Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls among Older Adults at High Risk of Falling

A Randomized Clinical Trial

Fuzhong Li, Peter Harmer, Kathleen Fitzgerald, Elizabeth Eckstrom, Laura Akers, Li Shan Chou, Dawna Pidgeon, Jan Voit, Kerri Winters-Stone

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Importance: Falls in older adults are a serious public health problem associated with irreversible health consequences and responsible for a substantial economic burden on health care systems. However, identifying optimal choices from among evidence-based fall prevention interventions is challenging as few comparative data for effectiveness are available. Objective: To determine the effectiveness of a therapeutically tailored tai ji quan intervention, Tai Ji Quan: Moving for Better Balance (TJQMBB), developed on the classic concept of tai ji (also known as tai chi), and a multimodal exercise (MME) program relative to stretching exercise in reducing falls among older adults at high risk of falling. Design, Setting, and Participants: A single-blind, 3-arm, parallel design, randomized clinical trial (February 20, 2015, to January 30, 2018), in 7 urban and suburban cities in Oregon. From 1147 community-dwelling adults 70 years or older screened for eligibility, 670 who had fallen in the preceding year or had impaired mobility consented and were enrolled. All analyses used intention-to-treat assignment. Interventions: One of 3 exercise interventions: two 60-minute classes weekly for 24 weeks of TJQMBB, entailing modified forms and therapeutic movement exercises; MME, integrating balance, aerobics, strength, and flexibility activities; or stretching exercises. Main Outcomes and Measures: The primary measure at 6 months was incidence of falls. Results: Among 670 participants randomized, mean (SD) age was 77.7 (5.6) years, 436 (65%) were women, 617 (92.1%) were white, 31 (4.6%) were African American. During the trial, there were 152 falls (85 individuals) in the TJQMBB group, 218 (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. At 6 months, the incidence rate ratio (IRR) was significantly lower in the TJQMBB (IRR, 0.42; 95% CI, 0.31-0.56; P <.001) and MME groups (IRR, 0.60; 95% CI, 0.45-0.80; P =.001) compared with the stretching group. Falls were reduced by 31% for the TJQMBB group compared with the MME group (IRR, 0.69; 95% CI, 0.52-0.94; P =.01). Conclusions and Relevance: Among community-dwelling older adults at high risk for falls, a therapeutically tailored tai ji quan balance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls. Trial Registration: ClinicalTrials.gov identifier: NCT02287740.

Original languageEnglish (US)
Pages (from-to)1301-1310
Number of pages10
JournalJAMA Internal Medicine
Volume178
Issue number10
DOIs
StatePublished - Oct 1 2018

Fingerprint

Tai Ji
Randomized Controlled Trials
Exercise
Incidence
Therapeutics
Independent Living
Accidental Falls
Intention to Treat Analysis
African Americans

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls among Older Adults at High Risk of Falling : A Randomized Clinical Trial. / Li, Fuzhong; Harmer, Peter; Fitzgerald, Kathleen; Eckstrom, Elizabeth; Akers, Laura; Chou, Li Shan; Pidgeon, Dawna; Voit, Jan; Winters-Stone, Kerri.

In: JAMA Internal Medicine, Vol. 178, No. 10, 01.10.2018, p. 1301-1310.

Research output: Contribution to journalArticle

@article{5bebb9cd906b404b822b1a4b46669e17,
title = "Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls among Older Adults at High Risk of Falling: A Randomized Clinical Trial",
abstract = "Importance: Falls in older adults are a serious public health problem associated with irreversible health consequences and responsible for a substantial economic burden on health care systems. However, identifying optimal choices from among evidence-based fall prevention interventions is challenging as few comparative data for effectiveness are available. Objective: To determine the effectiveness of a therapeutically tailored tai ji quan intervention, Tai Ji Quan: Moving for Better Balance (TJQMBB), developed on the classic concept of tai ji (also known as tai chi), and a multimodal exercise (MME) program relative to stretching exercise in reducing falls among older adults at high risk of falling. Design, Setting, and Participants: A single-blind, 3-arm, parallel design, randomized clinical trial (February 20, 2015, to January 30, 2018), in 7 urban and suburban cities in Oregon. From 1147 community-dwelling adults 70 years or older screened for eligibility, 670 who had fallen in the preceding year or had impaired mobility consented and were enrolled. All analyses used intention-to-treat assignment. Interventions: One of 3 exercise interventions: two 60-minute classes weekly for 24 weeks of TJQMBB, entailing modified forms and therapeutic movement exercises; MME, integrating balance, aerobics, strength, and flexibility activities; or stretching exercises. Main Outcomes and Measures: The primary measure at 6 months was incidence of falls. Results: Among 670 participants randomized, mean (SD) age was 77.7 (5.6) years, 436 (65{\%}) were women, 617 (92.1{\%}) were white, 31 (4.6{\%}) were African American. During the trial, there were 152 falls (85 individuals) in the TJQMBB group, 218 (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. At 6 months, the incidence rate ratio (IRR) was significantly lower in the TJQMBB (IRR, 0.42; 95{\%} CI, 0.31-0.56; P <.001) and MME groups (IRR, 0.60; 95{\%} CI, 0.45-0.80; P =.001) compared with the stretching group. Falls were reduced by 31{\%} for the TJQMBB group compared with the MME group (IRR, 0.69; 95{\%} CI, 0.52-0.94; P =.01). Conclusions and Relevance: Among community-dwelling older adults at high risk for falls, a therapeutically tailored tai ji quan balance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls. Trial Registration: ClinicalTrials.gov identifier: NCT02287740.",
author = "Fuzhong Li and Peter Harmer and Kathleen Fitzgerald and Elizabeth Eckstrom and Laura Akers and Chou, {Li Shan} and Dawna Pidgeon and Jan Voit and Kerri Winters-Stone",
year = "2018",
month = "10",
day = "1",
doi = "10.1001/jamainternmed.2018.3915",
language = "English (US)",
volume = "178",
pages = "1301--1310",
journal = "JAMA Internal Medicine",
issn = "2168-6106",
publisher = "American Medical Association",
number = "10",

