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Thread: Tai Chi as medicine

  1. #256
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    statistically noninferior

    Tai Chi Chih Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial

    Michael R. Irwin, Richard Olmstead, Carmen Carrillo, Nina Sadeghi, Perry Nicassio, Patricia A. Ganz, and

    Abstract

    Purpose
    Cognitive behavioral therapy for insomnia (CBT-I) and Tai Chi Chih (TCC), a movement meditation, improve insomnia symptoms. Here, we evaluated whether TCC is noninferior to CBT-I for the treatment of insomnia in survivors of breast cancer.

    Patients and Methods
    This was a randomized, partially blinded, noninferiority trial that involved survivors of breast cancer with insomnia who were recruited from the Los Angeles community from April 2008 to July 2012. After a 2-month phase-in period with repeated baseline assessment, participants were randomly assigned to 3 months of CBT-I or TCC and evaluated at months 2, 3 (post-treatment), 6, and 15 (follow-up). Primary outcome was insomnia treatment response—that is, marked clinical improvement of symptoms by the Pittsburgh Sleep Quality Index—at 15 months. Secondary outcomes were clinician-assessed remission of insomnia; sleep quality; total sleep time, sleep onset latency, sleep efficiency, and awake after sleep onset, derived from sleep diaries; polysomnography; and symptoms of fatigue, sleepiness, and depression.

    Results
    Of 145 participants who were screened, 90 were randomly assigned (CBT-I: n = 45; TCC: n = 45). The proportion of participants who showed insomnia treatment response at 15 months was 43.7% and 46.7% in CBT-I and TCC, respectively. Tests of noninferiority showed that TCC was noninferior to CBT-I at 15 months (P = .02) and at months 3 (P = .02) and 6 (P < .01). For secondary outcomes, insomnia remission was 46.2% and 37.9% in CBT-I and TCC, respectively. CBT-I and TCC groups showed robust improvements in sleep quality, sleep diary measures, and related symptoms (all P < .01), but not polysomnography, with similar improvements in both groups.

    Conclusion
    CBT-I and TCC produce clinically meaningful improvements in insomnia. TCC, a mindful movement meditation, was found to be statistically noninferior to CBT-I, the gold standard for behavioral treatment of insomnia.
    Tai Chi Chih as Medicine
    Gene Ching
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  2. #257
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    Tai Chi and Qigong for cancer-related symptoms and quality of life

    Tai Chi and Qigong for cancer-related symptoms and quality of life: a systematic review and meta-analysis.
    December 12, 2017
    This study aims to summarize and critically evaluate the effects of Tai Chi and Qigong (TCQ) mind-body exercises on symptoms and quality of life (QOL) in cancer survivors.

    A systematic search in four electronic databases targeted randomized and non-randomized clinical studies evaluating TCQ for fatigue, sleep difficulty, depression, pain, and QOL in cancer patients, published through August 2016. Meta-analysis was used to estimate effect sizes (ES, Hedges' g) and publication bias for randomized controlled trials (RCTs). Methodological bias in RCTs was assessed.

    Our search identified 22 studies, including 15 RCTs that evaluated 1283 participants in total, 75% women. RCTs evaluated breast (n = 7), prostate (n = 2), lymphoma (n = 1), lung (n = 1), or combined (n = 4) cancers. RCT comparison groups included active intervention (n = 7), usual care (n = 5), or both (n = 3). Duration of TCQ training ranged from 3 to 12 weeks. Methodological bias was low in 12 studies and high in 3 studies. TCQ was associated with significant improvement in fatigue (ES = - 0.53, p < 0.001), sleep difficulty (ES = - 0.49, p = 0.018), depression (ES = - 0.27, p = 0.001), and overall QOL (ES = 0.33, p = 0.004); a statistically non-significant trend was observed for pain (ES = - 0.38, p = 0.136). Random effects models were used for meta-analysis based on Q test and I 2 criteria. Funnel plots suggest some degree of publication bias. Findings in non-randomized studies largely paralleled meta-analysis results.

    Larger and methodologically sound trials with longer follow-up periods and appropriate comparison groups are needed before definitive conclusions can be drawn, and cancer- and symptom-specific recommendations can be made.

    TCQ shows promise in addressing cancer-related symptoms and QOL in cancer survivors.

    Journal of cancer survivorship : research and practice. 2017 Dec 08 [Epub ahead of print]

    Peter M Wayne, M S Lee, J Novakowski, K Osypiuk, J Ligibel, L E Carlson, R Song

    Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, 900 Commonwealth Avenue, 3rd floor, Boston, MA, 02215, USA. pwayne@partners.org., Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea., Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, 900 Commonwealth Avenue, 3rd floor, Boston, MA, 02215, USA., Zakim Center for Integrative Therapies and Healthy Living, Dana Farber Cancer Institute, Boston, MA, USA., Cumming School of Medicine, University of Calgary, Calgary, AB, Canada., College of Nursing, Chungnam National University, Daejeon, Republic of Korea.

    PubMed http://www.ncbi.nlm.nih.gov/pubmed/29222705
    More medicinal Qigong & Tai Chi
    Gene Ching
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  3. #258
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    VA Tai Chi Program

    Time to split off an indie thread dedicated to Tai Chi, Veterans & PTSD from our Tai Chi as medicine thread. This is important work.

    Local VA Offers 1st Ever Tai Chi Program For Veterans
    Alexandra Koehn
    3:22 PM, Feb 8, 2018
    9:03 PM, Feb 8, 2018


    The VA in Murfreesboro has offered a class to veterans that’s the first of its kind at any VA in the country. Veterans have been learning the art of tai chi, and it’s been changing their lives.

    MURFREESBORO, Tenn. - The Department of Veterans Affairs in Murfreesboro offers the only adaptive Tai Chi class in the country for veterans.

    After recognizing success from the pilot program, the instructor has been training people across the country on how to incorporate Tai Chi into VA programs.

    In the community room, socialization has helped some veterans find peace of mind.

    "Research has demonstrated that Tai Chi is one of the most effective ways of maintaining mind body health," Dr. Zibin Guo said.

    Guo helped launch the program two years ago. He said it was made possible by a grant.

    Mindfulness is something that's imperative for veterans like Bruce Stophlet.

    "Not the past, not tomorrow. Just now," Stophlet said.

    Stophlet said the class has helped him physically and mentally. He suffers from post traumatic stress disorder, anxiety, depression, and a neurological condition.

    "I have an issue with tremors and they tend to exacerbate when I'm in a stressful situation or around people," Stophlet said.

