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

A 'health message' on sustainable physical and mental health for the prolonged COVID-19 and other pandemics

The world has been living with another pandemic physical inactivity (PI) and sedentary behavior (SB) and of other nature for years. As social measures to prevent the spread of COVID-19 have been strengthened, the physical activity (PA) barrier has been hit and the PI/SB pandemic has been exacerbated, and in the current situation, triggered by its prolonged period, it is emerging as a problem to be considered in order to combat the PI/SB pandemic through PA and to maintain continuous physical and mental health. This review aims to summarize existing and recent studies on the effects of PA/SB on physical and mental health in preparation for the context of prolonged COVID-19 and provides an easy and fun way to motivate, access PA, and PA recommendations for maintaining physical and mental health. We performed search strategies on PubMed, Medline, Scopus, and Google Scholar databases, and used a literature review of the current available literature on the COVID-19 and the effects of PI, SB, and PA on physical and mental health. The clinical relevance of this review shows that integrating PA into daily life and reducing prolonged sitting time is an important strategy for continuing a healthy life physically and mentally. As a result, for those who have not yet incorporated exercise as part of their daily routine, fun and easy access to PA suggests that in the long run, may be an opportunity to implement newer habits. In addition, in an emergency such as the COVID-19 quarantine period or other pandemics, it is essential for one to maintain health through PA at home, and underscore the 'health message' of the current review that reducing SB, progressively increasing PA, and doing more PA regularly in the current context prolonged COVID-19 can bring significant benefits to long-term habits and physical and mental health.

Augmented reality-assisted training with selected Tai-Chi movements improves balance control and increases lower limb muscle strength in older adults: A prospective randomized trial

Background

Tai-Chi benefits older adults by enhancing balance control and increasing the muscle strength of the lower limbs. However, a complete set of traditional Tai-Chi exercises is sometimes too difficult for beginners. We investigated whether practicing augmented reality-assisted training with selected Tai-Chi movements tailored to the practitioner’s ability (selected Tai-Chi, or sTC) is as effective as performing a complete set of Tai-Chi sequences (complete traditional Tai-Chi, or tTC).

Methods

In this prospective randomized trial carried out in the Beitou District of Taipei City, Taiwan, community-dwelling adults aged ≥65 and without any debilitating diseases (n = 28) were included. Participants were randomly assigned to the sTC group (n = 14) or the tTC group (n = 14). Participants in the sTC group practiced selected Tai-Chi movements using the augmented reality Tai-Chi training system. Participants of the tTC group were asked to complete the 24-form Yang-style Tai-Chi following the instructions of Tai-Chi masters. Each training session lasted 30 min, with 3 sessions per week for 8 weeks. Pre- and post-intervention evaluations included functional balance tests, comprising the Berg Balance Scale (BBS), Timed Up and Go test (TUG), and Functional Reach Test (FRT), as well as muscle strength measurements of the lower extremities.

Results

Pre-intervention evaluations showed significant differences in FRT (p = 0.034) and left hip abductor muscle strength (p = 0.046) between the sTC and tTC groups. After 8 weeks of training, the BBS, TUG, and FRT scores in the sTC group showed significant improvement overall. Although all three functional balance test scores improved in the tTC group, only the improvement in BBS was statistically significant (p = 0.001). After 8 weeks, all muscle strength measurements increased by an average of 3.1 ± 1.0 kgw in the sTC group and 1.6 ± 0.8 kgw in the tTC group.

Conclusions

The augmented reality-assisted training with selected Tai-Chi movements, designed based on objective measurements of the practitioner’s capability, improved balance control and muscle strength of lower limbs at least as effectively as the complete sequence of traditional Tai-Chi exercises.

Trial registration

This study was approved by the Institutional Review Board of National Yang-Ming University (IRB number: 1000087). Written informed consent was obtained from all participants.

Effects of individualized Tai-Chi on balance and lower-limb strength in older adults

Background

To investigate whether a simplified and personalized Tai-Chi program could be beneficial for practitioners. A prospective quasi-experimental observer-blinded controlled trial was done in Beitou District of Taipei City.

Methods

Community-dwelling adults aged 65 and older without debilitating disease (N = 50) participated the study. Those who were willing to participate in exercise program were assigned to individualized Tai-Chi (iTC) group (n = 20), receiving iTC training for 8 weeks, and traditional Tai-Chi (tTC) group (n = 15), receiving tTC training for 8 weeks. Those who were not willing to participate in exercise training were included in the control group (n = 15). Functional balance tests, the Berg Balance Scale (BBS), timed up-and-go (TUG) test, functional-reach test, and measurement of lower-extremity muscle strength were conducted before and 8 weeks after the intervention.

