Disseminating Tai Chi in the Community: Promoting Home Practice and Improving Balance

Acceptability and Scalability of a Meditation App Among Adolescents With Type 1 Diabetes Mellitus

Background Adolescents with type 1 diabetes mellitus (T1DM) experience stress from general life stressors and diabetes-specific stressors. This stress manifests in a range of ways, such as mood swings, heightened frustration, strained familial relationships, and difficulties in T1DM self-management, which then leads to worse health outcomes. There is small to moderate evidence that frequent use of mental health applications (MHapps) improves mental and physical health outcomes. Meditation apps may help reduce some of the stress associated with living with T1DM. This study explores the acceptability and scalability of a self-guided, smartphone-based meditation app, the Healthy Minds Program (HMP) app, among adolescents with T1DM using the Unified Theory of Acceptance and Use of Technology. Methods Eight adolescents ages 15-19 were recruited from a pediatric clinic in a Midwestern state and introduced to the HMP app. After using the HMP app for one week, they were invited to participate in three successive focus group meetings. During the meetings, they shared their perspectives on the content, navigation, and acceptability of the HMP app and strategies to introduce and scale app utilization among adolescents with T1DM. Researchers conducted conventional content analysis using a hybrid coding approach. Data was managed and analyzed using NVivo 10 (Lumivero, Denver, Colorado, USA). Findings Participants believed that the HMP app has the potential to enhance their stress management, mood, and coping abilities when dealing with the challenges of T1DM management. They found the app enjoyable and easy to use but expressed concerns about time constraints as a potential barrier. To address this, they shared recommendations for facilitating app uptake and usage. Conclusions This study's results provide an in-depth understanding of how positively this subset of adolescents with T1DM viewed the HMP app. The participants also offered valuable suggestions that can promote the adoption and sustained use of MHapps by adolescents living with T1DM.

Effects of Tai Chi Chuan on Older Adults' Balance: A Systematic Review With Meta-Analysis

BACKGROUND

Tai Chi Chuan (TCC) is considered a mind and body practice of Chinese origin, considered as an intangible cultural heritage of humanity by UNESCO, and recommended by the World Health Organization as a therapeutic approach to prevent falls.

OBJECTIVE

To assess the effects of TCC on older adult's balance.

METHODS

A systematic review of randomized clinical trials was conducted by two independent reviewers using the ROB2 tool to assess the risk of bias under the following databases: PubMed, SCOPUS, Web of Science, PEDro, Embase, Cochrane, CINAHL, and LILACS. A meta-analysis of the selected articles for the dynamic and static balance criteria was conducted in a population of older adults (over 65 years) with publications from 2010 to 2024.

RESULTS

Eighteen randomized clinical trials fulfilled the criteria. TCC improves dynamic balance in the timed up and go and gait speeds tests, and static balance in the single-leg test and functional reach test when compared with the control group in the meta-analysis. Adverse events were found in only one study, and the training parameters were heterogeneous.

CONCLUSION

TCC improves older adults with both dynamic and static balance. The results of the parameters indicate a direction in which TCC is prescribed for clinical practice with minimal or no risk of adverse effects.

The effects of adapted mind-body exercises on physical function, quality of life and wellbeing for older people: a systematic review and meta-analysis

BACKGROUND

Participating in physical activity programmes is one way to optimise wellbeing and quality of life in older adults. Mind-body exercises could provide greater benefits than other forms of traditional physical activity and can be easily adapted for older people who are starting to develop functional decline.

OBJECTIVES

To synthesise the literature looking at the effects of adapted mind-body interventions on older people.

DESIGN

A systematic review and meta-analysis was conducted on articles from Web of Science, MEDLINE, SPORTDiscus, AMED and CINAHL that were searched up to 13 September 2023. Studies were extracted and assessed by two authors and included if they were adapted mind-body quasi experimental trials (QET) or randomised controlled trials (RCT) evaluating physical function, quality of life or wellbeing in community dwelling older adults aged 60 years and over. The Cochrane Risk of Bias 2 scale was used for quality appraisal. Analysis of the results included calculating standardised effect sizes (Hedge's g) and a narrative synthesis of results not included in meta-analysis.