    In Tai Chi class, he said he's able to achieve peace of mind.

    "It's more than just the Tai Chi," Stophlet said. "It's just a comfort place. It's mindfulness. When we're working together."

    Eventually the veterans in the class will be able to learn self defense through the martial arts practice.

    "A lot of people find the practice and the idea of those movements and improve self confidence," Dr. Guo said.

    So when these veterans go home, they have a new mission: to practice mindfulness, so they can heal.

    "The mind is very powerful," Guo said. "It can make your body become anything you want to."

    Aaron Grobengieser helps to manage the program.

    “We don’t just have to be there for them when they’re having an acute problem, and we can really help them find ways to cope with some of the things they go through in a proactive way," Grobengieser said.

    He said if you are a veteran, the class is free at the Murfreesboro location.

    “We are a starting point. We are a flagship. We are an opportunity to see how it goes. We have a great opportunity here to really see what works," Grobengieser said.

    Dr. Guo has recently visited the VA in Dallas and Salt Lake City to train instructors there in Tai Chi. He hopes to launch the programs soon.
    Gene Ching
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  4. #259
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    New British Medical Journal report

    The visual abstract is really helpful but I'd have to screen shot that to copy it here. Just follow the link below. This is the source of all the fibromyalgia news.


    Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial

    BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k851 (Published 21 March 2018)
    Cite this as: BMJ 2018;360:k851

    Chenchen Wang, director and professor of medicine1, Christopher H Schmid, professor of biostatistics and co-director2, Roger A Fielding, director and professor of medicine3, William F Harvey, assistant professor of medicine1, Kieran F Reid, scientist III3, Lori Lyn Price, statistician4, Jeffrey B Driban, assistant professor of medicine1, Robert Kalish, associate professor of medicine5, Ramel Rones, tai chi instructor6, Timothy McAlindon, division chief and professor of medicine1
    Author affiliations
    Correspondence to: C Wang cwang2@tuftsmedicalcenter.org
    Accepted 13 February 2018
    Abstract
    Objectives To determine the effectiveness of tai chi interventions compared with aerobic exercise, a current core standard treatment in patients with fibromyalgia, and to test whether the effectiveness of tai chi depends on its dosage or duration.

    Design Prospective, randomized, 52 week, single blind comparative effectiveness trial.

    Setting Urban tertiary care academic hospital in the United States between March 2012 and September 2016.

    Participants 226 adults with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010 criteria) were included in the intention to treat analyses: 151 were assigned to one of four tai chi groups and 75 to an aerobic exercise group.

    Interventions Participants were randomly assigned to either supervised aerobic exercise (24 weeks, twice weekly) or one of four classic Yang style supervised tai chi interventions (12 or 24 weeks, once or twice weekly). Participants were followed for 52 weeks. Adherence was rigorously encouraged in person and by telephone.

    Main outcome measures The primary outcome was change in the revised fibromyalgia impact questionnaire (FIQR) scores at 24 weeks compared with baseline. Secondary outcomes included changes of scores in patient’s global assessment, anxiety, depression, self efficacy, coping strategies, physical functional performance, functional limitation, sleep, and health related quality of life.

    Results FIQR scores improved in all five treatment groups, but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks (difference between groups=5.5 points, 95% confidence interval 0.6 to 10.4, P=0.03) and several secondary outcomes (patient’s global assessment=0.9 points, 0.3 to 1.4, P=0.005; anxiety=1.2 points, 0.3 to 2.1, P=0.006; self efficacy=1.0 points, 0.5 to 1.6, P=0.0004; and coping strategies, 2.6 points, 0.8 to 4.3, P=0.005). Tai chi treatment compared with aerobic exercise administered with the same intensity and duration (24 weeks, twice weekly) had greater benefit (between group difference in FIQR scores=16.2 points, 8.7 to 23.6, P<0.001). The groups who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks (difference in FIQR scores=9.6 points, 2.6 to 16.6, P=0.007). There was no significant increase in benefit for groups who received tai chi twice weekly compared with once weekly. Participants attended the tai chi training sessions more often than participants attended aerobic exercise. The effects of tai chi were consistent across all instructors. No serious adverse events related to the interventions were reported.

    Conclusion Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement. This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia.
    Gene Ching
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  5. #260
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    Copd

    Practicing Tai Chi helps improve respiratory function in patients with COPD
    Tai Chi offers a low-cost, easily accessible alternative to pulmonary rehabilitation, according to a new study in the journal CHEST®
    April 4, 2018

    Glenview, IL – Finding ways to help patients with COPD improve their functional status is an area of interest for pulmonary healthcare providers. Currently, pulmonary rehabilitation (PR) is used where available to improve exercise capacity and quality of life, but the treatment requires access to trained staff and specialized facilities. A new study in the journal CHEST® looked at Tai Chi as a lower cost, more easily accessed treatment option. Investigators found that this slow, methodical form of exercise is equivalent to PR for improving respiratory function in patients with COPD.

    Tai Chi, an ancient martial art that involves significant levels of physical exertion, is gaining popularity, especially among older people, across the globe. Originating in China, Tai Chi incorporates stretching, breathing, and coordinated movement and requires no special equipment. “Knowing the potential benefits of Tai Chi, we hypothesized that, in patients being treated with medication to manage their COPD symptoms, it could help improve the quality of life when compared to a course of classical western style PR,” noted Professor Nan-Shan Zhong, MD, State Key Laboratory of Respiratory Disease, Guangzhou, China.

    The study tracked 120 patients with COPD in rural China who had never used a bronchodilator. After beginning daily treatment with indacaterol, subjects were randomly assigned to groups receiving traditional PR or Tai Chi. Both the Tai Chi and PR groups showed similar improvements in Saint Georges Respiratory Questionnaire (SGRQ) scores, a standard measure of health status in patients with diseases causing airway obstruction. However, after twelve weeks, a clinically significant difference in SGRQ scores emerged favoring Tai Chi. Similar trends were noted in performance of a six-minute walk test.

    “Tai Chi is an appropriate substitute for PR,” explained lead investigator Professor Yuan-Ming Luo, PhD, also of the State Key Laboratory of Respiratory Disease. “While neither training approach differed from the other by more than the minimal clinically important difference of four SGRQ points at the end of this 12-week study, an additional twelve weeks after discontinuation of formal training, improvements emerged in favor of Tai Chi in SGRQ score, six-minute walk distance, modified Medical Research Council dyspnea score, and quadriceps strength. We conclude that Tai Chi is equivalent to PR and may confer more sustained benefit.”