Results

Significant improvements were noted in all functional balance tests and strength assessments of 16 major lower-limb muscle groups in participants of the iTC group compared to the control group, whereas only BBS and muscle strength of hips and ankles were improved in the tTC group. Practitioners of iTC outperformed tTC in BBS and strength of two major muscles.

Conclusions

Personalized Tai-Chi training designed based on an objective measurement and conducted according to graded intensity and complexity benefitted practitioners after a short period.

Trial registration

Trial registration number: ClinicalTrials.gov ID: NCT03659396, Unique Protocol ID: 1000087

Date of registration: 03/28/2017

The trial was registered retrospectively

Seated Tai Chi versus usual activities in older people using wheelchairs: A randomized controlled trial

OBJECTIVE

Compare the effect of seated Tai Chi exercise (intervention) to usual activities on quality of life and depression symptoms in older people using wheelchairs.

DESIGN

Randomized controlled trial.

SETTING

One long-term care facility in Taiwan.

PARTICIPANTS

86 long-term care residents were screened; 60 were eligible and randomized to Tai Chi group (n=30), or usual activity (n=30).

INTERVENTION

One certified trainer provided the intervention group with 40min of seated Tai Chi exercise, three times a week for 26 weeks. Trial registration ACTRN12613000029796.

MAIN OUTCOME MEASURES

Quality of Life (WHOQOL (BREF)); depression symptoms (GDS-SF) RESULTS: Participants in the Tai Chi group (M=3.76, SD=3.65) recorded significantly lower GDS-SF scores than participants in the control (M=7.76, SD=5.15) and the Tai Chi group registered significantly higher scores across overall QOL [p=0.03], general health [p=0.04], and the associated domains: physical health [p=0.00], psychological health [p=0.02], social relations [p=0.00], and environment [p=0.00].

CONCLUSIONS

The findings highlight the importance of Tai Chi in improving QOL and depression in this population.

Health Promotion Outcomes of a Newly Developed Elastic Band Exercise Program for Older Adults in the Community: A Pilot Test

BACKGROUND

Studies indicate that the incidence of disease, the mortality rate, and medical costs are significantly higher in people aged 65 years and over who do not engage in physical activities than in their peers who do engage in these activities. Therefore, promoting appropriate physical activity among older adults in the community is essential to delaying the health implications of aging.

PURPOSE

This pilot test was developed to assess the effectiveness of a newly developed Senior Elastic Band (SEB) exercise program on the health of older adults in community care stations.

METHODS

A quasiexperimental design was used. A convenience sample of 20 participants from a community care station was recruited. The SEB intervention included three phases (warm-up, aerobic motion, and static stretching) and was conducted three times per week, 40 minutes per session for 1 month. Twelve health indicators in three categories (functional fitness, self-perceived health status, and sleep quality) were examined before and immediately after 1 month of SEB exercises.

RESULTS

Participants showed improved performance at the end of the 1-month study for the following indicators: lung capacity, cardiopulmonary fitness, upper and lower body flexibilities, upper limb muscle power, lower limb muscle endurance, and self-perceived physical health status (all ps < .05). No significant differences were identified for the other indicators.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The SEB exercise program shows preliminary and promising effects on improving the health of older adults in a community care station. Healthcare professionals who work with older adults living in the community may consider the SEB exercise program as a health promotion modality to recommend and implement with this population. However, we recommend further testing the long-term effects of this program on a larger population.

"DIRECTION-ORIENTED MOTION AND BALANCED SHORT-STANCE TAI CHI" MODEL: BIOMECHANICAL CHARACTERISTICS AND PRACTICABILITY

Previous clinical studies on Tai Chi have often randomly adopted Tai Chi movements that are complicated and not systematic for the elderly and beginners to learn. This study aimed to develop a direction-based and easy-to-learn Tai Chi model, the practicability of which was also tested. This model adopted seven typical movements of the Yang-style Tai Chi form that were divided into four motion directions. The biomechanical characteristics, including muscle activation, body center of gravity movement, and center of pressure of the practitioner during Tai Chi were measured to identify the model's characteristics and practicability. After three months of training, the patterns of measured biomechanical characteristics of the beginners were similar to those of the masters. This model maintains the principal features of traditional Tai Chi and allows beginners to more easily practice the movements within a short period of time. Beginners can also use this model under relaxed conditions, with the correct kinesiology of Tai Chi motions, and quickly practice Tai Chi at a level similar to that of masters.

