The development of a Tai Chi exercise regimen for the prevention of conditions requiring long-term care in Japan

Association between Tai Chi Yuttari Exercise and Longevity and Prevention of Long-Term Care Need: Survival Analysis in Kitakata City, Japan

This study examined whether participation in Tai Chi Yuttari exercise is associated with a delay in the death and new certification for long-term care need of older adults. Individuals who participated in Tai Chi Yuttari exercise classes in 2011-2015 (participation group) were compared with individuals from the Basic Resident Register of Kitakata City (non-participation group). Death and new certification for long-term care need were selected to evaluate the effectiveness of participation in Tai Chi Yuttari exercise classes. The periods from the start date of the observation to each person's date of occurrence of events were calculated. The Kaplan-Meier method and log-rank test were used to compare survival curves between the groups. A total of 105 and 202 individuals in the participation and non-participation groups, respectively, were observed. Survival duration (χ2 = 8.782, p = 0.003) and the period before receiving certification for long-term care (χ2 = 5.354, p = 0.021) were longer in the participation group than in the non-participation group. In the stratified analysis by sex, survival duration was longer in the participation group in men only (χ2 = 7.875, p = 0.005). Participation in Tai Chi Yuttari exercise might be effective in delaying death, especially in men, and new certification for long-term care.

What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world

OBJECTIVE

The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing.

DESIGN

Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community.

INCLUSION CRITERIA

Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French.

RESULTS

305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13).

CONCLUSION

The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.

Tai Chi Ameliorates Coronary Heart Disease by Affecting Serum Levels of miR-24 and miR-155

The protective role of Tai Chi in coronary heart disease (CHD) has been widely reported. However, the exact molecular mechanism remains unclear. Serum levels of miR-24 and miR-155 have been found to potentially be involved with CHD risk. Thus, the effects of Tai Chi on CHD risk were explored by measuring serum levels of miR-24 and miR-155. A total of 326 CHD patients were evenly divided into the Tai Chi (TG) and control (CG) groups. The activities of daily living ability (ADL) and exercise of self-care agency (ESCA) scores were compared between the two groups. Left ventricular ejection fraction (LVEF), SF-36 life quality, self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate subjects’ cardiac function, quality of life, anxiety, and depression. Serum levels of miR-24 and miR-155 were measured by a real-time quantitative polymerase chain reaction (RT-qPCR). After a 6-month Tai Chi intervention, the ESCA, ADL, LVEF, and SF-36 scores in the TG group were higher than those in the CG group (p < 0.05). The time of arrhythmia and atrioventricular block recovery and hospital stay, and the scores of SAS and SDS in the TG group were lower than in the CG group (p < 0.05). Serum levels of miR-24 and miR-155 in the TG group were also lower than in the CG group (p < 0.05). In addition, serum levels of miR-24 and miR-155 were negatively associated with the ESCA, ADL, LVEF and SF-36 scores, and had adverse effects on life quality. Altogether, these present findings demonstrate that Tai Chi improves CHD prognosis, by affecting serum levels of the miR-24 and miR-155.

Tai Chi and whole-body vibrating therapy in sarcopenic men in advanced old age: a clinical randomized controlled trial

This study was to investigate the effects of Tai Chi (TC) and whole-body vibration (WBV) exercise in sarcopenic men in advanced old age. Ninety sarcopenic men (mean age 88.6 years; age range 85-101 years) were divided into three groups: TC group, WBV group, and control (CON) group. Patients in the two treatment groups received 8 weeks of training in either TC or WBV, while the control group received reminders not to change their level of physical exercise or lifestyle. Patients in all groups also received health information related to sarcopenia. Muscle mass, muscle strength, and physical performance [balance, gait speed, timed-up-and-go test (TUGT), and five-times-sit-to-stand test (FTSST)] were analyzed and compared among the three groups. Finally, seventy-nine subjects completed the study (TC n = 24; WBV n = 28; and CON 27). Muscle strength was significantly increased in the TC and WBV groups compared to the control group (P < 0.01). Following 8 weeks of exercise, improvements were observed in all physical performance tests for the TC and WBV groups (P < 0.05). The improvement in balance was greater in the TC group than the WBV group. Time × Group effects revealed significant improvements in muscle strength in the lower extremities (P < 0.05) and physical performance (P < 0.01) in both the TC and WBV groups. Changes in muscle mass, as measured by dual-energy X-ray absorptiometry, did not significantly differ between groups. These findings indicate that TC and WBV are effective treatments for improving muscle strength and physical performance in sarcopenic men in advanced old age.

