12-month Tai Chi training in the elderly: its effect on health fitness

Stability limits, single-leg jump, and body awareness in older Tai Chi practitioners

DESIGN

Cross-sectional study.

SETTING

University-based rehabilitation center.

PARTICIPANTS

Tai Chi practitioners (n=24; age+/-SD, 68.5+/-6.6 y) and control subjects (n=20; age, 71.3+/-6.7 y) were recruited.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Measures included the following: (1) subjects' intentional weight shifting to 8 different spatial positions within their base of support using the limits of stability test, (2) the ability to leave the floor in single-leg jumping and to maintain balance on landing using force platform measurements, and (3) body awareness and movement behaviors using the Body Awareness Scale-Health (BAS-H).

RESULTS

The findings showed that Tai Chi practitioners had a significantly better ability to lean further without losing stability and better directional control (P<0.01). They had a better ability to jump off the floor (P<0.05) and to maintain a longer single-leg stance after landing (P<.05) and better overall body awareness (P<.001). The single-leg jumps also correlated significantly with limits of stability measures of movement velocity, endpoint excursions, and maximum excursions but not with directional control. The BAS-H scores correlated significantly with the limits of stability measures except directional control. They also correlated significantly with the ability to jump off the floor and maintain stability after landing.

CONCLUSIONS

When compared with healthy controls, Tai Chi practitioners had better stability limits, increased ability to perform a single-leg jump, and more stability in landing on 1 leg as well as better body awareness. Significant correlations among limits of stability measures, single-leg jumping tests, and the BAS-H scores indicate the importance of body awareness in limits of stability, single-leg jumping, and landing.

Effectiveness of a Tai chi Qigong program in promoting health-related quality of life and perceived social support in chronic obstructive pulmonary disease clients

PURPOSE

This paper evaluates the effectiveness of a 3-month Tai chi Qigong (TCQ) program in promoting the psychosocial functional health of clients with chronic obstructive pulmonary disease (COPD) in Hong Kong.

METHODS

This study employed a single-blind, randomized controlled trial. Two hundred and six COPD clients were randomly assigned into three groups, namely, TCQ group, exercise group, and control group. Subjects in the TCQ group received a TCQ program, consisting of two 60-min sessions each week for 3 months. Subjects in the exercise group were taught to practice breathing techniques combined with walking as an exercise. Subjects in the control group received their usual care. Data collections were performed at baseline, on the sixth week and on the third month. The primary outcomes were health-related quality of life using St. George Respiratory Questionnaire-Hong Kong Chinese version and perceived social support using the Multidimensional Scale of Perceived Social Support-Chinese version.

RESULTS

The TCQ group showed greater improvements in the symptom (F4, 404=3.351, P=0.010) and activity domains (F4, 404=2.611, P=0.035). No differences were detected in perceived social support among the three groups.

CONCLUSIONS

Tai chi Qigong promoted health outcomes with respect to clients' perception of their respiratory symptoms. Moreover, TCQ decreased disturbances to their physical activities.

Tai Chi for osteopenic women: design and rationale of a pragmatic randomized controlled trial

Background

Post-menopausal osteopenic women are at increased risk for skeletal fractures. Current osteopenia treatment guidelines include exercise, however, optimal exercise regimens for attenuating bone mineral density (BMD) loss, or for addressing other fracture-related risk factors (e.g. poor balance, decreased muscle strength) are not well-defined. Tai Chi is an increasingly popular weight bearing mind-body exercise that has been reported to positively impact BMD dynamics and improve postural control, however, current evidence is inconclusive. This study will determine the effectiveness of Tai Chi in reducing rates of bone turnover in post-menopausal osteopenic women, compared with standard care, and will preliminarily explore biomechanical processes that might inform how Tai Chi impacts BMD and associated fracture risks.

Methods/Design

A total of 86 post-menopausal women, aged 45-70y, T-score of the hip and/or spine -1.0 and -2.5, have been recruited from primary care clinics of a large healthcare system based in Boston. They have been randomized to a group-based 9-month Tai Chi program plus standard care or to standard care only. A unique aspect of this trial is its pragmatic design, which allows participants randomized to Tai Chi to choose from a pre-screened list of community-based Tai Chi programs. Interviewers masked to participants' treatment group assess outcomes at baseline and 3 and 9 months after randomization. Primary outcomes are serum markers of bone resorption (C-terminal cross linking telopeptide of type I collagen), bone formation (osteocalcin), and BMD of the lumbar spine and proximal femur (dual-energy X-ray absorptiometry). Secondary outcomes include health-related quality-of-life, exercise behavior, and psychological well-being. In addition, kinetic and kinematic characterization of gait, standing, and rising from a chair are assessed in subset of participants (n = 16) to explore the feasibility of modeling skeletal mechanical loads and postural control as mediators of fracture risk.

Discussion

Results of this study will provide preliminary evidence regarding the value of Tai Chi as an intervention for decreasing fracture risk in osteopenic women. They will also inform the feasibility, value and potential limitations related to the use of pragmatic designs for the study of Tai Chi and related mind-body exercise. If the results are positive, this will help focus future, more in-depth, research on the most promising potential mechanisms of action identified by this study.

Trial registration

This trial is registered in Clinical Trials.gov, with the ID number of NCT01039012.

A study investigating the effects of Tai Chi Chuan: Individuals with traumatic brain injury compared to controls

OBJECTIVE

To explore the effects of a 6-week course in Tai Chi associated with traumatic brain injury (TBI) symptoms.

METHOD

Eighteen participants, with TBI assigned to a control (waiting list) group (n = 9) or Tai Chi group (n = 9) completed the Medical Outcome Scale Short Form 36 (SF-36) and Rosenberg Self-Esteem Scale (RSES) before, during, immediately after and 3 weeks after completion of the Tai Chi course. The Tai Chi group completed the Visual Analogue Mood Scales (VAMS) before and after each class.

RESULTS

Tai Chi was associated with significant improvement on all VAMS scores (except fatigue) with decreases in sadness, confusion, anger, tension, fear and increases in energy and happiness. There were no significant between-group differences on the SF-36 or RSES.

CONCLUSIONS

Tai Chi provides short-term benefits after TBI, with rigorous outcome measurement needed to examine long-term benefits.

Tai Chi and Meditation

The aim of this article is to review the literature on Tai Chi and meditation. A coherent construct is developed that includes a comparative analysis and conceptual synthesis of existing theories. The authors discuss a set of assumptions that justify this synthesis; they also argue that this construct would facilitate greater understanding of Tai Chi from the perspective of meditation. Such synthesis may bring “additional” benefits to Tai Chi practitioners as they could recognize that this mind—body technique holds the essence of meditation. Within the scope of this article, the evidence shows a majority of common features when concerning Tai Chi and meditation. These mutual similarities should be taken into account when performing this type of mind—body medicine by patients and/or therapists. Finally, the authors suggest that this inspiring compilation of movements and mindfulness can be used for practical purposes.