RESULTS

18 studies (8 quasi-experimental trial designs, n = 310; 10 randomised control trials, n = 1829) were included in the systematic review, with 14 studies (9 RCT, n = 1776, 5 QET, n = 100) retained for meta-analysis. For the RCT studies, some improvement was noted in mobility (ES 0.36: 95% CI: 0.01, 0.71), flexibility (ES 0.36: 0.01, 0.70), well-being (ES 0.54: 0.18, 0.91) and quality of life (ES 0.50: 0.21, 0.79). No positive effect was observed for leg power (ES 0.09: -0.33, 0.51), leg endurance (ES 0.16: -0.72, 1.03), back scratch test (ES 0.24: -0.10, 0.59), or balance, (ES 0.05: -0.06, 0.15). Heterogeneity varied from 0%-87% across the different outcomes. For the QET studies, gait velocity was shown to improve (ES 0.54: 0.18, 0.91), while fear of falling showed no significant improvements (ES 0.82: -0.06, 1.69). A meta-regression for quality of life in which the total physical activity of the intervention, in hours, was used as a covariate, showed ES = 1.1 for every 100 h of physical activity.

CONCLUSION

There is scope for adapted mind-body physical activity interventions to play a role in improving quality of life, wellbeing, and physical function in older adults. The provision of adapted interventions for older people might improve uptake of and engagement with physical activity interventions in older people with limited or reduced abilities.

Feasibility, Usability, and Acceptability of Online Mind-Body Exercise Programs for Older Adults: A Scoping Review

Objectives: Engaging in mind-body exercises (MBEs: e.g., Tai Chi and yoga) can have physical and mental health benefits particularly for older adults. Many MBEs require precise timing and coordination of complex body postures posing challenges for online instruction. Such challenges include difficulty viewing instructors as they demonstrate different movements and lack of feedback to participants. With the shift of exercise programs to online platforms during the COVID-19 pandemic, we conducted a scoping review to examine the feasibility, usability, and acceptability of online MBE classes for older adults. Materials and Methods: We followed the scoping review methodology and adhered to the PRISMA reporting checklist. We searched five databases: Medline, Embase, CINHAL, Web of Science, and ACM digital library. Screening of articles and data extraction was conducted independently by two reviewers. Settings/Location: Online/virtual. Subjects: Older adults ≥55 years of age. Outcome Measures: Feasibility measures. Results: Of 6711 studies retrieved, 18 studies were included (715 participants, mean age 66.9 years). Studies reported moderate to high retention and adherence rates (mean >75%). Older adults reported online MBE classes were easy to use and reported high satisfaction with the online format. We also identified barriers (e.g., lack of space and privacy and unstable internet connection) and facilitators (e.g., convenience and technical support) to the online format. Opinions related to social connectedness were mixed. Conclusion: Online MBE programs for older adults appear to be a feasible and acceptable alternative to in-person programs. It is important to consider the type of exercise (e.g., MBE), diverse teaching styles, and learner needs when designing online exercise classes.

Effects of Tai Chi and Qigong on cognitive and physical functions in older adults: systematic review, meta-analysis, and meta-regression of randomized clinical trials

BACKGROUND

Older adults experience age-related declines in physical and cognitive functions due to interactions between aging and chronic diseases. Tai Chi and Qigong (TCQ) might be beneficial in improving the physical function and delaying the cognitive decline of this population. The potential underlying mechanism was explored to determine the effects of TCQ on cognitive function via direct or indirect pathways.

PURPOSE

The objective of this systematic review was to determine the effects of TCQ on cognitive and physical functions in older adults using meta-analysis, and to determine the impact of TCQ on cognitive function while controlling for physical function using a meta-regression approach.

