Harmer.
Administrative, technical, or material support: Li, Voit.
Supervision: Li, Fitzgerald.
Conflict of Interest Disclosures: Dr Li, reported that he is the founder and owner of Exercise Alternatives, LLC, a consulting company, and that a licensing fee for Tai Ji Quan: Moving for Better Balance is paid directly to this company. No other disclosures were reported.
Funding/Support: This work was supported by grant AG045094 from the National Institute on Aging.
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank the intervention instructors and the research staff for their dedication to this study. Appreciation is also extended to all the volunteers who participated in this project.
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