Changes in muscle strength, endurance, and reaction of the lower extremities with Tai Chi intervention

This study examines the effects of a 16-week Tai Chi (TC) training program on the muscle strength, endurance, and reaction time of the lower extremities of elderly people. A total of 40 elderly individuals (aged 60 years) completed the study. They were divided into two groups: the TC group (11 men and 11 women) underwent a supervised TC exercise program for 16 weeks, while the control group (9 men and 9 women) received general education for a comparable time period. Pre- and post-intervention measurements were conducted. An isokinetic dynamometer was used to measure the maximum concentric strength and dynamic endurance of the knee flexors and the extensors, and the maximum concentric strength of the ankle plantarflexors and dorsiflexors. The neuromuscular response of the rectus femoris, semitendinosus, gastrocnemius, and anterior tibialis muscles was measured by the onset latency to sudden perturbations using an electromyography system. After 16 weeks, the TC group showed a 19.9% increase in muscle strength of the knee flexors (p<.000) that was significantly greater than that in the control group (p=.046). There was also a significant decrease in semitendinosus muscle latency (6.6%, p=.014) that was significantly shorter than that in the control group (p=.042). No significant training effects were found in other measures. These results suggest that improving biomechanical characteristics of lower extremity muscles may need longer TC intervention for elderly people.

Changes of aerobic capacity, fat ratio and flexibility in older TCC practitioners: a five-year follow-up

The objective of this study was to evaluate the 5-year changes of aerobic capacity, fat ratio and flexibility in older Tai Chi Chuan (TCC) practitioners and sedentary controls. Sixty-nine community-dwelling elderly individuals (mean age: 68.6 +/- 6.3 years) completed this study. The TCC group (18 M; 17 F) had been practicing TCC regularly for 6.3 +/- 3.7 years at baseline and continued training in the study interval. The control group (16 M; 18 F) did not participate in any regular exercise program. A graded bicycle exercise testing was conducted at the baseline and at 5-year to evaluate the age-related decline in aerobic capacity. Triceps and subscapular skinfolds, and thoracolumbar flexibility were also measured. At baseline, the TCC group displayed higher peak oxygen uptake $({\dot{\rm V}}{\rm O}_{2{\rm peak}})$ and thoraolumbar flexibility, and lower fat ratio than the control group. At the 5-year follow-up, the TCC group displayed a smaller decrease in $\dot{\rm V}{\rm O}_{2{\rm peak}}$ than the sedentary group. The annual decrease of $\dot{\rm V}{\rm O}_{2{\rm peak}}$ in TCC men and women was 0.32 and 0.22 ml . kg(-1) . min(-1), respectively. In the control group, the annual decrease of $\dot{\rm V}{\rm O}_{2{\rm peak}}$ was 0.50 and 0.36 ml . kg(-1) . min(-1) in men and women, respectively. The TCC group also showed a smaller increase of body fat ratio, and a less decrease of flexibility than the control group. In conclusion, long-term practice of TCC attenuates the age-related decline of aerobic capacity, and it also reduces the increase of body fat ratio in older individuals. TCC may be prescribed as a conditioning exercise for the elderly to maintain their health fitness.

Yoga as steadiness training: effects on motor variability in young adults

Exercise training programs can increase strength and improve submaximal force control, but the effects of yoga as an alternative form of steadiness training are not well described. The purpose was to explore the effect of a popular type of yoga (Bikram) on strength, steadiness, and balance. Young adults performed yoga training (n = 10, 29 +/- 6 years, 24 yoga sessions in 8 weeks) or served as controls (n = 11, 26 +/- 7 years). Yoga sessions consisted of 1.5 hours of supervised, standardized postures. Measures before and after training included maximum voluntary contraction (MVC) force of the elbow flexors (EF) and knee extensors (KE), steadiness of isometric EF and KE contractions, steadiness of concentric (CON) and eccentric (ECC) KE contractions, and timed balance. The standard deviation (SD) and coefficient of variation (CV, SD/mean force) of isometric force and the SD of acceleration during CON and ECC contractions were measured. After yoga training, MVC force increased 14% for KE (479 +/- 175 to 544 +/- 187 N, p < 0.05) and was unchanged for the EF muscles (219 +/- 85 to 230 +/- 72 N, p > 0.05). The CV of force was unchanged for EF (1.68 to 1.73%, p > 0.05) but was reduced in the KE muscles similarly for yoga and control groups (2.04 to 1.55%, p < 0.05). The variability of CON and ECC contractions was unchanged. For the yoga group, improvement in KE steadiness was correlated with pretraining steadiness (r = -0.62 to -0.84, p < 0.05); subjects with the greatest KE force fluctuations before training experienced the greatest reductions with training. Percent change in balance time for individual yoga subjects averaged +228% (19.5 +/- 14 to 34.3 +/- 18 seconds, p < 0.05), with no change in controls. For young adults, a short-term yoga program of this type can improve balance substantially, produce modest improvements in leg strength, and improve leg muscle control for less-steady subjects.

Qigong improving physical status in middle-aged women

Regular exercise has been shown to benefit its practitioners and prevent and control diseases. Muscle/Tendon Change Classic (MTCC) qigong, characterized by simple, slow, and full-body exercise, is appropriate for the middle-age population. This study aims to evaluate the effect of the MTCC qigong program in improving physical status for middle-aged women. A quasi-experimental design was used. The experimental group (n = 37) received an 8-week MTCC qigong program, whereas the control group (n = 34) received none. Physiological parameters of muscular performance, body composition, and bone strength were measured before and after the program. The average age was 49 +/- 4.13 years for the experimental group and 50 +/- 4.74 years for the control group. The demographic characteristics were homogeneous between the two groups. There were statistically significant differences between the two groups in muscular endurance, body fat, waist-to-hip ratio, and body mass index at the completion of 8-week MTCC qigong program. The MTCC qigong could improve muscle endurance and body composition but not bone strength for middle-aged women, thereby demonstrating the qigong practice has certain health-preserving effects on women in this stage of life.

Joint kinetics during Tai Chi gait and normal walking gait in young and elderly Tai Chi Chuan practitioners

BACKGROUND

Tai Chi Chuan is becoming a popular exercise among elders. This study measured the inter-segmental forces and moments at the lower extremity joints during a Tai Chi gait as compared to those during normal walking gait, in both apparently healthy young and elderly Tai Chi Chuan practitioners.

METHODS

Three-dimensional inter-segmental joint reaction force and moment were computed using the Inverse Dynamic Approach based on the kinematics and ground reaction force measurements in a laboratory setting in six young (two females, mean age 28; SD 6 years) and six elderly (five females, mean age 72; SD 8 years) subjects who had previous training of Yang style Tai Chi Chuan.

