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Tai Chi: Preventing falls in the aging population

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Falls are one of the major causes of hospitalizations in the aging population. In fact, one third of all individuals over the age of 65 will experience at least one fall in a 12 month period and of those falls more than 50% of them will result in at least some minor injury for which they will have to seek medical attention. Furthermore, falls in the elderly can result in morbidity and mortality if individuals sustain brain bleeds or broken hips and legs. Approximately 5-15% of the falls in the aging population will require hospitalization.

Though, most people do not like to admit that they are getting older, it's simply an unavoidable process that we must all be prepared for. Part of being prepared is being aware of what one can do to help stay healthy. Most of us are aware that we need to watch our cholesterol and blood pressure and that we should be active both mentally and physically to keep our bodies sound, but what something that many people likely have never heard of is that all exercise is not created equally with regards to preventing falls.

Though I am a strong proponent of strength training and cardiovascular training in all age groups, there is only one type of training that has actually been shown to reduce falls and therefore reduce morbidity in the aging population: Tai Chi.

T'ai chi ch'uan, more commonly known as tai chi is one of the more ancient forms of exercise that traces its origins back to ancient china. It translates to "Supreme ultimate fist/boxing." Tai Chi finds itself classified under the Wudang grouping of martial arts and is commonly typified by the slow movements in which the participants often demonstrate, but there are several subtypes of Tai Chi that also involve faster actions as well.

There are five main styles of Tai Chi: Chen, Hao, Sun, Wu, and Yang. Overall, the philosophy of tai chi is historically intertwined with the Taoist and Confucius mindsets. Though there are five elements in traditional Tai Chi, the neigong and qigong elements of the Yang style, involving meditation and awareness of breathing and body movements are the elements that are most commonly employed in Tai Chi exercises aimed for fall reduction in the aging population.

So how much data is there to suggest that this is truly an effective method of exercise to reduce falls in the aging population? Well, this has been a pretty hot topic globally since the early 2000s. There have been several strong studies involving 100s of individuals aged 65 and up as well as several comparison studies as well. For example, one of the first studies to examine tai chi in the elderly involved a 15-week trial that examined aging adults who were enrolled in a Tai Chi group and compared them to a control exercise group, doing simple stretches. They reported a 47% decrease in relative risk for multiple falls among the participants in the Tai Chi group as compared to their control.

Another study from 2005 published by Li et al in the Journal of Gerontology, aimed to follow up the previous studies by examining the efficacy of a 6-month trial of Tai Chi. They recruited their patients from a data base in Portland, Oregon and randomized 256 people (70-92 years old) and placed them into either a 3x per week Tai Chi group or a 3x per week stretching group and assessed the participants on a number of outcome scales including falls, balance, gait and even speed walks. They looked at the participants at baseline, 3 months, 6 months, and then again 6 months after they stopped the 3x per week classes to determine if the gains obtained from the exercises were actually maintained.

At the end of their 6 month trial, they found that significantly fewer falls occurred in the Tai Chi group as compared to the stretching group (38 vs. 73). They also reported that although some initial fall reduction was seen after the first month, it took 3 months of training before they were able to observe the more significant reductions in falls. When comparing injuries, they found that 7 of the Tai Chi participants versus 17 of the controls reported injurious falls during the trial period. Furthermore, they observed that of the individuals who fell during the trial the Tai Chi participants required fewer medical appointments.

Overall, after the end of the 6 month period following the exercise intervention, the Tai Chi group displayed 3.16 falls per 100 participants vs. 8.96 per 100 participants in the control group, providing evidence that the gains obtained from even a transient period may be maintained and prove helpful in reducing falls in the aging population.

These are just two of a number of papers that have found links between the practice of Tai Chi in the aging population and the apparent benefits is may have in reducing falls and fall morbidity/mortality. A 2008 review article in the Archives of Gerontology, examined a number of studies, comparing methods, design, and outcomes. They determined that there may be several factors that influence the effectiveness of Tai Chi participation.

The factor that seemed to play the biggest role in the outcomes of the various studies in which they reviewed was age. The studies in which the mean age was 69 seemed to have better outcomes than the studies with mean ages of 77.5 and 76.2. Though seemingly obvious it's important to consider how this may affect the data in some studies, which selected an older population because the effects of Tai Chi may be underrepresented in this population, though overall beneficial. Furthermore, it suggests that Tai Chi may be most beneficial for the aging individual who is still relatively young and non-fragile with fewer medical conditions because these individuals seemed to reap the most from this exercise modality.

Aging is an inevitable feature of life that doesn't mean that an individual will be bedridden and in poor health. With the increases in life expectancies associated with modern medicine, we are constantly looking at ways to improve the more chronic effects of aging and reduce the overall morbidity and mortality that can be associated with advancing age. Tai Chi is a wonderful way to stay active, socialize and possibly open up a whole new exercise world for a population that may not always feel the most comfortable in a community gym.

In fact, many state governments are even beginning to subsidize Tai Chi programs at local YMCAs designed especially for people aged 65 and up. Tai Chi not only improves one's body awareness ( proprioception), but may also even lead to improvements in happiness and overall stress-relief as well. It's an activity that requires few resources and can be implemented and catered to people of all walks of life and financial backgrounds.

Something as simple as preventing falls as we age can drastically improve and lengthen the lives of many. Though not typically in the forefront of our minds as we go about daily living, the numbers don't lie when we look at hospital records. Falls can be deadly. Falls can alter one's life as they know it, even permanently decreasing one's ability to maintain an independent lifestyle and ability to ambulate. Keeping healthy is not always easy, but it's the simple changes we can make that may add up to help keep us going stronger and longer.

Please feel free to leave me any comments, feedback, concerns, or insight on this page or email me at c_meltsakos@nymc.edu. Also, if you like what you've read subscribe to the feed to get my articles sent directly to your inbox!

Resources

Blake AJ, Morgan K, Bendall MJI, Dallosso H, Ebrahim SBJ, Arie THD, Fenem PH, Bassey EJ: Falls by elderly people at home: prevalence and associated factors. Age Aging. 17:365-372, 1988.

Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, Wilson NL: Tai Chi and fall reductions in older adults: a randomized control trial. Journal of Gerontology. 60A:187-194, 2005.

Logghe IHJ, Verhagen AP, Rademaker ACHJ et al: The effects of Tai Chi on fall prevention, fear of falling and balance in older people: a meta-analysis. Prev Med. 51:222-227, 2010.

Low S, Lang LW, Goh KS, Chew SK: A systematic review of the effectiveness of Tai Chi on fall reduction among the elderly. Archives of Gerontology and Geriatrics. 1848:1-7, 2008.

Robertson MC, Gardner MM, Devlin N, McGee R, Campbell AJ: Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. British Journal of Medicine. 322:1-5, 2001.

Taylor D, Hale L, Schlute P, Waters DL, Binns EE, McCracken H, McPherson K: Effectiveness of Tai Chi as a community based falls prevention intervention: a randomized control trial. Journal of the American Geriatrics Society. 60(5):841-848, 2012.

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