METHODS

A systematic search of 13 electronic databases (in English, Korean, and Chinese languages) identified 10,292 potentially eligible studies published between inception and May 2022. The bias in individual studies was assessed using the Cochrane Risk of Bias (version 2.0) tool. The heterogeneity of the studies was evaluated using a 95% prediction interval, and the meta-analysis and meta-regression were implemented using the Comprehensive Meta-Analysis (version 3) software.

RESULTS

Our search identified 17 randomized studies (n = 2,365, mean age = 70.3 years). The results of the meta-analysis that used a random-effects model indicated that TCQ had significant effects on both cognitive (Hedges' g = 0.29, 95% confidence interval [CI] = 0.17 to 0.42) and physical (Hedges' g = 0.32, 95% CI = 0.19 to 0.44) functions. We used meta-regression to explore the effect size of TCQ in association with physical function level. The regression model was significant (Q = 25.01, p = .070), and 55% of the heterogeneity was explained by physical function as a moderator variable. The effects of TCQ on cognitive function remained significant in this model when controlling for the effect of physical function (β = 0.46, p = .011).

CONCLUSION

This meta-regression of 17 randomized studies strongly suggests that TCQ has beneficial effects on physical and cognitive functions in older adults. The effect of TCQ on cognitive function remained significant after taking into account the significant effects of physical function as a moderator. The findings imply the potential health benefits of TCQ by promoting cognitive function in older adults directly and indirectly through enhancing physical function. PROSPERO REGISTRATION NUMBER: *PROSPERO international prospective register of systematic reviews, registration ID CRD42023394358.

Mind-Body Therapies From Traditional Chinese Medicine: Evidence Map

Background: The mind-body therapies of traditional Chinese medicine include several intervention types and combine physical poses with conscious relaxation and breathing techniques. The purpose of this Evidence Map is to describe these different interventions and report related health outcomes. Methods: This evidence map is based on the 3iE Evidence Gap Map methodology. We searched seven electronic databases (BVS, PUBMED, EMBASE, PEDro, ScienceDirect, Web of Sciences, and PschyInfo) from inception to November 2019 and included systematic reviews only. Systematic reviews were analyzed based on AMSTAR 2. We used Tableau to graphically display quality assessment, the number of reviews, outcomes, and effects. Results: The map is based on 116 systematic reviews and 44 meta-analyses. Most of the reviews were published in the last 5 years. The most researched interventions were Tai Chi and Qi Gong. The reviews presented the following quality assessment: 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 distinct outcome effect was classified: 421 as potential positive; 237 as positive; 21 as inconclusive/mixed; one potential negative and none no effect. Positive effects were related to chronic diseases; mental indicators and disorders; vitality, well-being, and quality of life. Potential positive effects were related to balance, mobility, Parkinson's disease, hypertension, joint pain, cognitive performance, and sleep quality. Inconclusive/mixed-effects justify further research, especially in the following areas: Acupressure as Shiatsu and Tuiná for nausea and vomiting; Tai Chi and Qi Gong for acute diseases, prevention of stroke, stroke risk factors, and schizophrenia. Conclusions: The mind-body therapies from traditional Chinese medicine have been applied in different areas and this Evidence Map provides a visualization of valuable information for patients, professionals, and policymakers, to promote evidence-based complementary therapies.

Encouraging the scale-up of proven interventions: Infrastructure development for the "Evidence-to-Implementation" award

Background/Objective

Although most research universities offer investigators help in obtaining patents for inventions, investigators generally have few resources for scaling up non-patentable innovations, such as health behavior change interventions. In 2017, the dissemination and implementation (D & I) team at the University of Wisconsin's Clinical and Translational Science Award (CTSA) created the Evidence-to-Implementation (E2I) award to encourage the scale-up of proven, non-patentable health interventions. The award was intended to give investigators financial support and business expertise to prepare evidence-based interventions for scale-up.

Methods

The D & I team adapted a set of criteria named Critical Factors Assessment, which has proven effective in predicting the success of entrepreneurial ventures outside the health care environment, to use as review criteria for the program. In March 2018 and February 2020, multidisciplinary panels assessed proposals using a review process loosely based on the one used by the NIH for grant proposals, replacing the traditional NIH scoring criteria with the eight predictive factors included in Critical Factors Assessment.