FINDINGS

The results showed significant gait differences in both age groups, with significantly smaller peak compressive forces, larger peak shear forces in the ankle, knee and hip joints, and larger peak moments in the knee and hip joints during Tai Chi gait as compared to normal gait. Moreover, the peak shear force was oriented more in the medial-lateral direction at the ankle and knee joints, and the peak moment was in the frontal plane at the knee and hip joints. The results also showed significant age differences, with significantly smaller peak shear forces in all three joints in the elderly group than in the young group during Tai Chi gait.

INTERPRETATION

Tai Chi gait has an increased shear force and frontal plane torque at lower extremity joints than normal gait. The shear force at all three lower extremity joints during Tai Chi gait is lower in the elderly subjects than young subjects. This data suggest that, in Tai Chi Chuan training, elderly people with degenerative joint diseases in the lower extremity should use caution when practicing Tai Chi Chuan.

Challenges inherent to t'ai chi research: part I--t'ai chi as a complex multicomponent intervention

In this, the first of 2 companion papers, we present a framework for viewing t'ai chi as a complex, multicomponent intervention that integrates numerous physical, cognitive, and ritualistic components. We discuss how the richness and complexity of t'ai chi poses challenges related to the traditional distinction between specific versus nonspecific effects, the development and interpretation of valid sham controls, and more generally, to the reductionist causal approach of attributing observed outcomes to single, independent component factors. We also discuss parallels between t'ai chi research and the emerging field of whole systems research, and how t'ai chi research may benefit from the use of an ecologic framework. In a second, companion paper, we discuss additional challenges inherent in defining the t'ai chi intervention itself, and more comprehensively outline the benefits and limitations of commonly used clinical research designs to evaluate the efficacy and safety of t'ai chi.

Postural stability and physical performance in social dancers

This cross-sectional study examined the benefits of social dancing on postural stability and physical performance in dancers aged 50 years or more. Walking speed, lower limb reaction time and low back flexibility were measured in 202 social dancers and 202 community-dwelling comparison subjects aged 50-87 years. The results showed that dancers who were older than 60 years had better postural stability and faster leg reaction times, whilst dancers aged 50-59 showed only better flexibility, when compared with the controls. Male dancers had greater low back flexibility and leg reaction time compared to controls. In contrast, female dancers had superior performance only for leg reaction time when compared with controls. The results indicate that social dancing is associated with enhanced postural stability and physical performance in older adults.

The effects of a Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults living in long-term care facilities: A single group design with multiple time points

BACKGROUND

Studies support the positive effects that Tai Chi has on the physical health of older adults. However, many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred.

OBJECTIVE

To test the effects of a newly-developed, Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults who resided in long-term care facilities.

DESIGN

A single group design with multiple time points: three pre-tests, one month apart; four post-tests at one month, two months, three months, and six months after intervention started.

SETTINGS

Two 300-400 bed veteran homes in Taiwan.

PARTICIPANTS

The 51 male older adults were recruited through convenience sampling, and 41 of them completed six-month study. Inclusion criteria included: (1) aged 65 and over; (2) no previous training in Tai Chi; (3) cognitively alert and had a score of at least eight on the Short Portable Mental Status Questionnaire; (4) able to walk without assistance; and (5) had a Barthel Index score of 61 or higher. Participants who had dementia, were wheel-chair bound, or had severe or acute cardiovascular, musculoskeletal, or pulmonary illnesses were excluded.

METHODS

The STEP was implemented three times a week, 50 min per session for six months. The outcome measures included cardio-respiratory function, blood pressure, balance, hand-grip strength, lower body flexibility, and physical health actualization.

RESULTS

A drop in systolic blood pressure (p=.017) and diastolic blood pressure (p<.001) was detected six months after intervention started. Increase in hand-grip strength from pre to post intervention was found (left hand: p<.001; right hand: p=.035). Participants also had better lower body flexibility after practicing STEP (p=.038).

CONCLUSIONS

Findings suggest that the STEP be incorporated as a floor activity in long-term care facilities to promote physical health of older adults.

Age-related differences in Tai Chi gait kinematics and leg muscle electromyography: a pilot study

OBJECTIVE

To compare the biomechanic features of Tai Chi gait by elders with those by young adults, and with those of normative gait.

DESIGN

Cross-sectional study.

SETTING

Laboratory-based testing.

PARTICIPANTS

Young (n=6; 3 women) and old (n=6; 5 women) Tai Chi practitioners.

INTERVENTION

All subjects had practiced Tai Chi for at least 4 months.

MAIN OUTCOME MEASURES

Spatial, temporal, and leg muscle electromyography during Tai Chi gait and normative gait.

RESULTS

The primary age-related differences in Tai Chi gait were during single stance, with elders having significantly shorter single-stance time (-50%), less lateral displacement (-30%), knee flexion (-42%), hip flexion (-39%), activation time in the tibialis anterior (-13%), soleus (-39%), and tensor fascia lata (TFL) (-21%), activation magnitude in the tibialis anterior (-39%), and coactivation time of the tibialis anterior and soleus (-47%). Compared with normative gait, elders during Tai Chi gait had significantly larger knee (139%) and hip (66%) flexions, longer duration (90%-170%) and higher magnitude (200%-400%) of the tibialis anterior, rectus femoris, and TFL muscle activities, and longer duration of coactivation of most leg muscle pairs (130%-380%).

CONCLUSIONS

The elders practice Tai Chi gait in higher posture than younger subjects. The Tai Chi gait poses significantly higher challenges to elder's balance and muscular system than does their normative gait.

Enhancement of sleep stability with Tai Chi exercise in chronic heart failure: preliminary findings using an ECG-based spectrogram method

OBJECTIVE

To assess the effects of a 12-week Tai Chi exercise program on sleep using the sleep spectrogram, a method based on a single channel electrocardiogram (ECG)-derived estimation of cardiopulmonary coupling, previously shown to identify stable and unstable sleep states.

METHODS

We retrospectively analyzed 24-h continuous ECG data obtained in a clinical trial of Tai Chi exercise in patients with heart failure. Eighteen patients with chronic stable heart failure, left ventricular ejection fraction <or= 40% (mean [+/-standard deviation] age, 59+/-14 years, mean baseline ejection fraction 24%+/-8%, mean) were randomly assigned to receive usual care (N=10), which included pharmacological therapy and dietary and exercise counseling, or 12 weeks of Tai Chi training (N=8) in addition to usual care. Using the ECG-based sleep spectrogram, we compared intervention and control groups by evaluating baseline and 12-week high (stable) and low (unstable) frequency coupling (HFC & LFC, respectively) as a percentage of estimated total sleep time (ETST).

RESULTS

At 12 weeks, those who participated in Tai Chi showed a significant increase in HFC (+0.05+/-0.10 vs. -0.06+/-0.09 % ETST, p=0.04) and significant reduction in LFC (-0.09+/-0.09 vs. +0.13+/-0.13 % ETST, p<0.01), compared to patients in the control group. Correlations were seen between improved sleep stability and better disease-specific quality of life.

