89 Randomised Controlled Trial of the Effect of Tai Chi on Postural Balance of People with Dementia

Abstract

Introduction We investigated the effect of Tai Chi exercise on postural balance among people with dementia (PWD), and the feasibility of a definitive trial on falls prevention. Method We conducted a randomised controlled trial. Dyads, comprising community-dwelling PWD and their informal carer (N=85), were randomised to usual care (n=43) or usual care plus the intervention (n=42). For the intervention, over 20 weeks, Tai Chi classes were provided weekly and Tai Chi home practice was facilitated by the carer. The primary outcome was the timed up and go test. Secondary outcomes for PWD included functional balance, static balance, fear of falling, cognitive functioning, quality of life, and falls. Secondary outcomes for carers included dynamic balance, static balance, quality of life, and carer burden. Outcomes were assessed six months post-baseline, except for falls, which were collected prospectively over the six-month follow-up period. Results For PWD, there was no significant difference at follow-up on the timed up and go test (mean difference [MD] = 0.82, 95% confidence interval [CI] = -2.17, 3.81, standardised effect size [ES] = 0.14). Among the secondary outcomes, at follow-up, PWD in the Tai Chi group had significantly higher quality of life (MD = 0.051, 95% CI = 0.002, 0.100, ES = 0.51) and a significantly lower rate of falls (rate ratio = 0.35, 95% CI =0.15, 0.81), which was no longer significant when an outlier was removed. Carers in the Tai Chi group at follow-up were significantly worse on the timed up and go test (MD = 1.83, 95% CI = 0.12, 3.53, ES = 0.61). The remaining secondary outcomes were not significant. No serious adverse events were related to participation in Tai Chi. Conclusion With refinement, this Tai Chi intervention has potential to reduce the incidence of falls and improve quality of life among community-dwelling PWD.

A secondary analysis of a randomised controlled trial to investigate the effect of Tai Chi on the instrumented timed up and go test in people with mild to moderate dementia

“…The aim of this study was to explore the effects of Tai Chi on iTUG in people with dementia. Previously, it was identified that there was no significant difference in total time to complete the TUG [19] and this study adds to the understanding by demonstrating that this lack of effect is evident across all sub phases of the iTUG. This provides new comprehension, as each sub phase of the iTUG constitutes subtle or large differences in their underlying physiological constructs (i.e.…”

“…If the Tai Chi intervention lacked the magnitude and intensity to yield any physiological change, then this could possibly explain the lack of change demonstrated in the iTUG. Fidelity of the intervention has been reported previously [19], and all participants were able to understand and follow the Tai Chi instructions. The mean supervised Tai Chi practice time was 8.4 h, which is less than half of that offered by Zou et al [35], who demonstrated significant reductions in total time to complete iTUG.…”

“…This resulted in 33 for the intervention group and 34 for the control group, see Fig. 1 or [19]. No serious adverse events relating to participation were noted.…”

“…The results of our recent trial suggested that PWD in the Tai Chi group, relative to a usual care control group, at 6-month follow-up had significantly greater scores for quality of life, and a strong trend for a reduction in falls [19]. However, these results were despite finding no difference between the Tai Chi and control group on measures of balance including the timed up and go test (primary outcome) [19].…”

Effect of Tai Chi Combined with Mental Imagery on Cutaneous Microcirculatory Function and Blood Pressure in a Diabetic and Elderly Population

“…In another Cochrane review of the effects of various types of exercise on the fear of falling in older adults, it was concluded that there was no evidence that the fear of falling was reduced after the exercise was over [ 31 ]. TC has also been shown to reduce falls in people with dementia [ 32 , 33 ]. A common problem in all of these studies is that the experience of the instructor and length of time TC is used and the number of times per week is variable and, therefore, it is hard to compare some of these studies to each other [ 34 ].…”