Results

two applications in 2018 and three applications in 2020 earned awards. Funding has ended for the first two awardees, and both innovations have advanced successfully.

Conclusion

Late-stage translation, though often overlooked by the academic community, is essential to maximizing the overall impact of the science generated by CTSAs. The Evidence-to-implementation award provides a working model for supporting late-stage translation within a CTSA environment.

Effects of Chinese Mind-Body Exercises on Executive Function in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

Chinese mind-body exercises (CMBEs) are positively associated with executive function (EF), but their effects on EF, from synthesized evidence using systematic and meta-analytic reviews, have not been conducted. Therefore, the present systematic review with meta-analysis attempted to determine whether CMBEs affect EF and its sub-domains, as well as how exercise, sample, and study characteristics moderate the causal relationship between CMBEs and EF in middle-aged and older adults. Seven electronic databases were searched for relevant studies published from the inception of each database through June 2020 (PubMed, Web of Science, Embase, Cochrane Controlled Trials Register, Wanfang, China National Knowledge Infrastructure, and Weipu). Randomized controlled trials with at least one outcome measure of CMBEs on EF in adults of mean age ≥ 50 years with intact cognition or mild cognitive impairment (MCI) and with or without chronic diseases were included. A total of 29 studies (N = 2,934) ultimately were included in this study. The results indicated that CMBEs improved overall EF (Standardized Mean Differences = 0.28, 95% CI 0.12, 0.44), as well as its sub-domains of working memory and shifting. The beneficial effects of CMBEs on EF occurred regardless of type (Tai Chi, Qigong), frequency of group classes (≤2 time, 3-4 time, ≥5 times), session time (≤45 min, 46-60 min), total training time (≥150 to ≤300 min, >300 min), and length of the CMBEs (4-12 week, 13-26 week, and >26 week), in addition to that more frequent participation in both group classes and home practice sessions (≥5 times per week) resulted in more beneficial effects. The positive effects of CMBEs on EF were also demonstrated, regardless of participants mean age (50-65 years old, >65 years old), sex (only female, both), and cognitive statuses (normal, MCI, not mentioned), health status (with chronic disease, without chronic disease), as well as training mode (group class, group class plus home practice) and study language (English, Chinese). This review thus suggests that CMBEs can be used as an effective method with small to moderate and positive effects in enhancing EF, and that more frequent group classes and home practice sessions may increase these effects. However, certain limitations, including strictly design studies, limited ES (effect size) samples for specific variables, and possible biased publications, required paying particular attention to, for further exploring the effects of CMBEs on EF.

Essential elements to "design for dissemination" within a research network-a modified Delphi study of the Community-Academic Aging Research Network (CAARN)

Background

The Community-Academic Aging Research Network (CAARN) was developed in 2010 to build partnerships, facilitate research, and ultimately accelerate the pace of development, testing, and dissemination of evidence-based programs related to healthy aging. CAARN has facilitated development and testing of 32 interventions, two of which are being packaged for scale-up, and three of which are being scaled up nationally by non-profit organizations. The purpose of this study is to describe CAARN’s essential elements required to replicate its success in designing for dissemination.

Methods

We conducted a modified Delphi technique with 31 participants who represented CAARN’s organization (staff and Executive Committee) and academic and community partners. Participants received three rounds of a web-based survey to rate and provide feedback about the importance of a list of potential key elements compiled by the authors. The criterion for establishing consensus was 80% of responses to consider the element to be extremely or very important.

Results

Response rate was 90% in Round 1, 82% in Round 2, and 87% in Round 3. A total of 115 items were included across rounds. Overall, consensus was achieved in 77 (67%) elements: 8 of 11 elements about academic partners, 8 of 11 about community partners, 29 of 49 about the role of the community research associate, 16 of 21 about the role of the director, 9 of 17 about the purveyor (i.e., the organization that scales up an intervention with fidelity), and 7 of 7 about the overall characteristics of the network.

