Tai Chi and Fall Reductions
in Older Adults
Fuzhong Li, PhD
Oregon Research Institute
Eugene, OR 97403
www.ori.org
E-mail: fuzhongl@ori.org
Shanghai
Background
What is Tai Chi?
– Originated as a style of martial arts
– Consists of a series of individual
forms linked together to flow
smoothly from one form to another
– Linked to the classic Chinese
philosophy of “yin” and “yang”
– The dynamic relationship between Yin
and Yang underpins all movements of
Tai Chi to create a continuous
reciprocity of yin states and yang
states.
About This Talk
[ Describe the growing body of research
assessing health benefits of Tai Chi
[ Falls Among Older Adults
[ Tai Chi and falls prevention
[ From Research to Community Practice:
A case study
Research on Tai Chi
Mental and Physical Health
• Improving
mental health, positive affect, life
satisfaction; reduced levels of depression
negative affect, and psychological distress,
and overall sense of well-being (Kutner et al.,
1997; Li et al., 2001).
• Improving movement/exercise self-efficacy
and arthritis self-efficacy, and domainspecific physical self-esteem (Hartman et al., 2000;
Li et al., 2001; Li et al., 2002).
Research on Tai Chi
Musculoskeletal Conditions
• Improving muscular strength – knee extensors, force
control (Christou et al., 2003; Wolfson et al., 1996)
• Improving tension, fatigue, pain and stiffness in joints,
range of motion in patients with osteoarthritis
(Hartman et al., 2000; Song et al., 2003)
• Improving symptom management and health-related
quality of life in patients with Fibromyalgia (Taggart et al.,
2003)
Research on Tai Chi
Musculoskeletal Conditions
• Retarding bone loss in older women (Chan et al., 2004)
• Lumbar spine, proximal femur (DXA), distal tibia (pQCT)
• a general bone loss in all measured skeletal sites (0.1-1.8%)
but with a slow rate for those in Tai Chi
• a significant 2.6- to 3.6 fold retardation of bone loss in distal
tibia
Research on Tai Chi
Cardiovascular and Respiratory Function
• Better cardiorespiratory function (heart rates,
energy cost; VO2 Max) in long-term Tai Chi
practitioners
(Chao et al., 2002; Lai et al., 1993; Lan et al., 1996)
• Enhanced cardiac function for patients who had
coronary artery bypass surgery (Lan et al., 1999)
Research on Tai Chi
Hypertension
• Reducing systolic and diastolic blood pressure
(Wolf et al., 1996; Young et al., 1999)
• -7.0 mm Hg in systolic, -2.4 mm Hg in diastolic
• Reducing blood pressure in patients recovering
from acute myocardial infraction (Channer et al.,
1996)
Research on Tai Chi
Quality of Sleep
• Improving overall quality of sleep with respect to
sleep-onset latency, sleep duration, sleep efficiency,
sleep disturbances, and daytime sleepiness (Li et al., 2004)
• sleep-onset latency of about 18 minutes less per night
• sleep duration of about 48 minutes more per night
Research on Tai Chi
Neurological Disease
• Increased walking speed and hamstring flexibility
in patients with multiple sclerosis after a 8-week Tai
Chi program (Husted et al., 1999).
• Improving physical performance in older adults
with Parkinson’s Disease (Li et al., 2007).
Research on Tai Chi
Immune Function
• Improving the antibody response to influenza
vaccine in older adults (Yang et al., 2007).
Tai Chi and Falls Prevention
The Problem
• More than one in three people age 65 years or older falls each
year. The risk of falling -- and fall-related problems -- rises with
age.
• Among older adults, falls are the leading cause of injury
deaths
• In 2005, 15,800 people 65 and older died from injuries
related to unintentional falls; about 1.8 million people 65
and older were treated in emergency departments for
nonfatal injuries from falls, and more than 433,000 of these
patients were hospitalized.
http://www.cdc.gov/ncipc/factsheets/adultfalls.htm
Tai Chi and Falls Prevention
Outcomes of Falls
• 20%-30% suffer moderate to severe injuries (e.g., bruises, hip
fractures, or head traumas)
• Falls are the most common cause of traumatic brain injuries
(or TBI).
• Most fractures among older adults are caused by falls.
• Many people who fall, even those who are not injured, develop
a fea4r of falling  activity restrictions  reduced mobility 
increased actual risk of falling
• In 2000, direct medical costs totaled $0.2 billion ($179 million)
for fatal falls and $19 billon for nonfatal fall injuries (Stevens et
al., 2006)
http://www.cdc.gov/ncipc/factsheets/adultfalls.htm
Tai Chi and Falls Prevention
Who Is at Risk?
• Men are more likely to die from a fall
• Women are 67% more likely than men to have a nonfatal fall
injury
• Rates of fall-related fractures among older adults are more
than twice as high for women as for men.