Sitting tai chi improves the balance control and muscle strength of community-dwelling persons with spinal cord injuries: a pilot study

Objective. To investigate the effects of sitting Tai Chi on muscle strength, balance control, and quality of life (QOL) among survivors with spinal cord injuries (SCI). Methods. Eleven SCI survivors participated in the sitting Tai Chi training (90 minutes/session, 2 times/week for 12 weeks) and eight SCI survivors acted as controls. Dynamic sitting balance was evaluated using limits of stability test and a sequential weight shifting test in sitting. Handgrip strength was also tested using a hand-held dynamometer. QOL was measured using the World Health Organization's Quality of Life Scale. Results. Tai Chi practitioners achieved significant improvements in their reaction time (P = 0.042); maximum excursion (P = 0.016); and directional control (P = 0.025) in the limits of stability test after training. In the sequential weight shifting test, they significantly improved their total time to sequentially hit the 12 targets (P = 0.035). Significant improvement in handgrip strength was also found among the Tai Chi practitioners (P = 0.049). However, no significant within and between-group differences were found in the QOL outcomes (P > 0.05). Conclusions. Twelve weeks of sitting Tai Chi training could improve the dynamic sitting balance and handgrip strength, but not QOL, of the SCI survivors.

Eight forms of moving meditation for preventing falls in community-dwelling middle-aged and older adults

BACKGROUND

In numerous countries worldwide, fall prevention among older adults is a major public health issue. For older adults, regular participation in moderate physical activity or exercise lowers the risks of falls. However, scant information is available regarding the prevention strategies that the most at-risk groups may undertake. The purpose of this study is to examine the effects of a fall prevention strategy, eight forms of moving meditation (EFMM), on community-dwelling middle-aged and older adults in Taiwan.

METHODS

This was a quasi-experimental study; 84 participants were recruited from Taipei in Taiwan. For 12 weeks, participants in the experimental group performed 30-min EFMM 3 times per week. The measurements included a Functional Reach Test (FRT), Timed Get-up-and-Go Test (TGUG), and a One-Leg Stance Test (OLST) with eyes both opened and closed. All were conducted at the baseline and 12 weeks after intervention.

RESULTS

The participants who performed EFMM showed a significant and positive performance on FRT, TGUG, and OLST with eyes opened and eyes closed compared to those in the control group.

CONCLUSION

The results suggest that EFMM is an effective strategy for enhancing balance and functional mobility and preventing falls among community-dwelling middle-aged and older adults.

Development and feasibility of a senior elastic band exercise program for aged adults: a descriptive evaluation survey

OBJECTIVE

This study aimed to develop a tailored elastic band exercise program for aged adults (persons 65 years and older), to evaluate the feasibility of a program, and to determine appropriate elastic band exercise frequencies and preferences of aged adults.

METHODS

This study had 2 phases. In phase I, 11 professional experts were consulted to develop the Senior Elastic Band (SEB) exercise program. They responded to detailed description and demonstrations of the program contained on either a hard copy or a DVD. In phase II, 20 participants 65 years or older were interviewed for their feedback on the SEB after participating in 1 month of instructor-led SEB group practice. Both quantitative and qualitative strategies were included in the subject evaluation. The quantitative evaluation results were analyzed using descriptive statistics of mean and SD. The qualitative revision suggestions were critically analyzed and summarized using content analysis to revise the program.

RESULTS

Both the experts in phase I and the senior participants in phase II rated the SEB highly and commented that the program was feasible, safe, suitable, and helpful. The participants further suggested practicing SEB 3 times per week for 60 minutes per session in a group of 20 to 29 people.

CONCLUSIONS

Based on the feedback from the expert panel, the final SEB included 3 phases with 20 movements. The program took 40 minutes to complete. The SEB program was supported by the 11 experts with 5 professional backgrounds and was well accepted by a small group of community seniors. The participants expressed that the program was feasible, was manageable, and could be helpful to their health promotion.

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

This study was to examine an effect of such an exercise program on preventing conditions requiring long-term care in the Japanese frail elderly who participated in a Tai Chi Yuttari-exercise program. The first-intervention group underwent an intervention program by participating in a Tai Chi Yuttari-exercise session once a week for 3 months. Each session lasted 90 min including a break time. Moreover, the subjects received a video recording of the exercise, and instructions to carry out the exercise at home. The same program was administered to the second-intervention group. Physical function improved significantly in the first-intervention group, with single-leg balance (SLB) increasing, and trunk anteflexion increasing after the intervention program. Furthermore, the total score of the Motor Fitness Scale (MFS) improved significantly. On the other hand, mono- and multi-variate analyses showed no significant differences observed in the second-intervention group during the study period. A careful interpretation of the results suggests that Tai Chi Yuttari-exercise improves physical function and ability for frail elderly individuals and could reduce the need for long-term care.

