Tai chi and postural stability in patients with Parkinson's disease

Fuzhong Li, Peter Harmer, Kathleen Fitzgerald, Elizabeth Eckstrom, Ronald Stock, Johnny Galver, Gianni Maddalozzo, Sara S. Batya

Research output: Contribution to journalArticle

368 Citations (Scopus)

Abstract

BACKGROUND: Patients with Parkinson's disease have substantially impaired balance, leading to diminished functional ability and an increased risk of falling. Although exercise is routinely encouraged by health care providers, few programs have been proven effective. METHODS: We conducted a randomized, controlled trial to determine whether a tailored tai chi program could improve postural control in patients with idiopathic Parkinson's disease. We randomly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale (which ranges from 1 to 5, with higher stages indicating more severe disease) to one of three groups: tai chi, resistance training, or stretching. The patients participated in 60-minute exercise sessions twice weekly for 24 weeks. The primary outcomes were changes from baseline in the limits-of-stability test (maximum excursion and directional control; range, 0 to 100%). Secondary outcomes included measures of gait and strength, scores on functional-reach and timed up-andgo tests, motor scores on the Unified Parkinson's Disease Rating Scale, and number of falls. RESULTS: The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion (between-group difference in the change from baseline, 5.55 percentage points; 95% confidence interval [CI], 1.12 to 9.97; and 11.98 percentage points; 95% CI, 7.21 to 16.74, respectively) and in directional control (10.45 percentage points; 95% CI, 3.89 to 17.00; and 11.38 percentage points; 95% CI, 5.50 to 17.27, respectively). The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistancetraining group in stride length and functional reach. Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training. The effects of tai chi training were maintained at 3 months after the intervention. No serious adverse events were observed. CONCLUSIONS: Tai chi training appears to reduce balance impairments in patients with mild-tomoderate Parkinson's disease, with additional benefits of improved functional capacity and reduced falls. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00611481.)

Original languageEnglish (US)
Pages (from-to)511-519
Number of pages9
JournalNew England Journal of Medicine
Volume366
Issue number6
DOIs
StatePublished - Feb 9 2012

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Tai Ji
Parkinson Disease
Resistance Training
Confidence Intervals
Accidental Falls
National Institute of Neurological Disorders and Stroke
Exercise
Gait
Health Personnel
Randomized Controlled Trials
Outcome Assessment (Health Care)
Incidence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Li, F., Harmer, P., Fitzgerald, K., Eckstrom, E., Stock, R., Galver, J., ... Batya, S. S. (2012). Tai chi and postural stability in patients with Parkinson's disease. New England Journal of Medicine, 366(6), 511-519. https://doi.org/10.1056/NEJMoa1107911

Tai chi and postural stability in patients with Parkinson's disease. / Li, Fuzhong; Harmer, Peter; Fitzgerald, Kathleen; Eckstrom, Elizabeth; Stock, Ronald; Galver, Johnny; Maddalozzo, Gianni; Batya, Sara S.

In: New England Journal of Medicine, Vol. 366, No. 6, 09.02.2012, p. 511-519.

Research output: Contribution to journalArticle

Li, F, Harmer, P, Fitzgerald, K, Eckstrom, E, Stock, R, Galver, J, Maddalozzo, G & Batya, SS 2012, 'Tai chi and postural stability in patients with Parkinson's disease', New England Journal of Medicine, vol. 366, no. 6, pp. 511-519. https://doi.org/10.1056/NEJMoa1107911
Li, Fuzhong ; Harmer, Peter ; Fitzgerald, Kathleen ; Eckstrom, Elizabeth ; Stock, Ronald ; Galver, Johnny ; Maddalozzo, Gianni ; Batya, Sara S. / Tai chi and postural stability in patients with Parkinson's disease. In: New England Journal of Medicine. 2012 ; Vol. 366, No. 6. pp. 511-519.
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abstract = "BACKGROUND: Patients with Parkinson's disease have substantially impaired balance, leading to diminished functional ability and an increased risk of falling. Although exercise is routinely encouraged by health care providers, few programs have been proven effective. METHODS: We conducted a randomized, controlled trial to determine whether a tailored tai chi program could improve postural control in patients with idiopathic Parkinson's disease. We randomly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale (which ranges from 1 to 5, with higher stages indicating more severe disease) to one of three groups: tai chi, resistance training, or stretching. The patients participated in 60-minute exercise sessions twice weekly for 24 weeks. The primary outcomes were changes from baseline in the limits-of-stability test (maximum excursion and directional control; range, 0 to 100{\%}). Secondary outcomes included measures of gait and strength, scores on functional-reach and timed up-andgo tests, motor scores on the Unified Parkinson's Disease Rating Scale, and number of falls. RESULTS: The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion (between-group difference in the change from baseline, 5.55 percentage points; 95{\%} confidence interval [CI], 1.12 to 9.97; and 11.98 percentage points; 95{\%} CI, 7.21 to 16.74, respectively) and in directional control (10.45 percentage points; 95{\%} CI, 3.89 to 17.00; and 11.38 percentage points; 95{\%} CI, 5.50 to 17.27, respectively). The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistancetraining group in stride length and functional reach. Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training. The effects of tai chi training were maintained at 3 months after the intervention. No serious adverse events were observed. CONCLUSIONS: Tai chi training appears to reduce balance impairments in patients with mild-tomoderate Parkinson's disease, with additional benefits of improved functional capacity and reduced falls. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00611481.)",
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AU - Maddalozzo, Gianni

AU - Batya, Sara S.

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