The case for Tai Chi in the repertoire of strategies to prevent falls among older people

Falls among older people is a global public health issue. In this article, Dr Samuel Nyman of Bournemouth University Dementia Institute, and Professor Dawn Skelton, Institute for Applied Health Research, Glasgow Caledonian University, highlight the effectiveness of Tai Chi as an alternative strategy to physiotherapy to combat this issue . [Image omitted: See PDF. ]Falls among older people is a major public health issue worldwide. [1] Several strategies to prevent falls are at the disposal of practitioners and policy makers. Exercise-based interventions in particular have strong evidence for preventing falls and fall-related injuries. [1] Two exercise-based strategies to prevent falls in wide use are the Falls Management Exercise (FaME)[2] and Otago[3] programmes that are predominantly class-based and home-based, respectively.However, Tai Chi is another exercise programme to be included in the repertoire of strategies to prevent falls and is also recommended in the Centers for Disease Control and Prevention (CDC) Compendium of Interventions. [4] Tai Chi is an ancient Chinese form of mind-body exercise, where people carry out smooth, fluid movements, either for health or as a martial art.[5] Below we highlight five reasons to support the case for greater promotion of Tai Chi among other widely used exercise-based strategies for the prevention of falls among older people.Tai Chi May be as Effective or More Effective than Other Exercise-Based Strategies for Preventing Falls among Older People Who are not FrailThere are few studies that directly compare the efficacy of exercise-based interventions on fall outcomes. For Tai Chi, a Korean trial randomised older women to either Tai Chi or Otago and found both to improve physiological measures associated with fall risk. [6] Furthermore, a Canadian randomised controlled trial compared the effect of Tai Chi with conventional physiotherapy among frail community-dwelling older adults. [7] They found that Tai Chi was significantly superior in reducing the incidence of falls compared with physiotherapy (rate ratio = .74, 95% confidence interval (CI) = . 56, . 98), which the authors attributed to sustained general self-efficacy among those in the Tai Chi group compared with diminished general self-efficacy in the physiotherapy group. [8] While not conclusive, these two studies suggest that Tai Chi can be effective or more effective than other exercise-based strategies to prevent falls. However, when Tai Chi is adapted for use with frailer older people (e.g. by using more static or seated movements, rather than the traditional flowing three-dimensional movements), it appears to no longer prevent falls. Frailer adults would then need alternative exercise programmes that have been shown to be more effective among this group. [2],[3],[9]Tai Chi May be as Cost-Effective or More Cost-Effective to Deliver than Other Fall Prevention StrategiesA cost-benefit analysis was conducted to compare the costs associated with different fall prevention interventions. [10] Tai Chi was found to have the largest return on investment (over 500%), far higher than the next best intervention for return on investment (127% for Otago for those aged 80+), with a net benefit of over US$500 per US$1 invested. While there are few studies that directly compare the cost-effectiveness of different fall prevention interventions, this analysis suggests that Tai Chi may be cost-effective compared with other strategies to prevent falls among older people.Tai Chi May Receive Higher Uptake and Adherence Rates than Other Exercise-Based Interventions to Prevent FallsUnlike prescribed/physiotherapy-based exercise interventions, Tai Chi is a form of physical activity that is widely practised among a general population of all ages and abilities. This means that participating in Tai Chi would be perceived as a 'normal' activity. …