    Subjects in the Tai Chi group met for formal instruction five hours per week for 12 weeks and were taught the 24 form Yang style. The results of the Tai Chi group were compared to that of another group of subjects who received PR 3 times a week for 12 weeks.

    Tai Chi
    After the initial 12 weeks, participants were encouraged to continue their Tai Chi either alone or with a group in their community; however, no formal assistance was provided to patients during this period. Those in the PR group were participants received verbal encouragement to remain as physically active as possible. Final analysis of all data was conducted 12 weeks after the formal training had concluded.

    Image: Study subjects participate in a daily Tai Chi session.

    For many patients, reducing the symptoms of COPD can greatly improve their quality of life. While medication continues to play an important role in treating COPD, the cost of those medicines can be a barrier for some patients, especially for treating a chronic illness like COPD.

    “This study demonstrates that a low-cost exercise intervention is equivalent to formal pulmonary rehabilitation and this may enable a greater number of patients to be treated,” concluded lead author of the study Michael I. Polkey, PhD, NIHR Respiratory Biomedical Research Unit, The Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom. “Physical activity is key to reducing symptoms in COPD. We do recommend pulmonary rehabilitation, but our study shows that Tai Chi is a viable alternative when there is no local PR service. We encourage pulmonary rehabilitation providers to consider offering Tai Chi as an alternative therapy that patients would then be able to continue unsupervised in their own home.”

    About the journal CHEST®
    The journal CHEST®, the official publication of the American College of Chest Physicians, features the best in peer-reviewed, cutting-edge original research in the multidisciplinary specialties of chest medicine: pulmonary, critical care and sleep medicine; thoracic surgery; cardiorespiratory interactions; and related disciplines. Published since 1935, it is home to the highly regarded clinical practice guidelines and consensus statements. Readers find the latest research posted in the Online First section each week and access series that provide insight into relevant clinical areas, such as Recent Advances in Chest Medicine; Topics in Practice Management; Pulmonary, Critical Care and Sleep Pearls; Ultrasound Corner; Chest Imaging and Pathology for Clinicians; and Contemporary Reviews. Point/Counterpoint Editorials and the CHEST Podcasts address controversial issues, fostering discussion among physicians. www.chestjournal.org

    About American College of Chest Physicians (CHEST)®
    CHEST is the global leader in advancing best patient outcomes through innovative chest medicine education, clinical research, and team-based care. Its mission is to champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research. It serves as an essential connection to clinical knowledge and resources for its 19,000 members from around the world who provide patient care in pulmonary, critical care, and sleep medicine. For information about the American College of Chest Physicians and its flagship journal CHEST®, visit chestnet.org.

    About Elsevier
    Elsevier is a global information analytics business that helps institutions and professionals progress science, advance healthcare, open science and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support and professional education, including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 35,000 e-book titles and many iconic reference works, including Gray’s Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

    THREADS:
    Simplified Yang 24 form?
    Tai Chi as medicine
    Gene Ching
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  6. #261
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    Adolescent depression

    A randomized controlled trial of mindfulness-based Tai Chi Chuan for subthreshold depression adolescents

    Authors Zhang JY, Qin SD, Zhou YQ, Meng LN, Su H, Zhao S

    Received 6 May 2018

    Accepted for publication 28 June 2018

    Published 10 September 2018 Volume 2018:14 Pages 2313—2321

    DOI https://doi.org/10.2147/NDT.S173255

    Checked for plagiarism Yes

    Review by Single-blind

    Peer reviewers approved by Dr Colin Mak

    Peer reviewer comments 3

    Editor who approved publication: Professor Wai Kwong Tang

    Jiayuan Zhang,1 Shida Qin,1 Yuqiu Zhou,1 Lina Meng,1 Hong Su,1 Shan Zhao2

    1Department of Psychological Nursing, Harbin Medical University, Daqing, Heilongjiang Province, China; 2Department of Mental Nursing, Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China

    Purpose: The incidence of subthreshold depression (StD) in adolescents is growing rapidly, which in turn is known to impair functioning and increase the risk of major depression. It is therefore important to provide effective intervention to prevent the transition from StD to major depression. As a traditional Chinese mind-body exercise, Tai Chi Chuan (TCC) may be an available selection. Researchers have shown the effectiveness of mindfulness-based therapy on depression; however, for the StD youth, there have been no studies to investigate whether mindfulness-based Tai Chi Chuan (MTCC) can be recommended as an effective exercise for improving their psychological state. The aim of present study was to evaluate the effect of MTCC on psychological outcomes of StD adolescents including the depression levels and mindfulness state in a randomized controlled trial (RCT).
    Patients and methods: An RCT was carried out. A sample of 64 participants who meet the inclusion criteria agreed to be arranged randomly to either the MTCC group (n=32) or the control group (n=32). Participants of the MTCC group received an 8-week, 2 days per week, 90-minute MTCC intervention for each session. Usual physical curriculum was administered to the participants in the control group. The effectiveness of MTCC training was measured by blinded evaluators through validated scales, which included depressive symptoms, stress, and mindfulness level before and after the intervention.
    Results: Significant improvements in psychological health were observed from MTCC groups. After 8-week intervention, superior outcomes were also observed for MTCC when compared with control group for decrease in depression (F=59.482, P<0.001) and stress level (F=59.482, P<0.001) and increase in mindfulness (F=59.482, P<0.001).
    Conclusion: The findings of this preliminary study indicated the effects of the MTCC intervention on depression level among StD youngsters. This study provides preliminary evidence that MTCC is suitable for Chinese adolescents and is effective in decreasing depression level.
    I'm not sure what the scientific definition of 'mindfulness-based Tai Chi Chuan' is. A curt web search didn't turn up any answers for me. Anyone?
    Gene Ching
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  7. #262
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    Tai Ji Quan: Moving for Better Balance [TJQMBB] & Fall Prevention

    September 10, 2018
    Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling
    A Randomized Clinical Trial
    Fuzhong Li, PhD1,2; Peter Harmer, PhD, MPH3; Kathleen Fitzgerald, MD4; et al Elizabeth Eckstrom, MD, MPH5; Laura Akers, PhD1; Li-Shan Chou, PhD6; Dawna Pidgeon, PT7; Jan Voit, PT8; Kerri Winters-Stone, PhD9
    Author Affiliations Article Information
    JAMA Intern Med. Published online September 10, 2018. doi:10.1001/jamainternmed.2018.3915

    Key Points
    Question 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?

    Findings 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.

    Meaning 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.

    Abstract
    Importance 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.