}

TY - JOUR

T1 - Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls among Older Adults at High Risk of Falling

T2 - A Randomized Clinical Trial

AU - Li, Fuzhong

AU - Harmer, Peter

AU - Fitzgerald, Kathleen

AU - Eckstrom, Elizabeth

AU - Akers, Laura

AU - Chou, Li Shan

AU - Pidgeon, Dawna

AU - Voit, Jan

AU - Winters-Stone, Kerri

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Importance: Falls in older adults are a serious public health problem associated with irreversible health consequences and responsible for a substantial economic burden on health care systems. However, identifying optimal choices from among evidence-based fall prevention interventions is challenging as few comparative data for effectiveness are available. Objective: To determine the effectiveness of a therapeutically tailored tai ji quan intervention, Tai Ji Quan: Moving for Better Balance (TJQMBB), developed on the classic concept of tai ji (also known as tai chi), and a multimodal exercise (MME) program relative to stretching exercise in reducing falls among older adults at high risk of falling. Design, Setting, and Participants: A single-blind, 3-arm, parallel design, randomized clinical trial (February 20, 2015, to January 30, 2018), in 7 urban and suburban cities in Oregon. From 1147 community-dwelling adults 70 years or older screened for eligibility, 670 who had fallen in the preceding year or had impaired mobility consented and were enrolled. All analyses used intention-to-treat assignment. Interventions: One of 3 exercise interventions: two 60-minute classes weekly for 24 weeks of TJQMBB, entailing modified forms and therapeutic movement exercises; MME, integrating balance, aerobics, strength, and flexibility activities; or stretching exercises. Main Outcomes and Measures: The primary measure at 6 months was incidence of falls. Results: Among 670 participants randomized, mean (SD) age was 77.7 (5.6) years, 436 (65%) were women, 617 (92.1%) were white, 31 (4.6%) were African American. During the trial, there were 152 falls (85 individuals) in the TJQMBB group, 218 (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. At 6 months, the incidence rate ratio (IRR) was significantly lower in the TJQMBB (IRR, 0.42; 95% CI, 0.31-0.56; P <.001) and MME groups (IRR, 0.60; 95% CI, 0.45-0.80; P =.001) compared with the stretching group. Falls were reduced by 31% for the TJQMBB group compared with the MME group (IRR, 0.69; 95% CI, 0.52-0.94; P =.01). Conclusions and Relevance: Among community-dwelling older adults at high risk for falls, a therapeutically tailored tai ji quan balance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls. Trial Registration: ClinicalTrials.gov identifier: NCT02287740.

AB - Importance: Falls in older adults are a serious public health problem associated with irreversible health consequences and responsible for a substantial economic burden on health care systems. However, identifying optimal choices from among evidence-based fall prevention interventions is challenging as few comparative data for effectiveness are available. Objective: To determine the effectiveness of a therapeutically tailored tai ji quan intervention, Tai Ji Quan: Moving for Better Balance (TJQMBB), developed on the classic concept of tai ji (also known as tai chi), and a multimodal exercise (MME) program relative to stretching exercise in reducing falls among older adults at high risk of falling. Design, Setting, and Participants: A single-blind, 3-arm, parallel design, randomized clinical trial (February 20, 2015, to January 30, 2018), in 7 urban and suburban cities in Oregon. From 1147 community-dwelling adults 70 years or older screened for eligibility, 670 who had fallen in the preceding year or had impaired mobility consented and were enrolled. All analyses used intention-to-treat assignment. Interventions: One of 3 exercise interventions: two 60-minute classes weekly for 24 weeks of TJQMBB, entailing modified forms and therapeutic movement exercises; MME, integrating balance, aerobics, strength, and flexibility activities; or stretching exercises. Main Outcomes and Measures: The primary measure at 6 months was incidence of falls. Results: Among 670 participants randomized, mean (SD) age was 77.7 (5.6) years, 436 (65%) were women, 617 (92.1%) were white, 31 (4.6%) were African American. During the trial, there were 152 falls (85 individuals) in the TJQMBB group, 218 (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. At 6 months, the incidence rate ratio (IRR) was significantly lower in the TJQMBB (IRR, 0.42; 95% CI, 0.31-0.56; P <.001) and MME groups (IRR, 0.60; 95% CI, 0.45-0.80; P =.001) compared with the stretching group. Falls were reduced by 31% for the TJQMBB group compared with the MME group (IRR, 0.69; 95% CI, 0.52-0.94; P =.01). Conclusions and Relevance: Among community-dwelling older adults at high risk for falls, a therapeutically tailored tai ji quan balance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls. Trial Registration: ClinicalTrials.gov identifier: NCT02287740.

UR - http://www.scopus.com/inward/record.url?scp=85053107208&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85053107208&partnerID=8YFLogxK

U2 - 10.1001/jamainternmed.2018.3915

DO - 10.1001/jamainternmed.2018.3915

M3 - Article

VL - 178

SP - 1301

EP - 1310

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

IS - 10

ER -