CONCLUSIONS

Tai Chi exercise may enhance sleep stability in patients with chronic heart failure. This sleep effect may have a beneficial impact on blood pressure, arrhythmogenesis and quality of life.

The effects of Tai Chi on bone mineral density in postmenopausal women: a systematic review

OBJECTIVE

To evaluate the evidence for Tai Chi as an intervention to reduce rate of bone loss in postmenopausal women.

DATA SOURCES

Literature search using Medline, Science Citation Index, Cochrane databases, China Biological Medicine Database, and additional manual reference searches of retrieved articles and personal libraries.

STUDY SELECTION

Randomized controlled trials (RCTs), prospective cohort studies, and cross-sectional studies that included Tai Chi as an intervention, and had at least 1 outcome related to measurement of bone mineral density (BMD).

DATA EXTRACTION

Authors critically reviewed studies, evaluated methodologic quality, and synthesized study results in a summary table.

DATA SYNTHESIS

Six controlled studies were identified by our search. There were 2 RCTs, 2 nonrandomized prospective parallel cohort studies, and 2 cross-sectional studies. The 2 RCTs and 1 of the prospective cohort studies suggested that Tai Chi-naive women who participated in Tai Chi training exhibited reduced rates of postmenopausal declines in BMD. Cross-sectional studies suggested that long-term Tai Chi practitioners had higher BMD than age-matched sedentary controls, and had slower rates of postmenopausal BMD decline. No adverse effects related to Tai Chi were reported in any trial.

CONCLUSIONS

Conclusions on the impact of Tai Chi on BMD are limited by the quantity and quality of research to date. This limited evidence suggests Tai Chi may be an effective, safe, and practical intervention for maintaining BMD in postmenopausal women. In combination with research that indicates Tai Chi can positively impact other risk factors associated with low BMD (eg, reduced fall frequency, increased musculoskeletal strength), further methodologically sound research is warranted to better evaluate the impact of Tai Chi practice on BMD and fracture risk in postmenopausal women.

Inferences on standardized mean difference: the generalized variable approach

The standardized mean difference has been widely used as the most common index of effect magnitude in many applied fields. In this paper, we propose a novel approach using the concept of generalized variable for the confidence interval estimation and hypothesis testing of standardized mean difference. Furthermore, we extend this approach to compare standardized mean differences between two studies or between two strata. Simulation results demonstrate that the proposed approach can provide confidence intervals with excellent coverage properties and can perform hypothesis testing with satisfactory type-I error control.

Comparison of the effects of Tai Chi Chuan and Wai Tan Kung exercises on autonomic nervous system modulation and on hemodynamics in elder adults

The health of the middle-aged and elderly people is a major concern given the rapid aging population and rising costs of medical care. Low-impact exercise on a regular basis is ideal for maintaining the well-being of an aging population. Tai Chi Chuan (TCC) is the most well-known and most widely practiced form of low-impact martial arts therapy and has been shown to have positive health effects. A lesser-known form of martial arts therapy is Wai Tan Kung (WTK), which our previous study found to have positive health effects as well. The present study compares the effects of TCC and WTK on autonomic nervous system modulation and on hemodynamics in adults among non-exercising control (30), TCC practitioners (30) and WTK practitioners (30). Our study found that in a short-term, WTK and TCC exercises enhanced the vagal modulation, lowered the sympathetic modulation and lowered arterial blood pressures in the practitioners. It was also observed that the forced vital capacity of TCC practitioners was significantly higher than that of WTK practitioners before exercise. There were no significant differences in the percentage changes in HRV measures and hemodynamics between WTK and TCC practitioners 30 and 60 min after exercise, indicating that the effects of WTK and TCC were similar in magnitude. In conclusion, TCC and WTK are comparable to each other in terms of their effects on autonomic nervous system modulation and hemodynamics, thus suggesting that WTK can be just as beneficial as TCC as a form of low-impact exercise for elderly adults.

The links between health-related behaviors and life satisfaction in elderly individuals who prefer institutional living

Background

Life satisfaction among residents of institutions is becoming an important issue in a rapidly aging population. The aim of this cross-sectional study was to investigate the links between life satisfaction and health-related behaviors amongst functionally independent elderly people who prefer institutional living in İstanbul, Turkey.

Methods

The socio-demographic characteristics, health-related behaviors, leisure-time activities and fall histories of 133 residents of an institution in Istanbul were assessed by a structured questionnaire during face-to-face interviews. A validated life-satisfaction index questionnaire (LSI-A) was completed.

Results

The mean age of the study group was 73.9 ± 8.0 (range 60–90 years). Within the group, 22.6% had never married and 14.3% had university degrees. The majority (71.4%) were in the low income bracket. The overall mean LSI-A score was 20.3 ± 5.9. Participants who declared moderate/high income levels had a significantly higher mean LSI-A score than those in the low-income bracket (p = 0.009). Multivariate analysis of the data suggested that leisure-time activities and participation in regular physical activities are significant predictors of LSI-A scores (R²: 0.112; p = 0.005 and p = 0.02, respectively).

Conclusion

The findings imply that regular physical activity and leisure-time activities are significantly related to life satisfaction among residents in institutions. Participation in physical activity and leisure-time activity programs may help to improve the life satisfaction of elderly people living in institutions.

Controlled Endurance Exercise Training and VO 2max Changes in Older Adults: A Meta‐Analysis

This meta-analysis of controlled clinical trials quantifies the effect of aerobic exercise on VO2max (aerobic fitness) among sedentary older adults and examines the associations of such magnitude with variables of intervention. Forty-one trials including 2102 older subjects (within-group mean age of 60 years and older) were identified by searches of databases, hand searching, and cross-referencing. Outcomes were homogeneous. The pooled standardized effect size by a fixed-effect model showed a higher moderate effect (mean +/- SEM) of 0.64+/-0.05; 95% confidence interval, 0.56-0.73; p<0.001, representing a net increase in VO2max (mean +/- SEM) of 3.78+/-0.28 mL.kg-1.min-1; 95% confidence interval, 3.24-4.33; or a 16.3% improvement, compared with control groups. Greater improvement in VO2max was associated with training length more than 20 weeks and training intensity of approximately 60% but less than 70% of VO2max. Endurance training improves aerobic fitness in older adults, thus providing protective benefits for cardiovascular aging and quality of later life.

Physical benefits of Tai Chi Chuan for individuals with lower-limb disabilities

This paper reports on an experimental study that examined the effect of a 15-week Tai Chi Chuan (TCC) exercise programme on the cardiovascular function, pulmonary function, and shoulder range of motion of persons with lower-limb disability. The experimental group comprised 22 people with lower limb disabilities and a control group of 17 participants. The experimental group was provided with 30 sessions of TCC training while the control group did not receive any intervention. After 30 sessions of TCC, significant improvements in shoulder external rotation and shoulder extension were found among participants of the experimental group. Improvements in cardiovascular and pulmonary functions were not significant. The investigators concluded that a 15-week TCC programme with mild exercise could be an effective tool for improving shoulder flexibility and muscle strength among sedentary individuals with lower-limb disabilities. Further research is recommended in examining the long-term effects of TCC on improving cardiovascular and respiratory functions in individuals with lower-limb disabilities.