    Objective 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.

    Interventions 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.

    Results 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.

    Trial Registration ClinicalTrials.gov identifier: NCT02287740

    Introduction
    Falls in older adults constitute a major public health problem in the United States.1,2 Annually, approximately 28% of community-dwelling adults 65 years or older report falling; an estimated 38% of these falls result in injuries2 leading to emergency department visits, hospital admissions, or death.3,4 Fall-related treatments are costly, averaging $9389 per fall for fall-related injuries among Medicare beneficiaries.5 In 2015, the total medical costs for falls in persons aged 65 years and older were more than $50 billion, 75% of which fell to Medicare/Medicaid.6

    Falls, however, are largely preventable, with mounting evidence suggesting that exercise can be a safe and effective way to reduce falls.7,8 However, identifying optimal choices from among available evidence-based fall prevention interventions is challenging because few comparative effectiveness data are available, especially for older adults with high fall risk.9 With the continuing growth of the older segment of the population10 and the concomitant projected increase in the number of falls,2 high health care spending,11 and escalating health care costs,12 identifying the exercise intervention that is the most safe, effective, and easily implementable would greatly aid clinicians and health care institutions in making informed decisions about which interventions to prescribe given clinical goals and fiscal constraints.

    This trial was designed to respond to this evidence gap and these clinical decision needs. We aimed to determine the comparative effectiveness of 2 proven interventions, therapeutically tailored tai ji quan exercise (Tai Ji Quan: Moving for Better Balance [TJQMBB])13-15 and multimodal exercise,16 relative to stretching exercise in reducing the incidence of falls in older adults at high risk of falling. Our primary hypothesis for this trial was that, compared with stretching or multimodal exercise programs, TJQMBB would be clinically more effective in reducing the number of falls.

    Methods
    Study Design
    We performed a single-blind, parallel-design, randomized clinical trial with participants randomly allocated to 1 of 3 active arms: TJQMBB, entailing modified tai ji quan forms (derived from the classic framework of tai ji, also known as tai chi) and associated therapeutic movement exercises; multimodal exercise, integrating aerobic, strength, balance, and flexibility activities; or stretching exercises (the control arm) (Figure). The trial protocol (available in the Supplement) was approved by the institutional review board of Oregon Research Institute, and an independent data and safety monitoring board appointed by the National Institute on Aging oversaw the study. Written informed consent was obtained from all participants.

    Population, Setting, and Recruitment
    The target population was community-dwelling older adults living in 7 urban and suburban cities across 3 counties in Oregon. These counties were strategically chosen because of a moderate to high density of older adult populations and a high incidence of fall injuries.17 Eligible participants were 70 years or older and met one of the following primary criteria: (1) having fallen at least once in the preceding 12 months and having a health care practitioner’s referral indicating that the participant was at risk of falls or (2) having impaired mobility as evidenced by a Timed Up & Go (TUG)18 result greater than 13.5 seconds.19 Other inclusion criteria were as follows: (1) ability to walk 1 or 2 blocks, with or without the use of an assistive device; (2) ability to exercise safely as determined by a health care practitioner; and (3) willingness to be randomly assigned to and complete a 6-month intervention. We excluded individuals who had (1) participated in daily or structured vigorous physical activity or walking for exercise that lasted 15 minutes or longer or muscle-strengthening activities on 2 or more days a week in the previous 3 months, (2) severe cognitive impairment (Mini-Mental State Examination20 score, ≤20 on a range of 0 to 30), or (3) major medical or physical conditions determined by their health care practitioner to preclude exercise.

    Recruitment strategies included promotions at local senior or community centers, senior meal sites, medical clinics, statewide senior falls prevention networks, targeted mass mailings, and local newspaper advertisements. Recruitment lasted from February 20, 2015, to August 29, 2018, with the final participant follow-up on January 30, 2018.

    Randomization and Masking
    Eligible older adults were randomly assigned in a 1:1:1 ratio to receive 1 of the 3 interventions via a computer-generated randomization sequence with a block size of 3 or 6 to prevent anticipation of assignment to study condition. Because this was a behavioral intervention, study participants were not blinded to intervention group allocation. Primary and secondary outcome assessors were masked to group allocation and remained separate from the intervention team, and class instructors (interventionists) were blinded to the study’s hypothesis.

    Interventions and Procedures
    Each of the 3 interventions involved a 60-minute exercise session twice weekly for 24 weeks. In all 3 groups, each session consisted of a 10-minute warm-up, 40 to 45 minutes of core exercises, and a 5-minute cool-down activity. Exercise intensity in each intervention group was monitored through a subjective measure of perceived exertion (Exercise Intensity section of Trial Protocol in the Supplement). Intervention classes varied in size, with a range of 9 to 21 participants, and were held in community facilities, such as senior or community centers, churches, or nonprofit organizations. All 3 interventions were conducted concurrently and delivered in 15 class sites throughout the study area. At each site, the 3 interventions were separated in time to avoid cross-contamination.
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  8. #263
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    Continued from previous post

    Therapeutic Tai Ji Quan
    The training protocol, Tai Ji Quan: Moving for Better Balance (see the Supplement for detail), involved practice of a core of 8 therapeutically modified exercise forms with built-in variations and a subroutine of integrated therapeutic movement exercises.14,15,21 Aimed at stimulating and integrating musculoskeletal, sensory, and cognitive systems, the practice focused on controlled, self-initiated tai ji quan–based exercises with synchronized breathing, including center of gravity displacement using a dynamic interplay of stabilizing and self-induced destabilizing postural actions involving unilateral weight-bearing and weight-shifting movements, trunk and pelvic rotation, ankle sway, and eye-head-hand movements.21

    During the initial 10 weeks, sessions focused on learning and performing the TJQMBB forms in various formats (ie, seated, standing in place, and stepping), accompanied by sets of therapeutic and functional tai ji quan–based exercises involving ankle sway, sit-to-stand, single-leg stands, turning, and stepping exercises(referred to as mini-therapeutic movements).21 At each session, participants practiced 3 to 4 sets of a tai ji quan form, with 3 to 5 repetitions in each set intermingled with 3 to 5 sets of 3 to 4 selected mini-therapeutic movements (4 to 5 repetitions in each set). After all 8 therapeutic tai ji quan forms had been learned (weeks 11 and 12), each session comprised 5 to 6 sets of variations in the 8-form routine and 3 to 4 mini-therapeutic movements in sets of 4 to 5.

