Tai Chi Exercise for Balance

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1 Tai Chi Exercise for Balance Many studies have shown that the practice of Tai Chi improves balance in older individuals, which can lead to reduced falls. The current program aimed to extend this benefit to lower risk groups (i.e.: younger adults) to improve balance, kinaesthetic sense and strength. Thornton et al. (2004) recruited healthy, community dwelling women of Chinese ethnicity (ranging from ages years) residing in Hong Kong. The women were screened to ascertain that they were free from cardiovascular, pulmonary and musculoskeletal disease and had not participated in other forms of sport or exercise for health or recreation for at least two years. The control group consisted of women who underwent the same screening process, lived in the same neighbourhood and were recruited in the same manner. The individuals in the intervention group participated in a 12-week Tai Chi exercise program held 3 days per week early in the morning with each exercise session lasting for approximately 60 minutes. Evaluation of the intervention consisted of pre- and post-intervention measurement of the Functional Reach Test (FRT). The Functional Reach test is a balance task that invokes several aspects of balance including strength, biomechanics, proprioception, vestibular mechanisms and motor planning. In addition, blood pressure was measured 1 week before and intervention and again 12 weeks later. Evaluation of both outcomes was performed by a trained examiner blind to intervention status. Analysis of paired comparisons (stratified by age, body size and activity profile) showed a significant improvement in balance for the Tai Chi intervention group, with no minimal change for the control group (Thornton et al., 2004). The mean value reached on the FRT was comparable to that measured in a younger (20-40 years) age group. Thornton and colleagues (2004) therefore concluded that Tai Chi offers a feasible intervention for younger age groups, and middle age women in particular, to maintain balance as they age leading to decreased susceptibility to falls. Visit Website I. Citation Information and Links Primary Source Document Authors: E.W. Thornton, K.S. Sykes, & W.K. Tang Document Title: Health benefits of Tai Chi exercise: improved balance and blood pressure in middle-aged women Publication or Source: Health Promotion International, 19(1),

2 Date: Type of Source Published journal Language English Web Links For reports about the intervention, etc.: Duncan, P.W., Weiner, D.K., Chandler, J. And Studenski S. (1990) Functional reach: a new clinical measure of balance. Journal of Gerontology Medical Sciences, 45, Systematic Review Linked to systematic review evidence II. About the Intervention: General Characteristics Intervention's Country of Origin Health Issues Addressed Chronic Disease Prevention Conditions: Hypertension Health Promotion & Behaviour-related Protective Factors Physical Activity [primary focus] Injury Prevention [primary focus] Determinants of Health Personal health practices and coping skills [primary focus] Priority/Target Population for Intervention Delivery: Sex Female 2

3 Newcomers/Immigrants The population addressed in the intervention faces the following challenges/risks available information Relevant Ecological Levels Individual level (e.g., individual behaviour, knowledge, beliefs, attitudes) Geographic Level of Intervention Urban Setting Other Community Settings: Community/neighbourhood [primary focus] Recreation/fitness/sport facilities Policy/Administrative Level of Intervention: Local community III. Foundations of the Intervention Developers of the Intervention The intervention was designed by: an individual or group of individuals (but not by a formal organization) Intervention was developed by researchers at the University of Liverpool, UK and Centre for Exercise Nutrition Science, Chester College, UK. Specifically, Dr. E. Thornton (Professor, Department of Psychology, University of Liverpool) with K.S. Sykes, (Research Associate) and W.K Tang (Research Associate) from the Centre for Exercise Nutrition Science, Chester College, UK. Intervention Goals and Objectives To improve balance and strength and to reduce falls as well as to improve blood pressure and vascular response in middle aged adults. Funding resources used to develop, implement and/or evaluate the intervention Short-term funding (1-3 years) Independent funding at the University 3

4 Other resources used to develop, implement and/or evaluate the intervention information available Program Sponsor/Funder Independent funds at the University Duration/Timing for Implementation Number of months required to implement the intervention: Three months Number of months required to evaluate the intervention: Three months Theories/Conceptual Frameworks: theory/conceptual framework indicated Values Inherent in the Intervention Health (e.g., holistic health physical, mental, spiritual health; optimal health for all) Evidence Selected/limited literature review (if not comprehensive literature review) IV. Implementation of the Intervention Strategies Individual education/skill development Individual behaviour change Key Activities of the Intervention Group process/program Brief intervention Implementers certified Tai Chi instructors Strengths of the Intervention 4