• The risk of being seriously injured in a fall increases with age
• Nearly 85% of deaths from falls in 2004 were among people 75
and older
• White women have significantly higher rates of fall-related
fractures than black women
http://www.cdc.gov/ncipc/factsheets/adultfalls.htm
Tai Chi and Falls Prevention
How Can Older Adults Prevent Falls
• Ask doctor or pharmacist to review medicines – reducing side
effects and interactions
• Have eyes checked at lest once a year
• Improve the lighting in home
• Reduce hazards in home that can lead to falls
• Exercise Regularly; Exercise programs like
Tai Chi that increase strength and improve
balance are especially good
http://www.cdc.gov/ncipc/factsheets/adultfalls.htm
Tai Chi and Falls Prevention
How Can Older Adults Prevent Falls
• Exercise Regularly; Exercise programs
like Tai Chi that increase strength and
improve balance are especially good
• CDC Compendium (2008)
• Designed for public health
practitioners and community-based
organizations, to help them address
the problem of falls among older
adults.
• Describes 14 scientifically tested and
proven interventions, and provides
relevant details about these
interventions for organizations who
want to implement fall prevention
programs.
http://www.cdc.gov/ncipc/factsheets/adultfalls.htm
Research on
Tai Chi and Falls Prevention
Balance Control
• Improving balance – static, dynamic,
functional (Jacobson et al., 1997; Li et al., 2005;
Schaller, 1996)
Research on
Tai Chi and Falls Prevention
Fall Reductions
• Reducing risk of multiple falls
• 40% - 55% (Barnett et al., 2003; Li et al., 2005; Wolf et al.,
1996)
• Frequency of falls - fewer falls (38 vs. 73), lower
proportions of falls (28 vs. 44%), injurious falls (7
vs. 18%) (Li et al., 2005)
Research on
Tai Chi and Falls Prevention
Reductions in Fear of Falling
• Reducing fear of falling (Wolf et al., 1996; Li et al.,
2005)
• ADLs/IADLs, mobility, and social activity
From Research to Practice
Translating and Disseminating
Evidence-based Falls Prevention
Programs into Community
Li et al (2008). Journal of Physical Activity & Health
Li et al (2008). American Journal of Public Health
RATIONALE
• Randomized controlled trials have
shown the efficacy of Tai Chi in
reducing frequency of falls and risks
of falling in older adults
• However, there is little evidence
for whether scientifically validated
falls prevention programs can be
translated and disseminated to
reach broader community-based
senior service providers
OBJECTIVE OF THIS RESEARCH
To evaluate Tai Chi – Moving for
Better Balance, an evidence-based
falls prevention program developed
for use in community-based
organizations such as senior
centers
Questions
REACH: % of individuals who responded to
the program promotion divided by the number
of eligible individuals qualified per study criteria
ADOPTION: % of local community senior
centers approached that agreed to participate
and implement the program
IMPLEMENTATION: the extent to which
providers/instructors successfully implemented
key elements of the program
Questions
EFFECTIVENESS: change in measures of
physical performance and qualify-of-life
MAINTENANCE: at the setting level: the
center’s: (1) willingness to consider Tai Chi as
part of a center’s programs, and (2) continuation
of the program upon completion of the intervention.
At the participant level: the extent to which
participants continued their Tai Chi practice
during the 12-weeks following class termination
Dissemination Area
^_
^_
Eugene
^_
^_ Springfield
^_
0
Average Daily Attendance
Percentage
Number of Clients
250
200
150
100
50
0
Willamalane
Adult Activity
Center
Petersen Barn
Community
Center
Activity Centers
River Road Park
and Recreatin
-
4
8 Miles
Average Program Attendance Rate
300
Campbell Senior
Center
2
Hilyard
Community
Center
92
90
88
86
84
82
80
78
76
74
Campbell Senior Willamalane
Center
Adult Activity
Center
Petersen Barn River Road Park
Community
and Recreatin
Center
Activity Centers
Hilyard
Community
Center
The Program
• 8 Forms – Tai Chi: Moving for Better
Balance
• Program package: Implementation plan,
teaching manual and user’s guide
• Training Schedule – a 6—minutes groupbased practice session implemented on a
twice per week in-class schedule,
supplemented by a 30-minutes weekly
home-based exercise session.
Class Instructor
• Average 8.5 years of teaching
experience (range: 0 – 15)
• Mean age – 59 (range: 56 – 82 years
old)
• Three master level (mean = 15 years
training); 2 novel (2 years of
training; 0 years of teaching)
Dissemination Outcome
REACH:87% (by study criteria);
45% by client attendance
ADOPTION: Six senior activity centers
from five communities: 100% adoption
IMPLEMENTATION: 75% completed;
>85% class attendance; average 32 min.
of home practice
Dissemination Outcome
Effectiveness: Improved physical
performance and quality-of life measures
(a) Functional Reach test; (b) Up and Go test; (c) time to rise
from a chair (chair stands), (d) the 50-foot speed walk, and SF-12.
Maintenances: Five centers continued;
87% participants continued
Impact
Adopted by the State of Oregon: being
implemented in four counties; three more
starting this year
Conclusion
The evidence-based Tai Chi
program is practical to
disseminate and can be effectively
implemented and maintained in
community settings.
Questions?
Thank You