TAI CHI FOR BALANCE STUDY

Timothy C. Hain, MD

STUDY: N.I.H. Office of Alternative Medicine (OAM). "Tai Chi for Balance Disorders." 1993-1994, Reference # 1R21RR09535-01. Site, Rehabilitation Institute of Chicago. Sponsoring Institution: Northwestern University, Chicago Illinois, USA. Principal Investigator: T. C. Hain, MD. Other investigators: J. Kotsias, Lynne Fuller (PT), L. Weil (PT)

Our aim was to determine if eight weeks of daily practice of an alternative health care exercise, T'ai Chi, can significantly improve balance of persons with mild balance disorders. We studied 22 persons with stable and mild balance disorders, with numbers distributed equally between 3 age groups : 20-44, 46-60, and 61 and beyond. We evaluated efficacy of T'ai Chi through comparison of functional tests of balance (Romberg, Duncan Reach Test, Moving Platform Posturography) and self-reports of balance and falls (Medical Outcomes Study (MOS) questionnaire, Dizziness Handicap Inventory (DHI) questionnaire), obtained prior to and following the Tai Chi course.

The Tai Chi movements that we used were selected from several different schools of T'ai Chi and included the following sequence: Hold the Ball (Wu style), Turning the Wheel (Yang style, as illustrated to the right), Brush Knee and Twist Step (Yang style), Step Back to Repulse Monkey (Yang style), Walking the Circle (Pa-Kua style), Kick heel to left and right (Wu style), Partition of the Wild Horse's Mane (Wu style), Hold the Ball.

RESULTS

Highly significant improvements were noted in posturography (average score improved from 59.5 to 64.3) and the MOS and DHI tests. An insignificant improvement was found in the Romberg test (although there was a strong trend). There was no effect on the Duncan reach test scores. Improvements were found in all age groups.

CONCLUSION:

Eight weeks of Tai Chi was associated with significant improvement in balance.

MORE INFORMATION:

You can download the Taichi handout (about 650K, pdf format, 20 pages) which are the instructions that were used in our study. The study instructional DVD ($30) is also available (click here for order form). See the journal article by Hain et al, 1999 ( full citation below) for more detail about the study. This article can be downloaded through the web as a PDF file from the archives of otolaryngology site. You will need Adobe acrobat to read a pdf file.

References:

Tai Chi forms used in our study

• Chou, JR. Pa Kua Palm Practice (Chinese), Tai Ping Book Store, Hong Kong, 1969
• Kotsias, J. The Essential Movements of Tai Chi. Paradigm Publications, 1989 (available through Redwing Books, see below).
• Ru HS. Wue (Hao )style T'ai Chi (Chinese), People's athletic publishers, Beijing, 1964
• Yang Cheng Pu. Practical use of T'ai Chi Chuan (Chinese), Ching Martial Arts Pub, Taipei, Taiwan, 1935
• Wu CC. Wu Style Tai Chi (Chinese), People's athletic publishers, Beijing, 1958

These references came from Mr. Kotsias's library and we do not know where most of them are obtained at present. They may be out of print. However, numerous similar books are available through Redwing Books (see link list at end).

Measures used in our study. These can be obtained through medical libraries.

• Stewart AL, Hays RD, Ware JE. The MOS short-form general health survey. Medical Care, 26, 1988, 724-735
• Jacobson GP, Newman CW. The development of the dizziness handicap inventory. Arch Otol HNS, 116, 1990, 424-427
• Duncan PW, Studenski S, Chandler J, Prescott B. Functional reach: predictive validity in a sample of elderly male veterans. J. Gerontology, 1992, 47, M93-M98

Health Effects of Tai Chi as well as some other martial arts. These references can be obtained through medical libraries and interlibrary loan.