Functional Capacity After Traditional Chinese Medicine (Qi Gong) Training in Patients With Chronic Atrial Fibrillation: A Randomized Controlled Trial

Evidence indicates that low energy expenditure protocols derived from traditional Chinese medicine may benefit patients with cardiac impairment; therefore, the authors carried out a randomized controlled trial to test a 16-week medically assisted qi gong training program for the physical rehabilitation of patients with stable chronic atrial fibrillation and preserved left ventricular function. Functional capacity variation was evaluated using the 6-minute walk test, which was performed at baseline, at the end of the intervention, and after 16 weeks. Thirty men and 13 women (mean age, 68+/-8 years) were randomized to the intervention protocol or to a wait-list control group. Qi gong training was well tolerated and, compared with baseline, trained patients walked an average 114 meters more (27%) at the end of treatment (P<.001) and 57 meters more (13.7%) 16 weeks later (P=.008). Control subjects showed no variation in functional capacity. These results seem promising and deserve confirmation with further research.

Group tele-exercise for improving balance in elders

This study was to assess the level of acceptance and efficacy of a group tele-exercise program designed for balance impaired elders to improve balance and reduce fear of falling. The program would allow a group of elderly subjects to participate in a structured, interactive, and supervised exercise class from their own homes through a videoconferencing system. A total of 17 independent living elderly subjects (mean age, 81 +/- 8 years) participated in the study. An Internet-based videoconferencing device (VCD) was installed in each subject's home, allowing real-time video and audio communication with the exercise instructor and all other participants. The exercise was in the form of Tai Chi Quan, three times per week for 15 weeks. The main study measures included exercise compliance, level of acceptance and satisfaction, and the effectiveness of the exercise program on balance, fear of falling, and general health. Three subjects dropped out of the study. For those remaining, the average compliance was 78% (range, 51% to 98%). All subjects were able to operate the VCD independently, and expressed earnest interest in continuing tele-exercise programs in the future. There were significant improvement (p < 0.05) postexercise in fear of falling score (18%), single leg stance time (43%), Up-and-Go time (21%), and body sway during quiet stance (>8%). This study has demonstrated that the group tele-exercise program is acceptable and welcomed by elders, and is effective for improving balance and reducing fear of falling.

Effect of equitation training on health and physical fitness of college females

Limited information exists concerning equitation as a viable form of physical activity. The study's purpose was to quantify effects of an equitation training program on health and physical fitness of college females. Following written informed consent, 15 college females enrolled in equitation and 10 controls (age = 23.6 +/- 2.5 years; ht = 165.3 +/- 5.3 cm; wt = 62.4 +/- 3.4 kg) underwent a comprehensive pre- and post-series of tests to assess cardiorespiratory response (Bruce; VO2(peak), HR(peak), VE(peak), RER(peak), MAP(peak), RPP(peak)), body composition (body mass, body fat, fat-free mass), muscular power [Wingate; peak and mean power (MP), total power output, fatigue index (FI)], muscular strength (curl-ups, reverse sit-ups, pushups, handgrip), blood chemistry, and coronary risk. The equitation group trained at various equine gaits for 14 weeks, 5 days/week. Multivariate analyses of variance (Wilks' Lambda) indicated a significant main effect of training across muscular power (F (4,25) = 3.965; P = 0.013), but not across cardiorespiratory response (F (11,18) = 1.472; P = 0.225), body composition (F (3,26) = 1.081; P = 0.375), or muscular strength (F (4,25) = 2.172; P = 0.102). Pre-post improvements in MP (+13.3%; P = 0.01), total work output (+11.8%; P = 0.015), and FI (-10.5%; P = 0.038) were observed. Nonsignificant improvements of 8.5-11.4% were observed in muscular strength and body composition. In conclusion, equitation does not provide an adequate stimulus to improve health and fitness in young adults. Individuals who participate in equitation need to supplement this activity with traditional aerobic and load-bearing training regimens.

Midlife Respiratory Function Related to White Matter Lesions and Lacunar Infarcts in Late Life

BACKGROUND AND PURPOSE

Increased evidence suggests that poor respiratory function increases risk of ischemic damage to the brain. Longitudinal studies on respiratory function and cerebral small-vessel disease are lacking. We examined midlife and late-life respiratory function in relation to small-vessel disease on computed tomography (CT) in women followed for 26 years.

METHODS

White matter lesions (WMLs) and lacunar infarcts were rated on brain CT scans in 2000 in 379 women 70 to 92 years of age from a longitudinal population study in Göteborg, Sweden. Respiratory function was measured by peak expiratory flow (PEF) in 1974 and 2000 and by forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) in 1980 and 2000.

RESULTS

Lower FVC and FEV1 in 1980 and 2000 were associated with presence and severity of WMLs and lacunar infarcts in 2000. Per 1-SD decrease of FVC in 1980, odds ratios (95% CIs) were 1.49 (1.11 to 2.02) for presence of WMLs and 1.95 (1.34 to 2.84) for lacunar infarcts after adjustment for potential confounders. Per 1-SD decrease of FEV1 in 1980, adjusted odds ratios were 1.46 (1.06 to 2.00) for presence of WMLs and 1.42 (1.02 to 1.97) for lacunar infarcts. PEF in 1974 and 2000 was not associated with WMLs or lacunar infarcts.

CONCLUSIONS

WMLs and lacunar infarcts in elderly women were related to lower midlife respiratory function. Although our data may not establish causation between lower respiratory function and small-vessel disease, they imply the importance of good respiratory function in midlife.

Development of the simplified Tai Chi exercise program (STEP) for frail older adults

OBJECTIVE

To develop a simplified Tai Chi exercise program for frail older adults.

DESIGN

For phase I, using a focus group, 40 frail Taiwanese older adults were interviewed to explore their viewpoints on Tai Chi and have been reported elsewhere. This paper emphasized on the phase II of the study in which the older adults' perspectives were validated by 10 experts using an evaluation survey.

SETTING

Long-term care facilities.

RESULTS

The newly developed simplified Tai Chi exercise program (STEP) included three stages-(1) warm-up: comprised nine exercises specifically designed to loosen up the body from head to toe; (2) Tai Chi movements: encompassed 12 easy-to-learn and easy-to-perform movements; (3) cool-down: included three activities to cease the chi and rest the body.

CONCLUSIONS

The STEP should be further evaluated for its effectiveness in enhancing the relative well being and quality of life of frail older adults and its applicability as a floor activity in long-term care facilities.