    Multimodal Exercise
    The training protocol involved aerobic conditioning, strength, balance, and flexibility activities.16 The aerobic exercises included long strides, heel-toe walking, narrow- and wide-based walking, and sidestepping for cardiovascular fitness. Strength training included exercises for ankle dorsiflexors, knee extensors, and hip abductors. Balance training involved tandem foot-standing, heel-toe and line walking, single-leg standing, alternation of the base of support, weight transfers, and various reaching movements away from the center of gravity. Flexibility exercises included a static stretching routine of major upper- and lower-body muscle groups. At 4 months, use of gym-based equipment (hand and ankle weights, resistance tubing, and balance foams) was integrated into the strength and balance exercises.

    Training was progressive, with challenges increasing with respect to movement pace, patterns and coordination, and joint range of motion. Strength training was graduated, beginning with 4 repetitions in month 1, 6 to 8 repetitions in month 2, 8 to 10 repetitions in month 3, 11 to 15 repetitions in month 4, and 25 to 30 repetitions in months 5 and 6. Resistance training involved hand weights (beginning with 0.45 kg [1 lb] for each hand in month 4 and progressing to 0.91 kg [2 lb] in months 5 and 6), tubing (beginning with extra-light resistance in month 4, moving to light resistance in month 5, and to medium resistance in month 6), and ankle weights (beginning with 0.45 kg for each limb in month 4 and progressing to 1.13 kg [2.5 lb] in month 6). These resistance exercises were implemented with 3 to 5 repetitions in month 4, increasing to a maximum of 8 to 10 repetitions in month 6.

    Stretching Exercise
    The training routine consisted of breathing, stretching, and relaxation activities, with most of them performed in a seated position. Each session began with a set of warm-up exercises, such as arm, neck, and leg circles; trunk rotation; and light walking. The core part of the training session consisted of a variety of combined seated and standing stretches involving the upper body (neck, arms, upper back, shoulders, and back and chest) and lower extremities (quadriceps, hamstrings, calves, and hips), along with slow and gentle trunk rotations. Also included were deep abdominal breathing exercises that emphasized inhaling and exhaling to maximum capacity as well as progressive relaxation of major muscle groups.

    Baseline and Outcome Assessment
    At enrollment, participants’ demographic information regarding sex, age, race/ethnicity, income, education, living arrangements, medical conditions, fall-related information, and physical activity was collected. Study outcome measures were assessed at baseline, 4 months (midpoint), and 6 months (at the end of the intervention).

    The primary outcome was the incidence of falls, which was ascertained on a monthly basis. Participants were asked to use a daily “fall calendar”13 diary to record any fall event (defined as “when you land on the floor or the ground, or fall and hit objects like stairs or pieces of furniture, by accident”) and to indicate whether they sought medical attention. Information was also collected on injurious falls.13,22 Data on falls were collected starting from the date of the first intervention class and continuing until 24 weeks later (ie, the end of the intervention period) or until a participant withdrew, died, or was lost to follow-up.

    Prespecified secondary outcomes were physical performance measures of (1) functional reach,23 which assessed the maximal distance a participant could reach forward, beyond arm’s length, while maintaining a fixed based of support in a standing position; (2) the Instrumented Timed Up & Go (APDM, Inc), which represents an extended version of TUG18 and assessed walking duration (in seconds) and 3 subdomain timed-based activities—sit-to-stand, turning, and turn and stand-to-sit—during a 14-m walk at normal pace (7 m toward a line, turn, and 7 m toward the chair); and (3) the Short Physical Performance Battery,24 which measured repeated chair stands, 3 increasingly challenging standing balance tasks, and a 4-m speed walk. Scores on the 3 tasks were combined to create an overall performance score of 0 (worst) to 12 (best), with higher values indicating improvement. In addition, global cognitive function was measured by the 30-item Montreal Cognitive Assessment,25 which assesses cognitive function of multiple domains (memory recall, visuospatial abilities, executive functions, attention, language, and orientation to time and place; scores range from 0 to 30, with higher scores indicating better cognitive function).

    Statistical Analysis
    Sample Size
    The study was powered to detect a difference between 2 negative binomial rates resulting from the 6-month intervention between the 2 exercise interventions (TJQMBB and multimodal exercise) relative to stretching exercise. On the basis of data collected from previous trials,13,16 our power calculations found that a sample size of 567 participants (189 per group) would be required to detect a 35% reduction in the fall incidence rate (a respective incidence rate ratio [IRR] of 0.65) between either of the 2 intervention groups relative to stretching exercise. Although a difference was anticipated to favor the TJQMBB intervention, power was not calculated between TJQMBB and multimodal exercise owing to the lack of a priori effect size estimates. With an estimated 15% attrition, we planned to recruit a total of 666 participants.

    Analyses
    Baseline characteristics and unadjusted study outcome measures were summarized by intervention group using descriptive statistics such as mean (SD) or percentage and used to assess between-group equivalence at baseline. Prespecified baseline covariates in both primary and secondary outcome analyses included age, sex, health status, history of falls, and cognitive function (Mini-Mental State Examination score, ≤20).

    Baseline demographic descriptors and primary and secondary outcome measures were compared across groups by using analysis of variance for continuous variables and the χ2 (or Fisher exact) test for categorical variables. The planned descriptive data on monthly falls was tabulated across the intervention groups. In our primary analysis of the falls count outcome, we used negative binomial regression to estimate absolute differences in IRRs with their corresponding 95% CIs comparing TJQMBB and multimodal exercise with stretching exercise. In a prespecified secondary analysis, we also estimated the rate differences with 95% CIs between TJQMBB and multimodal exercise. Follow-up on falls data was censored at the last visit or contact during which a complete data point was collected. Following an intention-to-treat protocol, we analyzed the secondary (continuous) outcomes with estimates and their 95% CIs generated from the linear mixed-effects models. All primary and secondary outcome analyses were conducted with and without adjustment for prespecified baseline covariates. Bonferroni correction was made to control for multiple testing of secondary outcomes, with an adjusted α value of .007 (.05 per 7 comparisons) for each test considered statistically significant. Two-sided P values of less than .05 were considered statistically significant. Analyses were conducted using SPSS version 23 (IBM Corp) or Stata (release 13; StataCorp LP).

