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The Benefits of Tai Chi for the Elderly
by Andrew L. Judelson, M.D.
Division of Physical Medicine and Rehabilitation
Recent attention has been focused on alternative (or complementary) medical treatments, including Tai Chi and yoga. This article will examine the history of Tai Chi, as well as its proven medical benefits. A significant amount of research has emphasized the potential use of Tai Chi in improving the health of the elderly. This form of exercise can help the elderly in areas of balance, strength, and flexibility, with a reduction o falls that lead to serious injury.
Aging: A Demographic Snapshot
Recent predictions of population growth estimate there will be 70 million people over the age of 65 by the year 2030. Those over age 85, the "oldest old," represent the fastest growing segment; they will account for 18% of all those over 65. Tai Chi has been proposed as an exercise tool to prevent the illness and disability commonly seen among the elderly.
Aging and Functional Decline
The aging process affects the whole body, resulting in decreased reserve capacity and impaired ability to adapt to environmental changes. Decreased muscle mass, strength and flexibility are often seen in the musculoskeletal system. Increased postural sway, prolonged reaction time, and decreased righting reflex make the elderly more susceptible to falls. These changes are typically also associated with deconditioning due to reduced physical activity. The combination of aging and deconditioning leads to a functional decline.
Data from the National Center for Health Statistics indicate that among non-institutionalized people over the age of 70, 20% had difficulty with at least one activity of daily living (ADL). Between 7-10% had trouble with more than one ADL. The level of disability increases with age, and is greater in women than in men.
In addition, each year almost one-third of those over the age of 65 sustain a fall. The consequences can be significant: 10-15% result in serious injuries, such as fractures and soft tissue injuries. The fear of subsequent falls may lead to immobility, isolation, and weakness. Moreover, falls account for 23% of all injury deaths among people over 65. Risk factors for falls include illness, medications, environmental hazards, changes associated with aging, and social/lifestyle elements. A previous fall is a significant risk factor for another fall.
Reducing Falls and Tai Chi
The recent Frailty and Injuries: Cooperative Studies of Intervention Techniques Trial (FISCIT) evaluated different interventions for reducing falls and frailty among the elderly. This multi-centered study examined functional, psychosocial, and environmental variables and different forms of exercise were included in all of the trials. Subjects were between 60 and 75 years old and included both community-dwelling individuals and nursing home residents. The major findings from FISCIT were that assignment to an exercise group led to decreases in the risk of falls, and that exercise which included balance training led to a significant reduction in falls.
One FISCIT study that resulted in a significant decrease in risk of falling compared a 15-week course of computerized balance training to Tai Chi as a form of balance training. The Tai Chi group showed a decrease in the fear of falling, and an increased sense of being able to be more active. After adjusting for fall-risk factors, Tai Chi was found to decrease the risk of multiple falls by 47%; no reduction in rate of falls was seen in the computerized balance-training group.
Initial studies of Tai Chi compared long-time practitioners of Tai Chi with sedentary controls. Tai Chi groups had better balance control, flexibility (hamstring and body rotation), and cardiovascular fitness measured by heart rate after a 3-minute step test. In another study, the Tai Chi practitioners had higher peak oxygen uptake (18-19%) than controls, and they also had higher maximal work rate, greater flexibility, and lower percent body fat. Tai Chi was shown to be as effective in lowering blood pressure as a program of moderate intensity aerobics.
Tai Chi: Practice and Benefits
Tai Chi was created between 300 and 700 years ago in China. Tai Chi Chuan literally means "supreme ultimate fist," and it was initially created as a form of shadow boxing and then a martial art to ward off invaders. Later, it became incorporated into body control and mind-body interaction. Harmony and the balance of opposites in nature and the human body are dominant themes in the practice of Tai Chi.
Practicing Tai Chi involves keeping the body extended and relaxed while the mind is alert, but calm. It involves well-coordinated sequences of events, with whole body rotational movements and a progressively decreasing base of support. Movement is continuous, but always controlled.
Relaxation is a critical component of Tai Chi. After performing Tai Chi, subjects have reported feeling less tension, anger, fatigue, and depression Other studies have shown increased sense of well-being and more confidence, leading to better overall quality of life.
Tai Chi and the Elderly
No major complications have been observed from practicing Tai Chi, although transient muscle soreness may occur as the programs are started. One study specifically examined the safety of a modified Tai Chi program in patients with rheumatoid arthritis. After 10 weeks, no changes were seen in disease activity (joint tenderness or swelling). Patients had improved sense of well-being, better mobility, and less pain.
Tai Chi should be considered a potential form of exercise for the elderly. Previous studies have shown benefits with strength training and low-intensity aerobics in the elderly. The American College of Sports Medicine guidelines stress that neither extreme age nor frailty are contraindications to exercise. Exercise programs for the elderly should include progressive resistance exercise, balance training, and aerobic activity. Tai Chi also fulfills the current recommendations for exercise for fitness: it is moderate intensity (between 70-90% max heart rate), uses large muscles, lasts between 20-60 minutes, and can be done most days of the week.
Tai Chi has many advantages as an exercise program. No special equipment is required, allowing it to be performed anywhere. It can be done alone or with others; group participation also provides opportunity for socialization. In addition, the compliance rate was high among the many studies, indicating that people enjoyed the activity, and did it on their own. This is crucial to establishing a regular exercise program.
Conclusion
Tai Chi has been shown to have positive results in both men and women, young and old, after both short-term and long-term practice. Positive effects are seen in the areas of balance, strength, flexibility, blood pressure and episodes of falls. These benefits of Tai Chi may be used to forestall the changes associated with aging and help reduce the prevalence of falls that lead to serious injury.
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