Preliminary validation of an exercise program suitable for pregnant women with abnormal glucose metabolism: inhibitory effects of Tai Chi Yuttari-exercise on plasma glucose elevation

[Purpose] There is insufficient evidence related to exercise programs that are safe and efficacious for pregnant women with abnormal glucose metabolism. Tai Chi Yuttari-exercise is an exercise program with validated safety and efficacy in improving physical function in the elderly. In this study, we investigated this program’s inhibitory effects on plasma glucose elevation when it was adapted to a pregnancy model. [Subjects and Methods] Twelve 18- to 19-year-old females without a history of pregnancy were randomly assorted into two groups: an intervention group, for which six subjects were outfitted with mock-pregnancy suits and asked to perform Tai Chi Yuttari-exercise, and a control group who did not perform exercise. The intervention group had a mean Borg Scale score of 11.1 ± 0.9 during the exercise. [Results] No significant intragroup differences were observed in fasting, baseline, or post-intervention/observation plasma glucose levels. On the other hand, the intergroup change in plasma glucose levels after intervention/observation was significant when comparing the intervention and control groups: −1.66 ± 7.0 and 9.42 ± 6.57 mg/dl, respectively. [Conclusion] Tai Chi Yuttari-exercise appears to effectively inhibit plasma glucose elevation at intensity and movement levels that can be safely applied to pregnant women with abnormal glucose metabolism.

Role of Physical Therapists in Health Care of the Elderly

Japan is one of the leading countries worldwide in terms of longevity. However, with the increase in the elderly population, the number of individuals requiring some type of daily living assistance has currently exceeded 6 million. Cerebrovascular disease is the main reason for the requirement of care among the elderly. However, individuals in the late old age (≥75 years)-the number of which is rapidly increasing-also experience problems related to the functional decline of their musculoskeletal system, owing to age-related frailty and falls/fractures. Increasing the amount of physical activity not only helps prevent the onset of lifestyle-related diseases, but can also prevent the age-related decline in motor function. Hence, elderly individuals should perform exercises for health promotion and preventative care. However, as the physical functions and chronic diseases differ among individuals, it appears that the exercise programs offered as part of primary and secondary prevention programs may not be effective. Hence, physical therapists should play a large role in establishing appropriate and individualized exercise programs, as they have considerable experience in providing exercise therapy in the context of medical care for elderly people with varying conditions and risks.

Physical Activity and Exercise as a Basic Preventive Measure (Primary Prevention, Prevention after Renal Transplantation)

Movement is an inseparable part of one's life, and has been a basic everyday activity through the history of mankind. However, a lack of physical activity and availability of food have resulted in a variety of serious health impairments. The 20th century has witnessed a steep rise of mortality from cardiovascular disease, increase in the prevalence of type-2 diabetes mellitus, malignant diseases, and dramatic increase in body weight initially in industrialized nations followed, in the last two decades of the last century, by the populations of third-world countries with all inherent consequences of this phenomenon. Preventive programmes involving physical activity have also been on the list of top priorities of various materials issued by the World Health Organization. Physical activity is one of the simplest non-pharmacological tools in the prevention of a plethora of diseases. The simplest physical activity, even for therapeutic purposes, is walking. We can walk any time, virtually anywhere, so walking is also the least expensive therapeutic option.

Effects of Tai Chi on balance and fall prevention in Parkinson's disease: a randomized controlled trial

OBJECTIVES

To examine the effects of Tai Chi on balance and functional mobility in people with Parkinson's disease, and determine whether fall incidence could be reduced by the Tai Chi exercise.

DESIGN

Single blinded randomized control trial with 6 months' follow-up.

SETTING

A hospital and general community.