    Results
    Enrollment
    Of 1147 individuals screened, 670 were enrolled and randomized (224 to TJQMBB, 223 to multimodal exercise, and 223 to stretching exercise) (Figure). Of the total participants, 581 (86.7%) (194 in TJQMBB, 193 in multimodal exercise, and 194 in stretching exercise) completed their assigned interventions. At 6 months, 664 (99.1%) of the 670 participants provided full follow-up data on falls and 633 (94.5%) provided data on secondary outcomes. There were no statistically significant differences in baseline demographic variables or primary outcomes between the 581 participants who completed the intervention (defined as attending classes either regularly or irregularly without dropping out of the study) and the 89 who did not complete the intervention (defined as dropping out of the study).
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    Participant Characteristics
    Baseline characteristics were similar by intervention group (Table 1). The mean (SD) age was 77.7 (5.6) years (median [interquartile range (IQR)], 76 [73-81] years), 436 (65.1%) were women, 617 (92.1%) were white, 31 (4.6%) were African American. Four hundred eighty-five participants (72.4%) reported having at least 1 fall 6 months before the intervention, 355 (53.0%) reported having 3 or more chronic conditions, and 67 (10.0%) were taking 4 or more medications. The mean (SD) mobility score was 8.3 (2.2) measured on the Short Physical Performance Battery and 14.25 (5.2) seconds on TUG.

    Intervention Compliance and Adherence
    The overall attrition rate was 13%, which was lower than our planned 15%. The median (IQR) time to stopping the intervention across the 3 intervention groups was 3.0 months (2.0-4.0). The intervention attendance rate across the 24-week period for all participants was 77% (78% in the TJQMBB group; 77% in the multimodal exercise group; and 77% in the stretching exercise group), and the mean (SD) number of completed sessions was 37 (10.6) (median, 40 sessions; range, 2-48 sessions) (37 [10.8] in the TJQMBB group; 37 [10.2] in the multimodal exercise group; and 37 [10.7] in the stretching exercise group; P = .82).

    Safety
    Serious adverse events, defined as death or medical conditions that required 1 or more days of hospitalization, were observed. Forty-seven participants reported hospital admission: 11 in the TJQMBB group (1.0 per 100 person-months), 12 in the multimodal exercise group (1.1 per 100 person-months), and 16 in the stretching exercise group (1.2 per 100 person-months) (P = .83). One death from unknown causes in the stretching exercise group was documented. None of these serious events were related to the intervention. Seven falls with no injury were documented during classes: 2 in the TJQMBB group; 3 in the multimodal exercise group; and 2 in the stretching exercise group. One participant in the TJQMBB group required an emergency department visit owing to hyponatremia during a class, but the participant recovered and completed the intervention.

    Intervention Resource Use
    The resources needed to conduct our intervention primarily involved costs associated with promotion, recruitment, room rental, class instruction, supplies, administrative overhead, exercise equipment (eg, weights, chairs), and participant travel expenses to and from each intervention class. The intervention cost $202 949 ($906 per person) to deliver a 24-week TJQMBB program to 224 participants, $223 849 ($1004 per person) to deliver the multimodal exercise program to 223 participants, and $201 468 ($903 per person) to deliver the stretching exercise component to 223 participants.

    Primary Outcome
    At 6 months, 733 falls were recorded among 324 of the 670 participants (48.4%) (85 in the TJQMBB group, 112 in the multimodal exercise group, and 127 in the stretching exercise group ). The mean (SD) follow-up on falls was 5.98 (0.21) months (median [IQR], 6.0 [6.0-6.0] months). Although both the TJQMBB and multimodal exercise groups showed a significantly lower incidence of falls (11 per 100 person-months for TJQMBB, and 16 per 100 person-months for multimodal exercise) compared with the stretching exercise group (27 per 100 person-months, P < .001), the incidence of falls was significantly lower in the TJQMBB group (total falls [mean (SD)] 152 [0.68 (1.3)]) than in the multimodal exercise group (218 [0.98 (1.8)]) (P = .04). There were no between-group differences on moderate injurious falls (TJQMBB, 88 falls [0.39 (0.9)]; multimodal exercise, 109 [0.49 (1.2)]; and stretching exercise, 156 [0.70 (1.7)]) (P = .05), but TJQMBB had a lower incidence of injurious falls than stretching exercise (TJQMBB, 8 [0.04 (0.2)]; stretching, 25 [0.11 (0.4)]) (P = .008) (Table 2).

    Binominal regression of unadjusted analyses showed that both the TJQMBB and multimodal exercise groups had a lower IRR (IRR, 0.42; 95% CI, 0.31-0.56; P < .001 for TJQMBB; IRR, 0.60; 95% CI, 0.45-0.80; P = .001 for multimodal exercise) compared with the stretching exercise group. In addition, the TJQMBB group showed a significantly lower IRR than the multimodal exercise group (IRR, 0.69; 95% CI, 0.52-0.94; P = .01). The estimates of the intervention effects between TJQMBB and the stretching and multimodal exercise groups showed no change after adjusting for the prespecified covariates (data not shown).

    Secondary Outcomes
    At 6 months, the participants in both the TJQMBB and multimodal exercise groups performed significantly better than those in the stretching exercise group on secondary outcomes of physical performance (functional reach, Short Physical Performance Battery, and Instrumented TUG and its subdomain scores [sit-to-stand, turning, turn and stand-to-sit]) and global cognitive function measures (Table 3). Participants in the TJQMBB and multimodal exercise interventions performed significantly better than those in the stretching intervention on tests of physical and cognitive function: functional reach (TJQMBB: mean difference, 1.77; 95% CI, 1.42-2.12; P < .001; multimodal exercise: mean difference, 1.49; 95% CI, 1.15-1.83; P < .001); Short Physical Performance Battery (TJQMBB: mean difference, 1.57; 95% CI, 1.25-1.88; P < .001; multimodal exercise: mean difference, 1.59; 95% CI, 1.27-1.90; P < .001); total walking duration in the instrumented walking test (TJQMBB: mean difference, −2.42; 95% CI, −3.19 to −1.65, P < .001; multimodal exercise: mean difference, −2.20; 95% CI, −2.97 to −1.43; P < .001); and Montreal Cognitive Assessment (TJQMBB group: mean difference, 1.54; 95% CI, 1.04-2.04; P < .001; multimodal exercise group: mean difference, 1.39; 95% CI, 0.92-1.86; P < .001). There were no differences between TJQMBB and multimodal exercise on secondary outcomes. The significant effects of TJQMBB and multimodal exercise relative to stretching exercise on the secondary outcomes remained after adjustment for covariates (data not shown).

