J Korean Acad Nurs.  2013 Jun;43(3):341-351. 10.4040/jkan.2013.43.3.341.

Effects of Tai Chi on Fall Risk Factors: A Meta-Analysis

• Park M
• Song R

• KMID: 1707124
• DOI: http://doi.org/10.4040/jkan.2013.43.3.341

Abstract

PURPOSE
This study was done to analyze the effects of Tai Chi on fall-related risk factors through meta-analysis of randomized clinical trials published in English and Korean between 2000 and 2010.
METHODS
Using health related database and hand search of references and Google, 28 randomized studies were collected from doctoral dissertation and published peer reviewed articles. The Comprehensive Meta-analysis version 2.0 was used for the analysis.
RESULTS
The effect sizes for Tai Chi for 3 months were significant with ES=0.54 for static balance, ES=0.24 for dynamic balance, ES=0.69 for balance measured by scale, and ES=0.40 for flexibility, ES=0.48 for muscle strength, ES=0.71 for ADL, and ES=0.37 for fear of falling. Also, the effect sizes of Tai Chi for 6 months were significant for most fall-related variables. The 6 month data for flexibility was not analyzed since only one study was published.
CONCLUSION
The analysis of studies of randomized clinical trials indicate that Tai Chi is effective in improving balance, flexibility, muscle strength, activities of daily living, and fear of falling when applied for 3 or 6 months. The findings provide the objective evidence to apply Tai Chi as a fall preventive intervention.

Keyword

Tai Chi; Meta-analysis; Fall; Risk factors

MeSH Terms

Accidental Falls/*prevention & control
Activities of Daily Living
Databases, Factual
Fear
Humans
Muscle Strength
Program Evaluation
Risk Factors
*Tai Ji

Figure

• 

  Figure 1 Analysis framework of Tai Chi for fall risk factors.

• 

  Figure 2 Flow diagram of study selection process.

Reference

1. American Geriatrics Society, British Geriatrics Society. American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc. 2001; 49(5):664–672.

2. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis. Chichester, WS: Wiley;2009.

3. Carter ND, Kannus P, Khan KM. Exercise in the prevention of falls in older people: A systematic literature review examining the rationale and the evidence. Sports Med. 2001; 31(6):427–438.

4. Choi JH, Lee EO, Lee HY, Eun Y. Analysis of the effects of Tai Chi on muscle strength and flexibility. J Rheumatol Health. 2005; 12(1):69–80.

5. Cohen J. Statistical power analysis for the behavioral sciences. New York, NY: Academic Press;1977.

6. Erim Z, Beg MF, Burke DT, de Luca CJ. Effects of aging on motor-unit control properties. J Neurophysiol. 1999; 82(5):2081–2091.

7. Fransen M, Nairn L, Winstanley J, Lam P, Edmonds J. Physical activity for osteoarthritis management: A randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Arthritis Rheum. 2007; 57(3):407–414. http://dx.doi.org/10.1002/art.22621.

8. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; 9:CD007146. http://dx.doi.org/10.1002/14651858.CD007146.pub3.

9. Glass GV. Primary, secondary, and meta-analysis of research. Educ Res. 1976; 5(10):3–8.

10. Harling A, Sompson JP. A systematic review to determine the effectiveness of Tai Chi in reducing falls and fear of falling in older adults. Phys Ther Rev. 2008; 13(4):237–248.

11. Health Insurance Review & Assessment Service. 2011 statistics indicators of medical expenses. 2012. Retrieved December 26, 2012. from http://www.hira.or.kr/dummy.do?pgmid=HIRAA020045030000&cmsurl=/cms/information/05/03/03/1214408_13609.html&subject=2011%eb%85%84+%ec%9d%98%eb%a3%8c%ea%b8%89%ec%97%ac+%ec%a7%84%eb%a3%8c%eb%b9%84+%ed%86%b5%ea%b3%84%ec%a7%80%ed%91%9c.

12. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions: Cochrane book series. Chichester, WS: John Wiley & Sons Ltd;2008.

13. Lam P. A handbook for Tai Chi for arthritis. Narwee: East Acton Publishing;2000.

14. Lee YJ. The effects of Tai Chi exercise program using transtheoretical model applied to degressive arthritis patients. Seoul: Hanyang University;2008. Unpublished doctoral dissertation.

15. Liu B, Liu ZH, Zhu HE, Mo JC, Cheng DH. Effects of tai chi on lower-limb myodynamia in the elderly people: A meta-analysis. J Tradit Chin Med. 2011; 31(2):141–146.

16. Logghe IH, Verhagen AP, Rademaker AC, Bierma-Zeinstra SM, van Rossum E, Faber MJ, et al. The effects of Tai Chi on fall prevention, fear of falling and balance in older people: A meta-analysis. Prev Med. 2010; 51(3-4):222–227. http://dx.doi.org/10.1016/j.ypmed.2010.06.003.

17. Low S, Ang LW, Goh KS, Chew SK. A systematic review of the effectiveness of Tai Chi on fall reduction among the elderly. Arch Gerontol Geriatr. 2009; 48(3):325–331. http://dx.doi.org/10.1016/j.archger.2008.02.018.

18. Menz HB, Morris ME, Lord SR. Foot and ankle risk factors for falls in older people: A prospective study. J Gerontol A Biol Sci Med Sci. 2006; 61(8):866–870.

19. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009; 6(7):e1000097. http://dx.doi.org/10.1371/journal.pmed.1000097.

20. Orwin RG. A fail-safe N for effect size in meta-analysis. J Educ Stat. 1983; 8(2):157–159.

21. Rand D, Miller WC, Yiu J, Eng JJ. Interventions for addressing low balance confidence in older adults: A systematic review and meta-analysis. Age Ageing. 2011; 40(3):297–306. http://dx.doi.org/10.1093/ageing/afr037.

22. Rothstein HR, Sutton AJ, Borenstein M. Publication bias in meta-analysis, prevention, assessment and adjustments. New York, NY: John Wiley and Sons Ltd;2005.

23. Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: Measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. 2008; 37(1):19–24. http://dx.doi.org/10.1093/ageing/afm169.

24. Scottish Intercollegiate Guidelines Network. SIGN 50; A guideline developer's handbook. 2008. Retrieved July 1, 2010. from http://www.sign.ac.uk/guidelines/fulltext/50/.

25. Song R, Lee EO, Lam P, Bae SC. Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: A randomized clinical trial. J Rheumatol. 2003; 30(9):2039–2044.

26. Stump TE, Clark DO, Johnson RJ, Wolinsky FD. The structure of health status among Hispanic, African American, and white older adults. J Gerontol B Psychol Sci Soc Sci. 1997; 52(Spec No):49–60.

27. Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR. Empirical assessment of effect of publication bias on meta-analyses. BMJ. 2000; 320(7249):1574–1577.

28. Tideiksaar R. Falls in older people: Prevention and management. 3rd ed. Baltimore, MD: Health Professions Press;2002.

29. Wooton AC. An integrative review of Tai Chi research: An alternative form of physical activity to improve balance and prevent falls in older adults. Orthop Nurs. 2010; 29(2):108–116. quiz 117-108. http://dx.doi.org/10.1097/NOR.0b013e3181d243b3.

30. World Health Organization. Falls. 2012. Retrieved November 26, 2012. from http://www.who.int/mediacentre/factsheets/fs344/en/.