Conclusions

The development of evidence-based programs designed for dissemination requires the involvement of community partners, the presence of a liaison that facilitates communications among academic and community stakeholders and a purveyor, and the presence of a pathway to dissemination through a relationship with a purveyor. This study delineates essential elements that meet the priorities of adopters, implementers, and end-users and provide the necessary support to community and academic partners to develop and test interventions with those priorities in mind. Replication of these key elements of the CAARN model may facilitate quicker development, testing, and subsequent dissemination of evidence-based programs that are feasible to implement by community organizations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-021-00122-z.

Tai Chi training for attention deficit hyperactivity disorder: A feasibility trial in college students

OBJECTIVE

Many young adults are affected by attention deficit hyperactivity disorder (ADHD) and often desire non-pharmacological treatment options. Mind-body techniques might serve as complementary therapies to first-line stimulant medications, but studies are limited. Tai Chi is an increasingly popular practice that integrates movement with cognitive skills relevant to ADHD. We performed a feasibility trial of Tai Chi training in undergraduates to inform the design of a fully powered randomized controlled trial (RCT).

METHOD

Undergraduates with ADHD were recruited, screened, enrolled, and assessed at baseline. They were assigned to three parallel seven-week intervention arms, Tai Chi, Active Control (cardio-aerobic fitness), and Inactive Control (no contact), with follow-up assessments. Feasibility of a larger clinical trial was evaluated, especially with respect to enrollment and retention. Additionally, potential clinical outcome measures were examined for practicality and reliability.

RESULTS

21 participants were assessed at baseline and 19 at follow-up (90 % retention). The primary clinical outcome measure, self-reported inattention symptoms (Conners' CAARS-S:L DSM-IV Inattentive Symptoms subscale), exhibited good test-retest reliability in controls (r = 0.87, n = 10) and correlated with reduced mindfulness (FFMQ acting with awareness subscale) at baseline (r = -0.74, n = 20). Class attendance and self-reported daily practice time were variable. Randomization to group classes was hindered by the college students' restricted schedules.

CONCLUSION

The high retention rate and good data quality suggest that an RCT of Tai Chi for ADHD is feasible. Further measures are identified to improve enrollment rates, adherence, and randomization procedures. Future work might extend to other young adult populations and high school students.

The Community-Academic Aging Research Network: A Pipeline for Dissemination

BACKGROUND/OBJECTIVES

The Community-Academic Aging Research Network (CAARN) was created to increase the capacity and effectiveness of Wisconsin's Aging Network and the University of Wisconsin to conduct community-based research related to aging. The purpose of this article is to describe CAARN's infrastructure, outcomes, and lessons learned.

DESIGN

Using principles of community-based participatory research, CAARN engages stakeholders to participate in the design, development, and testing of older adult health interventions that address community needs, are sustainable, and improve health equity.

SETTING

Academic healthcare and community organizations.

PARTICIPANTS

Researchers, community members, and community organizations.

INTERVENTION

CAARN matches academic and community partners to develop and test evidence-based programs to be distributed by a dissemination partner.

MEASUREMENTS

Number of partnerships and funding received.

RESULTS

CAARN has facilitated 33 projects since its inception in 2010 (30 including rural populations), involving 46 academic investigators, 52 Wisconsin counties, and 1 tribe. These projects have garnered 52 grants totaling $20 million in extramural and $3 million in intramural funding. Four proven interventions are being prepared for national dissemination by the Wisconsin Institute for Healthy Aging: one to improve physical activity; one to reduce bowel and bladder incontinence; one to reduce sedentary behavior; and one to reduce falls risk among Latinx older adults. Additionally, one intervention to improve balance using a modified tai chi program is being disseminated by another organization.

CONCLUSION

CAARN's innovative structure creates a pipeline to dissemination by designing for real-world settings through inclusion of stakeholders in the early stages of design and by packaging community-based health interventions for older adults so they can be disseminated after the research has been completed. These interventions provide opportunities for clinicians to engage with community organizations to improve the health of their patients through self-management. J Am Geriatr Soc 68:1325-1333, 2020.