Exercise prescription and the patient with type 2 diabetes: a clinical approach to optimizing patient outcomes

PURPOSE

To review the current recommendations for physical activity in type 2 diabetes mellitus (T2DM) and propose methods to optimize compliance, reduce the pharmaceutical burden, and improve the general health and well-being of patients with T2DM.

DATA SOURCES

PubMed, SportDiscus, Ovid MEDLINE, Psychinfo, Web of Science, LexisNexis, and EBM reviews.

CONCLUSIONS

T2DM is a condition in which physical activity has been documented to improve patient outcomes, yet research has noted that healthcare professionals inadequately address this issue, resulting in physical activity being an underutilized therapy.

IMPLICATIONS FOR PRACTICE

An exercise prescription consists of mode (type), frequency, intensity, duration, and progression. Determining the appropriate mode depends upon patient preference and safety issues regarding the state of T2DM or other conditions. Frequency, intensity, and duration are specific to the type of activity and should be tailored to the patient's abilities to safely perform the activity. Finally, the health professional addresses periodic progression in order to maintain the exercise stimulus needed to promote continued health improvements and prevent "plateauing." In this article, on the basis of the current scientific research, we propose recommendations that enable healthcare professionals to advocate for their patients with T2DM by offering safe and effective treatment options.

Challenges inherent to t'ai chi research: part II-defining the intervention and optimal study design

Although a growing body of clinical research has begun to evaluate the efficacy and safety of t'ai chi as a therapeutic tool for a variety of health conditions, little attention has been devoted to evaluating "how" t'ai chi is scientifically studied, and the advantages or limitations of different methodological approaches. In a companion to this paper (Part I), we argued that t'ai chi is a complex, multicomponent intervention, which poses unique challenges regarding the distinction of specific versus nonspecific effects and limitations regarding the use of reductionistic research frameworks. In this second, companion paper, we discuss additional obstacles inherent in precisely defining the t'ai chi intervention in an experimental paradigm. These challenges include t'ai chi's pluralism, the concept of t'ai chi dosage, and long- versus short-term evaluations of t'ai chi's efficacy and safety. To address these challenges, and with a goal to provide complete and unbiased evidence, we propose a pluralistic methodological approach to clinical research that includes controlled randomized trials of fixed protocols, community-based pragmatic trials, cross-sectional studies of long-term practitioners, and studies that integrate qualitative methods.

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.

Development and evaluation of a yoga exercise programme for older adults

AIM

This study reports the development and evaluation of a new yoga exercise programme for older adults, called the Silver Yoga Programme.

BACKGROUND

Yoga practice is associated with numerous health improvements, including reduced cardiovascular risk, body mass index and blood pressure. Yoga is also associated with improved respiration, psychological health and pain management. Studies have suggested the beneficial effects of yoga in the older population.

METHOD

The study was conducted in 2005 and it had two phases. Phase I consisted of sending a survey to 10 experts to help develop the Silver Yoga Programme. A hard copy and a video containing detailed descriptions and demonstrations of the programme were then sent to the experts for review and critique regarding the clarity and feasibility of the yoga postures. Phase II was an enquiry into older adults' views on the programme using a quantitative evaluation and semi-structured qualitative inquiry. Fourteen women participants from a senior activity centre were interviewed individually after 1 month of Silver Yoga group practice, three times per week, 70 minutes per session. They were asked to evaluate the appropriateness of postures based on the criteria of difficulty, acceptability, feasibility and helpfulness. Five open-ended questions asked participants to reflect on their yoga experiences.

RESULTS

Participants' mean ratings of the acceptability, feasibility and helpfulness of the four aspects of the programme (warm-up, Hatha yoga, relaxation and guided-imagery meditation) ranged from 8.8 +/- 1.9 to 9.3 +/- 1.5; mean ratings of the difficulty of the programme revealed that relaxation and guided-imagery meditation were fairly easy to follow (0.1 +/- 0.3 and 0.1 +/- 0.3 respectively), but the postures in the Hatha yoga were relatively challenging (2.1 +/- 2.6).

CONCLUSION

The Silver Yoga Programme should undergo further pilot-testing with larger samples of older adults before it is taken up internationally as a health-promotion activity for older adults.