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    Discussion
    In this study of community-dwelling older adults at high risk of falling, we found that a 6-month TJQMBB intervention, when compared with a conventional stretching exercise control, was effective in reducing the incidence of falls. In addition, our study also showed for the first time, to our knowledge, that TJQMBB was effective in reducing the incidence of falls compared with a well-known conventional, evidence-based multimodal exercise program.9,16 Thus, of the 3 exercise interventions, TJQMBB yielded the greatest reduction in number of falls, whereas both TJQMBB and multimodal exercise significantly improved physical function and global cognitive function compared with the stretching exercise control.

    The findings from this study are aligned with systematic review and meta-analyses on the effect of exercise on reducing the incidence of falls7,26 and are commensurate with the results from a meta-analysis27 and previous controlled tai ji quan studies involving community-dwelling older adults13,28,29 and persons with Parkinson disease.30 This clinically oriented and functionally driven tai ji quan–based program,21 however, is shown to be more efficacious in the magnitude of reduction in the incidence of falls compared with earlier trial or meta-analysis results.13,27-29

    Our study also extends the current literature by comparing, head-to-head, 2 evidence-based interventions,13,16 with the results showing 31% fewer falls in TJQMBB compared with multimodal exercise, thus adding new clinical knowledge on the effectiveness of a therapeutically tailored tai ji quan intervention strategy for preventing falls among older adults. The findings that TJQMBB was more effective than a multimodal exercise program are of considerable practical importance because they suggest the utility of an equipment-free, low-cost, non–space-constrained exercise intervention in addressing the clinical problem of falls and balance deficits in the older population.

    To our knowledge, our intervention is the only tai ji quan–based program uniquely designed to facilitate therapeutic training of balance and postural control for older adults with balance deficits,14,15,21 with the specific focus of targeting reductions in falls and tailoring implementation for clinical practice. A previous study has shown that the intervention is readily implementable in clinical practice with a high rate of adoption among health care practitioners, including internal medicine physicians, and that it is sustainable.14 Experience from that study indicated that proactive steps, such as communicating frequently with clinicians, offering educational outreach workshops, and even providing training to clinicians, can facilitate the referral process. Thus, although substantial communication gaps exist between clinicians and community service providers,9 we have shown that this program can be accessible to clinicians and implementable in the context of geriatric clinics or medical centers.

    The TJQMBB intervention evaluated in this study has been the model program for multiple successful research-to-practice implementation efforts in both community and clinical settings as well as program delivery evaluation by public health organizations or senior service agencies by public health organizations or senior service agencies.14,15,31-35 The program is also currently listed as one of the highest-tier evidence-based health-promoting and disease prevention programs under Title IIID of the Older Americans Act.36 With increasing evidence of community adoption and implementation14,15,31-35 and information from cost-benefit and cost-effectiveness analyses,15,37 the intervention program represents a promising approach to low-cost and easily implementable fall prevention programs. Its demonstrated generalizability and scalability can facilitate nationwide adoption of this effective fall prevention program to benefit community-dwelling older adults.

    Limitations
    The study findings should be interpreted in the context of trial limitations. Falls data were collected via falls calendars kept by participants. Although such calendars remain the criterion standard for ascertaining best available evidence on falls in the field,13,16,22,38 self-reports are known to be subject to recall bias. However, to ensure that self-reporting bias was minimized, we used multiple methods, including monthly telephone calls, confirmations during follow-up assessments, proxies, and medical records, to ensure data accuracy. Participation in the study classes required traveling. Therefore, the results are most likely to be generalizable to persons who are able to travel regularly to exercise class sites. The relatively low representation of African American participants was noted given this group has high rates of falls and of injurious falls.2 However, there is no indication in the results that these participants responded differently to the interventions than did other participants. Finally, this trial was conducted in a single state. Although Oregon has one of the nation’s highest death rates from falls,39 generalizability of the findings could be enhanced by a multicenter trial involving multiple states.

    Conclusions
    Among older adults with high risk of falling, a 24-week therapeutically developed tai ji quan balance training intervention resulted in a significant reduction in the incidence of falls compared with a stretching exercise modality and a multicomponent exercise program.

    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 (fuzhongl@sus.edu.cn).

    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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    Gallant MP, Tartaglia M, Hardman S, Burke K. Using tai chi to reduce fall risk factors among older adults: an evaluation of a community-based implementation [published online April 1, 2017]. J Appl Gerontol. 2017;733464817703004.PubMedGoogle Scholar
    36.
    National Council on Aging. Highest tier evidence-based health promotion/disease prevention programs. https://www.ncoa.org/resources/ebpchart/. Accessed May 5, 2018.
    37.
    Carande-Kulis V, Stevens JA, Florence CS, Beattie BL, Arias I. A cost-benefit analysis of three older adult fall prevention interventions. J Safety Res. 2015;52:65-70. doi:10.1016/j.jsr.2014.12.007PubMedGoogle ScholarCrossref
    38.
    Lusardi MM, Fritz S, Middleton A, et al. Determining risk of falls in community dwelling older adults: a systematic review and meta-analysis using posttest probability. J Geriatr Phys Ther. 2017;40(1):1-36. doi:10.1519/JPT.0000000000000099PubMedGoogle ScholarCrossref
    39.
    Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS). https://www.cdc.gov/injury/wisqars/. Accessed January 5, 2018.

    THREADS:
    Tai Chi as medicine
    Tai Ji Quan: Moving for Better Balance® (TJQMBB)
    Fall prevention
    Gene Ching
    Publisher www.KungFuMagazine.com
    Author of Shaolin Trips
    Support our forum by getting your gear at MartialArtSmart

  12. #267
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    Jan 1970
    Location
    Fremont, CA, U.S.A.
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    47,946

    Effects of Mind‐Body Exercises on Cognitive Function in Older Adults: A Meta‐Analysi

    Journal of the American Geriatrics Society
    Clinical Investigation
    Effects of Mind‐Body Exercises on Cognitive Function in Older Adults: A Meta‐Analysis

    Chunxiao Wu Qu Yi Xiaoyan Zheng Shaoyang Cui Bin Chen Liming Lu Chunzhi Tang
    First published: 18 December 2018

    Abstract
    BACKGROUND/OBJECTIVES
    Mind‐body exercise has positive effects on cognitive performance, according to clinical observation and experts’ recommendations. However, its potential benefits for the cognitive function of aging adults are uncertain and still lack systematic estimations. Therefore, we conducted a systematic review and meta‐analysis to evaluate the overall efficacy and effectiveness of mind‐body exercises for cognitive performance in aging individuals with or without cognitive impairment.

    DESIGN
    A systematic review and meta‐analysis.

    SETTING AND PARTICIPANTS
    We searched related trials through June 2018 from four databases: Medline, Embase, PsycINFO (all via Ovid), and the Cochrane Library/Central Register of Controlled Trials.