• Brown, D. D., W. G. Mucci, et al. (1989). "Cardiovascular and ventilatory responses during formalized T'ai Chi Chuan exercise." Research Quarterly for Exercise & Sport 60(3): 246-50.
• Brown, D. R., Y. Wang, et al. (1995). "Chronic psychological effects of exercise and exercise plus cognitive strategies." Medicine and science in sports and exercise 27(5): 765-775.
• Forrest WR. Anticipatory postural adjustment and T'ai Chi Ch'u. Biomedical Sciences Instrumentation, 1997;33;65-69
• Hain TC, Fuller L, Weil L, Kotsias J. Effects of T'ai Chi on Balance. Arch Otolaryngol Head Neck Surg 1999 Nov;125(11):1191. Also see PDF file on Arch Otolaryngol site.
• Hain TC, Kotsias J, Pai CY. Tai Chi: Applications to Neurology. Chapter 19. Alternative and complementary treatment in Neurologic Illness, Weintraub MI, Ed. (Micozzi MS, senior editor). Churchill Livingstone, 2001. 248-254
• Jacobson, B. H., H. C. Chen, et al. (1997). "The effect of T'ai Chi Chuan training on balance, kinesthetic sense, and strength." Perceptual & Motor Skills 84(1): 27-33.
• Jin, P. (1992). "Efficacy of Tai Chi, brisk walking, meditation, and reading in reducing mental and emotional stress." Journal of Psychosomatic Research 36(4): 361-70.
• Judge, J. O., C. Lindsey, et al. (1993). "Balance improvements in older women: effects of exercise training." Physical Therapy 73(4): 254-62; discussion 263-5.
• Kirsteins, A. E., F. Dietz, et al. (1991). "Evaluating the safety and potential use of a weight-bearing exercise, Tai-Chi Chuan, for rheumatoid arthritis patients." American Journal of Physical Medicine & Rehabilitation 70(3): 136-41.
• Koh, T. (1981). "Tai Chi and ankylosing spondylitis -- a personal experience." Am. J. Chinese Ed 9: 15-22. Koh, T. (1981). "Tai Chi Chuan." American Journal of Chinese Medicine IX: 15-22.
• Kutner, N. G., H. Barnhart, et al. (1997). "Self-report benefits of Tai Chi practice by older adults." Journals of Gerontology. Series B, Psychological Sciences & Social Sciences 52(5): 242-6.
• Lai, J. S., C. Lan, et al. (1995). "Two-year trends in cardiorespiratory function among older Tai Chi Chuan practitioners and sedentary subjects." Journal of the American Geriatrics Society 43(11): 1222-7.
• Lai, J. S., M. K. Wong, et al. (1993). "Cardiorespiratory responses of Tai Chi Chuan practitioners and sedentary subjects during cycle ergometry." Journal of the Formosan Medical Association 92(10): 894-9.
• Lan, C., J. S. Lai, et al. (1998). "12-month Tai Chi training in the elderly: its effect on health fitness." Medicine & Science in Sports & Exercise 30(3): 345-51.
• Lan, C., J. S. Lai, et al. (1996). "Cardiorespiratory function, flexibility, and body composition among geriatric Tai Chi Chuan practitioners." Archives of Physical Medicine & Rehabilitation 77(6): 612-6.
• lansheng, g., J. Q, et al. (1981). "Changes in heart rate and electrocardiogram during taijiquan exercise. Analysis by telemetry in 100 subjects." Chinese Medical Journal 94(9): 589-592.
• Lumsden, D. B., A. Baccala, et al. (1998). "T'ai chi for osteoarthritis: an introduction for primary care physicians." Geriatrics 53(2): 84.
• Perrin P, Deviterne D, Hugel F, Perrot C. Judo, better than dance, develops sensorimotor adaptabilities involved in balance control. Gait and Posture, 15:2, 187, 2002
• E. C. Hadley, et al. (1995). "The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques [see comments]." JAMA 273(17): 1341-7.
• Ryan, A. (1974). "Tai Chi Chuan for Mind and Body." The physician and Sports Medicine(March 1974): 58-61. Schaller, K. (1996). "Tai Chi Chih. An exercise option for older adults." J. Gerontological Nursing 22(10): 12-17.
• Schneider, D. and R. Leung (1991). "Metabolic and Cardiorespiratory Responses to the performance of Wing Chun and T'ai Chi Chuan Exercises." Int J. Sports MEd 12: 319-323.
• Tse, S. K. and D. M. Bailey (1992). "T'ai chi and postural control in the well elderly." American Journal of Occupational Therapy 46(4): 295-300. Weiser, M., I. Kutz, et al. (1995). "Psychotherapeutic aspects of the martial arts." American Journal of Psychotherapy 49(1): 118-27.
• Wolf, S. L., H. X. Barnhart, et al. (1997). "The effect of Tai Chi Quan and computerized balance training on postural stability in older subjects. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies on Intervention Techniques." Physical Therapy 77(4): 371-81; discussion 382-4.
• Wolf, S. L., H. X. Barnhart, et al. (1996). "Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques [see comments]." Journal of the American Geriatrics Society 44(5): 489-97.
• Wolf, S. L., C. Coogler, et al. (1997). "Exploring the basis for Tai Chi Chuan as a therapeutic exercise approach [see comments]." Archives of Physical Medicine & Rehabilitation 78(8): 886-92.
• Wolf, S. L., N. G. Kutner, et al. (1993). "The Atlanta FICSIT study: two exercise interventions to reduce frailty in elders." Journal of the American Geriatrics Society 41(3): 329-32.
• Wolfson, L., R. Whipple, et al. (1996). "Balance and strength training in older adults: intervention gains and Tai Chi maintenance [see comments]." Journal of the American Geriatrics Society 44(5): 498-506.
• Zhuo, D., R. J. Shephard, et al. (1984). "Cardiorespiratory and metabolic responses during Tai Chi Chuan exercise." Canadian Journal of Applied Sport Sciences - Journal Canadien des Sciences Appliquees au Sport 9(1): 7-10.

Other Links:

• Golden Tai Chi: http://www.taichiforseniors.com/. Dr. Hain has reviewed this videotape. It is a modified Tai Chi similar to the sequence used in our study. The tape does not indicate the source of exercises, and the naming convention is not conventional. Nevertheless, it is a commercial Tai Chi format that may be helpful. It is formated so that one can use it as an exercise video. The exercises are more difficult than the ones above, and persons with significant balance disorders may not be able to perform the later movements.
• www.redwingbooks.com -- The Redwing Book company (617-738-4664) in Brookline Mass carries an immense selection of Tai Chi Books and videos.