Muscle activation profiles about the knee during Tai-Chi stepping movement compared to the normal gait step

The purpose of this study was to investigate knee muscle activity patterns in experienced Tai-Chi (TC) practitioners during normal walking and TC stepping. The electromyographic (EMG) activity of vastus lateralis (VL), vastus medialis (VM), bicep femoris (BF), and gastrocnemius (GS) muscles of 11 subjects (five females and six males) during the stance phase of normal walking was compared to stance phase of a TC step. Knee joint motion was also monitored by using an Optotrak motion analysis system. Raw EMG was processed by root-mean-square (RMS) technique using a time constant of 50 ms, and normalized to maximum of voluntary contraction for each muscle, referred to as normalized RMS (nRMS). Peak nRMS and co-contraction (quantified by co-contraction index) during stance phase of a gait cycle and a TC step were calculated. Paired t-tests were used to compare the difference for each muscle group peak and co-contraction pair between the tasks. The results showed that only peak values of nRMS in quadriceps and co-contraction were significantly greater in TC stepping compared to normal walking (Peak values of nRMS for VL were 26.93% for normal walking and 52.14% for TC step, p=0.001; VM are 29.12% for normal walking and 51.93% for TC stepping, p=0.028). Mean co-contraction index for VL-BF muscle pairs was 13.24+/-11.02% during TC stepping and 9.47+/-7.77% in stance phase of normal walking (p=0.023). There was no significant difference in peak values of nRMS in the other two muscles during TC stepping compared to normal walking. Preliminary EMG profiles in this study demonstrated that experienced TC practitioners used relatively higher levels of knee muscle activation patterns with greater co-contraction during TC exercise compared to normal walking.

Effects of long term Tai Chi practice and jogging exercise on muscle strength and endurance in older people

OBJECTIVES

To investigate the influence of regular Tai Chi (TC) practice and jogging on muscle strength and endurance in the lower extremities of older people.

METHODS

Twenty one long term older TC practitioners were compared with 18 regular older joggers and 22 sedentary counterparts. Maximum concentric strength of knee flexors and extensors was tested at angular velocities of 30 degrees/s and 120 degrees/s. Ankle dorsiflexors and plantar flexors were tested at 30 degrees/s and the dynamic endurance of the knee flexors and extensors was assessed at a speed of 180 degrees/s.

RESULTS

The differences in the muscle strength of the knee joint amongst the three experimental groups were significant at the higher velocity. The strengths of knee extensors and flexors in the control group were significantly lower than those in the jogging group and marginally lower than those in the TC group. For the ankle joint, the subjects in both the TC and jogging groups generated more torque in their ankle dorsiflexors. In addition, the muscle endurance of knee extensors was more pronounced in TC practitioners than in controls.

CONCLUSION

Regular older TC practitioners and joggers showed better scores than the sedentary controls on most muscle strength and endurance measures. However, the magnitude of the exercise effects on muscles might depend on the characteristics of different types of exercise.

Neural mechanisms underlying balance improvement with short term Tai Chi training

BACKGROUND AND AIMS

Though previous research has shown that Tai Chi reduces falls risk in older adults, no studies have examined underlying neural mechanisms responsible for balance improvement. We aimed to determine the efficacy of Tai Chi training in improving neuromuscular response characteristics underlying balance control in balance-impaired older adults.

METHODS

Twenty-two balance-impaired older adults were randomly divided into Tai Chi (TC) or control groups. Nineteen subjects (age 68-92, BERG 44 or less) completed the study. TC training included repetitive exercises using TC motor and biomechanical strategies, techniques, and postural elements. Control training included axial mobility exercises, balance/awareness education and stress reduction. Groups trained 1.5 hours/day, 5 days/week for 3 weeks. After post-testing the control group received TC training. Subjects walked across a force plate triggered to move forward 15 cm at 40 cm/sec at heel strike. Tibialis anterior (TA) and medial gastrocnemius (GA) responses during balance recovery were measured with electromyograms (EMGs). Four clinical measures of balance were also recorded.

RESULTS

TC subjects, but not controls, significantly reduced both TA response time from 148.92 +/- 45.11 ms to 98.67 +/- 17.22 ms (p < or = 0.004) and occurrence of co-contraction of antagonist muscles (p < or = 0.003) of the perturbed leg. Clinical balance measures also significantly improved after TC.

CONCLUSIONS

TC enhanced neuromuscular responses controlling the ankle joint of the perturbed leg. Fast, accurate neuromuscular activation is crucial for efficacious response to slips or trips.

Hemodynamic responses to a community-based Tai Chi exercise intervention in ethnic Chinese adults with cardiovascular disease risk factors

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death among older adults worldwide, including Europe, Asia, and North America. In the United States (US), CVD is also the leading cause of death among Asian-Americans. Physical activity has been shown to reduce CVD risk factors. Reduction in blood pressure (BP) in response to Tai Chi (TC) exercise in persons with CVD risk factors have been reported, though not in ethnic Chinese living in the US.

AIM

Hemodynamic responses to a 12-week community-based TC exercise intervention among ethnic Chinese with CVD risk factors were examined.

METHODS

Quasi-experimental design. Ethnic Chinese > 45 years old with at least 1 major CVD risk factor, living in the San Francisco Bay Area, attended a TC intervention three times a week for 12 weeks. A 2-min step-in-place test assessed aerobic endurance. BP and heart rate were measured at rest, and within 1-min after the step-test. Data were collected at baseline, 6 and 12 weeks.

RESULTS

A total of 39 subjects (69% women), 66 +/- 8.3 years old, with hypertension (92%), hypercholesteremia (49%), and/or diabetes (21%), and 1 current smoker participated. Adherence to the intervention was high (87%). Subjects were sedentary at baseline, though had a statistically significant improvement in aerobic endurance over-time (eta2 = 0.39). At baseline, the average BP at rest was 150/86, while BP in response to the step-test was 178/99. Clinically and statistically significant reductions in BP at rest (131/77), and in response to the step-test (164/82) were found over 12 weeks of TC (p < 0.01). No significant change in heart rate was observed.

CONCLUSIONS

This innovative, culturally relevant, community-based 12-week TC exercise intervention, appealed to Chinese adults with CVD risk factors, with significant reductions in BP and improvement in aerobic endurance. Given the number of persons estimated to have HTN and other CVD risk factors, the identification of new approaches to improve health, combined with risk factor reduction is needed. This is particularly important, given the rise in HTN among adults in the US and the associated public health burden of HTN. TC has the potential to reduce expenditures associated with CVD by facilitating a lifestyle that promotes physical activity, while remaining a low-tech, low-cost alternative to exercise.

Ground contact characteristics of Tai Chi gait

BACKGROUND

To date, no direct measurement has been done that quantitatively characterizes the foot-ground contact during Tai Chi Chuan movements. The goal of this study was to quantify the biomechanical characteristics of foot-ground contact during a Tai Chi gait (TCG), one of the basic but common Tai Chi Chuan movements.

METHODS

The ground reaction force profiles, center of pressure (COP) and plantar pressure patterns under the stance foot of TCG were directly measured in a sample of 10 healthy young individuals.