    MEASUREMENTS
    Methodological quality was assessed using the Cochrane Risk of Bias Tool. A meta‐analysis of comparative effects was performed using Review Manager v.5.3 software, and publication bias was examined using Egger's test.

    RESULTS
    A total of 32 randomized controlled trials with 3624 participants were ultimately included in this meta‐analysis. The results revealed that mind‐body exercises as a whole had benefits in improving global cognition compared with that of the control group (mean difference [MD] = 0.92; 95% confidence interval [CI] = 0.33‐1.51; p = .002) and were more effective than control interventions in promoting cognitive flexibility (MD = −8.80; 95% CI = −15.22 to −2.38; p = .007), working memory (MD = 0.32; 95% CI = 0.01‐0.64; p = .05), verbal fluency (standardized mean difference [SMD] = 0.27; 95% CI = 0.09‐0.45; p = .003), and learning (SMD = 0.24; 95% CI = 0.10‐0.39; p = .001) on cognitively intact or impaired older adults. In dose‐subgroup analysis, only moderate exercise intensity (60‐120 min per week) significantly increased global cognition scores compared with those of the control group (MD = 1.15; 95% CI = 0.34‐1.97; p = .006).

    CONCLUSION
    Mind‐body exercises, especially tai chi and dance mind‐body exercise, are beneficial for improving global cognition, cognitive flexibility, working memory, verbal fluency, and learning in cognitively intact or impaired older adults. Moderate intensity is recommended as the optimal dose for older adults.
    And trolls call Tai Chi 'dance' as a derogatory jab...
    Gene Ching
    Publisher www.KungFuMagazine.com
    Author of Shaolin Trips
    Support our forum by getting your gear at MartialArtSmart

  13. #268
    Join Date
    Jun 2006
    Location
    IL
    Posts
    998
    Recently, they gave added a quasi named category called 'Meditative Movement" to address how the physiological and mechanistic elements work regarding taijiquan.
    They have also addeed qigong and yoga to that list of 'intervention mind body" category to address objective criteria as oppsoed to the curernt qi curing/qi hugging cure all of these adjunct therapies.

    I applaud this because the science behind it is necessary for some understanding of how and when to use as opposed to the 'qi curing all that aids you" mentality.

  14. #269
    I also agree that massage can be considered as a 100% treatment from many diseases. Also, it is a great opportunity to try something new and just stay relaxed. Once I saw that people are looking for a tantric massage in Paris during my last tour around the EU. Seems a little but strange to me, but people like it. Moreover, they are willing to pay hundreds of dollars for these services. Well, has anyone tried it? Worth it?

  15. #270
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    Tai Chi & MS

    APRIL 17, 2019
    Comparing the benefits of Tai Chi and meditation on multiple sclerosis symptoms

    by University of Massachusetts Amherst


    Study participants will be enrolled either in community-based mindfulness meditation or tai chi classes. Credit: UMass Amherst

    Kinesiology researchers at the University of Massachusetts Amherst have received funding to compare the effects of tai chi and mindfulness meditation on both the physical balance and psychosocial well-being of people with multiple sclerosis (MS).

    In a pilot study with 30 participants who have mild to moderate MS symptoms, researchers at the Motor Control Lab of Richard van Emmerik, professor of kinesiology, will use a one-year, $54,972 pilot grant from the National Multiple Sclerosis Society to measure the immediate and ongoing benefits of the two mind-body practices.

    Julianna Averill, a doctoral student in motor control working in Van Emmerik's lab, hopes the results will validate the approach of community-based classes and lead to a larger scale study across the commonwealth.

    Tai chi, a Chinese martial art, involves stretching and slow, focused, flowing postures that keep the body in constant motion. Mindfulness-based stress reduction, the meditation component of the study, teaches various mindfulness practices, such as body scan meditation and loving kindness meditation.

    "This is our first intervention study which has a teaching component," Averill says. "The participants will be trained, and they will be able to practice on their own."

    Characterized by unpredictable periods of relapse and remission, MS is the most common disabling neurological disorder among young adults, with many diagnoses occurring between age 20 and 40, according to the National Institute of Neurological Disorders and Stroke.



    Kinesiology researchers are recruiting people with multiple sclerosis to take part in a pilot study. Credit: UMass Amherst
    People with MS may have a range of symptoms, including vision problems, muscle weakness, coordination and balance problems, tingling and burning sensations or numbness, extreme fatigue, fuzzy thinking and depression. The symptoms occur because the signals between the brain and body are disrupted when the fatty layer surrounding neurons in the brain and spinal cord—called the myelin sheath—is slowly destroyed.

    "While MS symptoms vary depending on where the damage in the brain and spinal cord is located, balance issues are a common occurrence in MS," Averill says. "Mind-body interventions are beneficial as they train dynamic balance, such as transitioning between postures, turning, reaching, etc., in a manner similar to movements in daily life."

    Finding ways to improve postural control and balance confidence is crucial to reducing the risk and fear of falls, a common and serious hazard for people with MS, which also affects their quality of life, Averill says. The study is designed to offer a fresh and expanded look at the effects of tai chi and mindfulness meditation.

    "With mindfulness meditation, studies have been primarily looking at the mental constructs and not the impact on physical balance," she says. Previous studies involving tai chi focused on standing balance, and UMass Amherst's study will also seek to measure participants' balance as they move.

    Researchers are recruiting people with mild to moderate symptoms who are between age 21 and 70 and able to stand and move without assistance for 15 minutes. At three lab sessions over 10 weeks—before the classes start, after they end and two weeks later—participants will wear inertial sensors that collect postural sway data as they perform various movements. During the same sessions, the participants also will answer questionnaires that gauge their fall history, balance confidence, level of fatigue and ability to cope and adapt.

    "We're taking a more holistic look, considering the whole person and overall quality of life," Averill says.

    After the first data collection, participants will be randomly assigned to either eight weeks of free tai chi at YMAA Western Mass Tai Chi or free mindfulness meditation classes at Downtown Mindfulness, both local businesses that are partnering with UMass Amherst for the study. Participants will attend classes for 2.5 hours a week and have 2.5 hours of homework, either listening to meditation podcasts or watching tai chi videos on an innovative website that tracks participants' activity.
    As always, I'm curious about the details of which style of Tai Chi and meditation, but not curious enough to watch the video yet.
    Gene Ching
    Publisher www.KungFuMagazine.com
    Author of Shaolin Trips
    Support our forum by getting your gear at MartialArtSmart

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