5 Adequate resources such as funding, equipment, time, skills, organizational support and understanding Challenges of the Intervention Information not available V. Evaluation Design of the Intervention Link to evaluation document/article Thornton E.W., Sykes, K.S. & Tang, W.K. (2004). Health benefits of Tai Chi exercise: improved balance and blood pressure in middle-aged women. Health Promotion International, 12(1), URL: Experimental Study/Evaluation Design Quasi-experimental design (controlled studies without random assignment, but employing control/comparison groups, or counter-balanced designs) Methods Quantitative Individual behaviour measures: Balance was assessed using the Functional Reach Test. Systolic and diastolic blood pressures were recorded using a sphygmomanometer. Stakeholder Information Sources Members of priority population who are participants in the program Recruitment Participants were recruited through leaflets posted in a local and restricted housing area. Inclusion and exclusion criteria were applied to both the intervention group and controls through ascertaining medical history, physical activity history and demographic information. Was rigour used in the recruitment/selection of participants? Yes; Participants were recruited through leaflets posted in a local and restricted housing area. The medical history of each individual was reviewed to ensure no contraindications to participation and to confirm that participants did not suffer from cardiovascular, pulmonary or musculoskeletal disease. Individuals could not participate if they had seen a physician in the past six months or participated in sport or exercise for health in the last 2 years. The control group lived in the same area, in similar housing and were recruited in the same manner. The groups were matched using stratification with respect to age, body size and activity profile. Statistical analyses confirmed the absence of any between-group effects with respect to baseline systolic and diastolic blood pressure and Functional Reach Test. Informed consent was obtained from both groups. 5

6 Research Limitations Limitations identified by authors The specific cultural setting (Hong Kong) may have led to the observed high compliance with the programme. The absence of inclusion of an alternative form of exercise comparison group is limiting, and the uptake and adherence rates in other ethnic and cultural settings are not assessed by the current study. A second limitation is that the present evaluation assessed only females and can therefore not be generalized to males. Limitations identified by annotators or others N/A Nature of Processes Quality assurance methods were used Yes; Test-re-test reliability of the Functional Reach Test (FRT) was assessed and found to be high. Inter-rater-reliability was measured at The examiners performing FRT evaluations were trained and blind to the treatment group of the individual being tested. Two blood pressure measurements were taken and recorded by a certified health care assistant blind to group status, using guidelines established by the American Heart Association. The findings, including methods, of the study were published in a peer-reviewed medical journal that publishes in association with the World Health Organization (i.e. Health Promotion International). Ongoing results from research and evaluation were collected and acted on? available information VI. Intervention Outcomes What percentage of the interventions' process implementation objectives were achieved? High (75-100%) Specific Intervention Outcomes Health and Behaviour Outcomes - Evidence provided regarding: Positive outcomes on health Knowledge, Skills, Attitudes and Intentions Outcomes - Evidence provided regarding: evidence provided 6

7 Physical Environment Outcomes - Evidence provided regarding: evidence provided Community and social level outcomes - Evidence provided regarding: evidence provided Organizational Outcomes - Evidence provided regarding: evidence provided Political/Economic Outcomes - Evidence provided regarding: evidence provided Impact of Intervention on health-related outcomes - Evidence provided regarding: Positive outcomes on health VII. Adaptation Do the results indicate the intervention can be generalized to the general target population? Yes Has this initiative been adapted from another jurisdiction? Circumstances that the intervention would fit best: This intervention would be best integrated into community recreation centers, fitness clubs or through community groups. It does not require any equipment or resources with the exception of an instructor, and therefore can be taught in many settings, including public spaces such as parks and can therefore be implemented in underfunded or low resource settings. The intervention is feasible for: A wide range of circumstances Has the intervention been replicated? Are there supports available for implementation? Are there resources and/or products associated with the intervention? Yes 7

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