RESULTS

The medial force reached a peak value of 12 +/- 2% body weight (BW) during early stance. The vertical force reached and maintained a peak value of 109 +/- 2% BW during single stance, and shifted within a range of 10% and 70% BW during double stance phases. There was a uniformly small rate of loading in all three directions throughout stance. The peak plantar pressure was fairly constant throughout stance in the rear-foot region (maximum value of 0.27 +/- 0.07 kPa/kg), but changed from 0 to 0.16 +/- 0.04 kPa/kg in the fore-foot region. The peak pressure difference between the fore-foot and rear-foot regions was less than 0.06 +/- 0.01 kPa/kg during single stance and the second double stance. The maximum plantar contact area during TCG was 60 +/- 9% of the foot area. The foot COP displaced largely during the early and late part of the stance and maintained fairly stationary during single stance. The maximum COP displacement in the medial-lateral direction was 64 +/- 8% of foot width.

CONCLUSIONS

TCG had a low impact force, a fairly evenly distributed body weight between the fore-foot and rear-foot regions, and a large medial-lateral displacement of the foot COP.

Effects of Sun-style Tai Chi exercise on physical fitness and fall prevention in fall-prone older adults

AIM

This paper reports a study to determine changes in the physical fitness (knee and ankle muscle strength, balance, flexibility, and mobility), fall avoidance efficacy, and fall episodes of institutionalized older adults after participating in a 12-week Sun-style Tai Chi exercise programme.

BACKGROUND

Fall prevention has a high priority in health promotion for older people because a fall is associated with serious morbidity in this population. Regular exercise is effective in fall prevention for older adults because of improvements in strength and balance. Tai Chi exercise is considered to offer great potential for health promotion and rehabilitation, particularly in the maintenance of good mental and physical condition in older people.

METHODS

A quasi-experimental design with a non-equivalent control group was used. Data were collected from September 2001 to January 2002. A total of 68 fall-prone older adults with a mean age of 77.8 years participated in the study, and 29 people in the Tai Chi group and 30 controls completed the post-test measures. The Tai Chi exercise programme was provided three times a week for 12 weeks in the experimental group. Data were analysed for group differences using t-tests.

RESULTS

At post-test, the experimental group showed significantly improved muscle strength in knee and ankle flexors (P < 0.001) and extensors (P < 0.01), and improved flexibility (P < 0.01) and mobility (P < 0.001) compared with the control group. There was no significant group difference in fall episodes, but the relative risk ratio for the Tai Chi exercise group compared with the control group was 0.62. The experimental group reported significantly more confidence in fall avoidance than did the control group.

CONCLUSION

The findings reveal that Tai Chi exercise programmes can safely improve physical strength and reduce fall risk for fall-prone older adults in residential care facilities.

Effectiveness of a community-based Tai Chi program and implications for public health initiatives

OBJECTIVES

To establish whether the reported beneficial physiologic effects of Tai Chi when performed under stringent experimental conditions can be generalized to the community.

DESIGN

Phase 1: pre-post comparison in a group inexperienced in Tai Chi. Phase 2: baseline comparison between inexperienced and experienced Tai Chi groups.

SETTING

A community in Hong Kong.

PARTICIPANTS

Phase 1: 51 subjects inexperienced in Tai Chi (novice group) participated in the program. Phase 2: baseline measures of the novice group were compared with those of an experienced group (n=49) who had practiced Tai Chi for at least 6 months.

INTERVENTION

A Cheng 119 style program was taught by a Tai Chi master for 1.5 hours, 3 times weekly, for 12 weeks.

MAIN OUTCOME MEASURES

Lung function and physical activity evaluated before and after the completion of the program. Resting heart rate, blood pressure, oxygen saturation, handgrip strength, flexibility, and balance measured at the program commencement, 6 weeks, and 12 weeks.

RESULTS

Phase 1: after the program, the novice group had increased handgrip strength, flexibility, and peak expiratory flow rate. Phase 2: the experienced group had greater flexibility, lower resting heart rate but higher diastolic blood pressure than the novice group prior to training.

CONCLUSIONS

A community-based Tai Chi program produces beneficial effects comparable to those reported from experimental laboratory trials of Tai Chi; therefore, it should be considered as a public health strategy.

Comparison of Muscle Torque, Balance, and Confidence in Older Tai Chi and Healthy Adults

PURPOSE

The objectives of this cross-sectional study were to examine whether older Tai Chi practitioners had better knee muscle strength, less body sway in perturbed single-leg stance, and greater balance confidence than healthy older adults.

METHODS

Tai Chi and control subjects (N = 24 each, aged 69.3 +/- 5.0 and 71.6 +/- 6.1 yr, respectively) were matched with respect to age, gender, height, weight, and physical activity level. Concentric and eccentric isokinetic tests of the subjects" dominant knee extensors and flexors were conducted at an angular velocity of 30 degrees.s(-1). Control of body sway was assessed in static double-leg stance and in single-leg stance perturbed by forward or backward platform perturbations. The Activities-specific Balance Confidence (ABC) scale was used to investigate subjects" balance confidence in daily activities.

RESULTS

Tai Chi practitioners had higher peak torque-to-body weight ratios in concentric and eccentric isokinetic contractions of their knee extensors and flexors (P = 0.044). They manifested less anteroposterior body sway angles in perturbed single-leg but not static double-leg stance than did control subjects (P < 0.001). Tai Chi practitioners also reported significantly higher balance confidence score ratios (P = 0.001). Older adults" knee muscle strengths showed negative correlations with body sway angles in perturbed single-leg stance and positive correlations with ABC score ratios. Moreover, their body sway angles in perturbed single-leg stance were negatively correlated with their ABC score ratios (all P < 0.05).

CONCLUSION

Our results demonstrate that long-term Tai Chi practitioners had better knee muscle strength, less body sway in perturbed single-leg stance, and greater balance confidence. Significant correlations among these three measures uncover the importance of knee muscle strength and balance control during perturbed single-leg stance in older adults" balance confidence in their daily activities.

Shingles Immunity and Health Functioning in the Elderly: Tai Chi Chih as a Behavioral Treatment

Both the incidence and severity of herpes zoster (HZ) or shingles increase markedly with increasing age in association with a decline in varicella zoster virus (VZV)-specific immunity. Considerable evidence shows that behavioral stressors, prevalent in older adults, correlate with impairments of cellular immunity. Moreover, the presence of depressive symptoms in older adults is associated with declines in VZV-responder cell frequency (VZV-RCF), an immunological marker of shingles risk. In this review, we discuss recent findings that administration of a relaxation response-based intervention, tai chi chih (TCC), results in improvements in health functioning and immunity to VZV in older adults as compared with a control group. TCC is a slow moving meditation consisting of 20 separate standardized movements which can be readily used in elderly and medically compromised individuals. TCC offers standardized training and practice schedules, lending an important advantage over prior relaxation response-based therapies. Focus on older adults at increased risk for HZ and assay of VZV-specific immunity have implications for understanding the impact of behavioral factors and a behavioral intervention on a clinically relevant end-point and on the response of the immune system to infectious pathogens.