PARTICIPANTS

Patients (n=76) diagnosed with idiopathic Parkinson's disease, over 40 years old, able to walk independently and fell at least one time during the past 12 months.

INTERVENTIONS

The Tai Chi group (n=37) received 24-form Yang style Tai Chi exercise for 60 minutes each time, three times a week and lasted for 12 weeks. The control group (n=39) received no intervention.

MAIN OUTCOME MEASURES

Berg Balance Scale (BBS), Unified Parkinson's Disease Rating Scale (UPDRS) III, Timed Up&Go (TUG) and occurrences of falls.

RESULTS

The Tai Chi group improved more than the control group on the BBS (p<0.05), but there was no difference on UPDRS III scores and Timed Up&Go (p>0.05). During the 6-month follow-up, only 8 (21.6%) out of 37 patients in the Tai Chi group had experience of falls comparing to 19 (48.7%) out of 39 patients in the control group (p<0.05). The average times of falls were 0.30±0.62 in the Tai Chi group compared with 0.64±0.74 in the control group (p<0.05).

CONCLUSIONS

Our findings suggested that Tai Chi exercise could improve the balance and decrease the fall risks in patients with Parkinson's disease.

Community-based exercise program reduces chronic knee pain in elderly Japanese women at high risk of requiring long-term care: a non-randomized controlled trial

AIM

To estimate the prevalence of low back pain and/or knee pain among the elderly at high risk of requiring long-term care, and to determine the effectiveness of a community-based exercise program provided in accordance with the Motor Function Improvement Program for improving low back and/or knee pain.

METHODS

The target population of this study was 320 residents aged ≥65 years who were eligible for the exercise program. For the intervention group, weekly exercise classes of 120 min duration were held 12 times over 3 months. The main outcome measures were changes between the baseline and 3-month follow up in visual analog scale (VAS) scores for pain and in the Western Ontario McMaster Osteoarthritis Index (WOMAC) pain for severity of knee pain.

RESULTS

The number of participants reporting chronic low back and/or knee pain was 252 with a prevalence of 78.8%. Among them, 68 who were allocated to the intervention group and 125 to the control group completed the study, and were stratified by sex. In women, change in the VAS scores of low back pain was -17.5±23.2 for the intervention group and -7.2±23.4 for the control group (between-group differences P=0.03). For knee pain, significant changes in the VAS scores (between-group differences P=0.04) and WOMAC pain (P<0.001) were observed; -14.9±24.9 and -0.6±3.1 for the intervention group, and -0.2±28.5 and 2.2±3.2 for the control group, respectively. No significant difference was observed in men.

CONCLUSION

Community-based exercise programs might reduce prevalent knee pain in elderly women at high risk of requiring long-term care.

Balance of older trekkers: data on alpine accidents and performance as assessed using a video game machine

The number of alpine accidents involving older trekkers has increased markedly in developed countries in recent years. More than 76.8% of the trekkers involved in alpine accidents in Japan were older than 40 years, with some experiencing a stroke or myocardial infarction while trekking at altitude. In the present study, we surveyed social trends in trekkers by interview at a popular mountain site, Mt Tanigawa (1963 m in altitude). The total number of trekkers interviewed was 511, and more than 60% of these were older than 40 years. Of trekkers older than 60 years, 42% complained of conditions such as hypertension or diabetes. In 2 volunteer groups (10 younger subjects and 10 older subjects), physical condition was assessed before and after trekking. Significant body weight loss induced by dehydration was observed more often in older subjects than in younger subjects (P < .05). Balance, as measured using the Nintendo WiiFit (Nintendo, Kyoto, Japan), worsened in the older group (P < .05). Local police records for 2009 showed that the total number of alpine accidents was 65. Injuries provoked by stumbling, slipping, and falling accounted for 51% of these, and 82% of casualties were older than 40 years, with 35% being older than 60 years. In conclusion, many older people involved in nonchallenging middle-altitude trekking have problems with regard to overall health and balance. Alpine accidents caused by myocardial infarction, stroke, or hypoglycemia tend to be more common in this population. Alpine rescue teams should be well prepared for this, and older trekkers should be made aware of their increased risk of injury in alpine settings.