Effects of tai chi mind-body movement therapy on functional status and exercise capacity in patients with chronic heart failure: a randomized controlled trial

PURPOSE

To examine the effects of a 12-week tai chi program on quality of life and exercise capacity in patients with heart failure.

METHODS

Thirty patients with chronic stable heart failure and left ventricular ejection fraction < or =40% (mean [+/- SD] age, 64 +/- 13 years; mean baseline ejection fraction, 23% +/- 7%; median New York Heart Association class, 2 [range, 1 to 4]) were randomly assigned to receive usual care (n = 15), which included pharmacologic therapy and dietary and exercise counseling, or 12 weeks of tai chi training (n = 15) in addition to usual care. Tai chi training consisted of a 1-hour class held twice weekly. Primary outcomes included quality of life and exercise capacity. Secondary outcomes included serum B-type natriuretic peptide and plasma catecholamine levels. For 3 control patients with missing data items at 12 weeks, previous values were carried forward.

RESULTS

At 12 weeks, patients in the tai chi group showed improved quality-of-life scores (mean between-group difference in change, -25 points, P = 0.001), increased distance walked in 6 minutes (135 meters, P = 0.001), and decreased serum B-type natriuretic peptide levels (-138 pg/mL, P = 0.03) compared with patients in the control group. A trend towards improvement was seen in peak oxygen uptake. No differences were detected in catecholamine levels.

CONCLUSION

Tai chi may be a beneficial adjunctive treatment that enhances quality of life and functional capacity in patients with chronic heart failure who are already receiving standard medical therapy.

Comprehensive Therapeutic Benefits of Taiji

This literature review offers physical rehabilitation professionals an update on the current breadth and strength of research evidence regarding comprehensive therapeutic benefits of Taiji practice. A critical analysis distinguishes between what is known from controlled clinical research and what is suggested in preliminary research. Of >200 published reports examined, 17 controlled clinical trials were judged to meet a high standard of methodological rigor. Controlled research evidence was found to confirm therapeutic benefits of Taiji practice with regard to improving quality of life, physical function including activity tolerance and cardiovascular function, pain management, balance and risk of falls reduction, enhancing immune response, and improving flexibility, strength, and kinesthetic sense. Preliminary research on implementation feasibility of Taiji programming exists for a variety of clinical populations. Further controlled clinical study is justified for a wide variety of clinical contexts.

Using a novel exercise programme for patients with muscular dystrophy. Part II: a quantitative study

PURPOSE

To quantitatively evaluate the effects of qigong in patients with muscular dystrophy.

METHODS

Thirty-six patients with muscular dystrophy were assigned to either a treatment or comparison group, by means of a stratified randomization procedure. The intervention period lasted for 3 months. Balance and respiratory function were assessed by means of Berg's Balance Scale and an electronic spirometer, respectively. Health-related quality of life was tested by means of a Swedish version of the Medical Outcome Study Short Form Health Survey (SF-36), coping levels by means of a Swedish version of the Ways of Coping Questionnaire and depression levels by means of a modified version of the Montgomery åsberg Depression Rating Scale.

RESULTS

Perceived general health was maintained in the treatment group whereas this was not the case in the comparison group (p=0.05). Positive reappraisal coping decreased in the treatment group but not in the comparison group (p=0.05). There was a tendency to maintain balance function during training and performance of qigong whilst there was a decline when not training.

CONCLUSION

Qigong may be useful as an adjunct therapy regimen in patients with muscular dystrophy in that it can bring about a decreased rate of decline in general health. The change in coping pattern in this study needs more investigation. More research is also needed in order to more fully investigate the effects of qigong on such physical variables as balance function.

Effects of exercise on joint sense and balance in elderly men: Tai Chi versus golf

PURPOSE

Our previous studies showed that experienced Tai Chi practitioners had better joint proprioception and balance control during weight shifting. The objective of the present study was to examine whether experienced golfers had attained similar improvement when compared with the Tai Chi practitioners, as well as healthy elderly subjects and young university students.

METHODS

We compared 12 experienced elderly Tai Chi practitioners, with 11 experienced elderly golfers, 12 healthy elderly subjects, and 12 young university students, who were all males, using: 1) passive knee joint repositioning test to assess their joint proprioceptive acuity and 2) limits of stability test to assess their ability to voluntarily weight shift within their base of support.

RESULTS

Both Tai Chi practitioners and golfers had better knee joint proprioceptive acuity than did the elderly control subjects (P < 0.05). Of special interest is that their performance was similar to that of the young subjects. In the limits of stability test, Tai Chi practitioners and golfers had faster reaction time, leaned further without losing stability, and showed better control of leaning trajectory than did elderly control subjects (all P < 0.05). The latter two outcome measures were also comparable to those of the young subjects.

CONCLUSION

These results demonstrate that both experienced Tai Chi practitioners and golfers had improved knee joint proprioception and limits of stability, when compared with those of elderly control subjects similar in age, gender (male), and physical activity level. Such improved outcome measures were comparable to those of young male subjects. These findings suggest that experienced Tai Chi practitioners and golfers had improved joint proprioceptive acuity and dynamic standing balance control, despite the known aging effects in these specific sensorimotor functions.

Relative exercise intensity of Tai Chi Chuan is similar in different ages and gender

This study aims to determine the relative exercise intensity of classical Yang Tai Chi Chuan (TCC) in different ages and gender. One hundred TCC practitioners (54 men and 46 women) aged 25 to 80 years participated in this investigation. Men and women were separated into three groups: young (25-44 y/o), middle-aged (45-64 y/o) and elderly (65-80 y/o). Heart rate (HR) responses during TCC practice were measured by using electrocardiographic telemetry. An exercise test with breath-by-breath measurements of cardiorespiratory function was also performed for each subject during the incremental exercise of leg cycling. Measurements obtained during the TCC practice and exercise testing were compared to determine the exercise intensity of TCC. While performing TCC, the mean HR of men was 141 +/- 12 bpm, 132 +/- 9 bpm and 120 +/- 10 bpm in the young, middle-aged and elderly groups, respectively. Men practiced TCC with mean HR corresponding to 57.8 +/- 3.7%, 56.6 +/- 3.4% and 55.1 +/- 3.1% of heart rate reserve (HRR) in the three groups. Meanwhile, the mean HR of women was 136 +/- 10 bpm, 126 +/- 11 bpm and 115 +/- 12 bpm in the young, middle-aged and elderly groups, respectively. Women practiced TCC with mean HR corresponding to 52.7 +/- 2.8%, 51.5 +/- 2.6% and 50.3 +/- 2.9% of HRR in the three age groups. The results demonstrate that classical Yang TCC is an exercise with moderate intensity, and its exercise intensity is similar across different ages in each gender. In conclusion, TCC is an aerobic exercise and suitable for participants of different ages and gender to improve their functional capacity.