# Exercise as it relates to Disease/Tai Chi and its implications on elderly health

This is a critique of the research paper ''‘12-month Tai Chi training in the elderly: its effect on health fitness', published in 1998

## What is the background to this research?

It is well documented that physical activity levels and all-round health diminish with age, with only 26.1% of the elderly population engaging in sufficient PA. With the growing burden placed on society, improved health outcomes for elderly would assist in leading a longer, more healthy life.
Tai Chi is an ancient Chinese form of exercise, comprising simple movements aimed at improving both physical and mental health. Studies have proven Tai Chi beneficial in a range of health outcomes; including reductions in depressive and anxious tendencies, improving flexibility, mobility and cardiorespiratory function. This study looks at the practice of Tai Chi and how it can improve the lives and well-being of the elderly.

## Where is the research from?

This research was conducted in the city of Taipei, in Taiwan. The study comprised 52 community-dwelling elderly individuals from Taipei, and was overseen by various health bodies, including; The National Taiwan University Hospital and Chang Gung Memorial Hospital. The article was published in the journal ‘Medicine & Science in Sports & Exercise’, written and supervised by four authors; all of whom were employees at the aforementioned hospitals.

## What kind of research was this?

This research was a cross-sectional study. The study follows a population over a period of time, and looks at how a particular intervention affects them at a given point in time.

## What did the research involve?

Subjects were recruited from various senior citizen centers throughout Taipei. 87 volunteers completed questionnaires to determine their level of health, and the applicability of Tai Chi to each individual. Individuals who had any history of serious diseases or heart conditions were immediately excluded from the study. Baseline examinations on cardiac health, spirometric evaluation and a physical ‘check-up’ were conducted, with a further eight subjects being withdrawn. The remaining 52 subjects enrolled in the study; all of whom were community-dwelling, hadn’t engaged in regular exercise for at least 5 years and ranged in age from 58-70 years.
Prior to the exercise intervention, every participant was run through further assessments to gather important data for comparison at the conclusion of the study. The assessments utilised were:
* VO2 Max- Completed on a cycle erg (60RPM @10W with a 10W increase every minute until muscular fatigue.
** Heart rate, Blood Pressure and Blood Lactate were also taken during this assessment
* Knee Strength- Measured by an isokinetic dynamometer (extensor and flexor)
* Skinfolds- Measured using calipers (only at tricep and subscapular sites)
* Respiratory function- Measured using a spirometer
* Flexibility (Thoracic/Lumbar)- Assessed using an electronic digital inclinometer
The subjects were split into two groups; a control (N= 24) and an experimental group (N= 28). A 12 month Tai Chi Chuan (TCC) intervention was designed for the experimental group, with session attendance recorded. Sessions were run by a Tai Chi master every morning in parks around Taipei, easily accessible for all participants. Each session included 108 common Tai Chi postures, with participants following the instructor as well as a pre-recorded sequence to ensure accuracy and reliability.
Following the conclusion of the TCC intervention, the assessments were repeated to measure the body’s response to the exercise.
Although the study design proves reasonably successful, giving participants complete control over attendance can lead to potentially skewed results. Providing individuals with a less-frequent, but more compulsory session may have led to greater attendance and differing results. Furthermore, a 12 month intervention poses significant concerns regarding commitment and attendance. A shorter intervention would still illicit similar results, and may assist in engaging more participants and enhancing attendance.

## What were the basic results?

Throughout the 12 month period, there were some withdrawals from the study. Of the initial 52 participants, 38 (73.1%) completed the study, with an equal proportion of drop-outs from both groups.
Table 1: Male participant results
| Assessment | Control Pre | Control Post | TCC Pre | TCC Post |
| VO2 Max (mL.kg.min) | 24.0 +/- 4.8 | 23.6 +/- 5.0 | 24.2 +/- 5.2 | 28.1 +/- 5.4 |
| HR Max (beats/min) | 165 +/- 12 | 164 +/- 17 | 167 +/- 14 | 168 +/- 16 |
| Muscle strength- Knee extensor/flexor (ft-lb) | 102.1 +/- 20.4 / 59.4 +/- 11.6 | 98 +/- 20.9 / 58.8 +/- 12.1 | 98.2 +/- 21.2 / 56.6 +/- 14.2 | 116 +/- 22.5 / 65.3 +/- 13.7 |
| Body Fat (%) | 20.2 +/- 4.5 | 20.6 +/- 4.3 | 20.6 +/- 4.0 | 19.5 +/- 4.2 |
| Thoracolumbar Flexibility (degrees) | 50.6 +/- 8.5 | 48.1 +/- 9.1 | 52.2 +/- 9.6 | 63.2 +/- 10.2 |
Table 2: Female participant results
| Assessments | Control Pre | Control Post | TCC Pre | TCC Post |
| VO2 Max (mL.kg.min) | 15.8 +/- 2.5 | 15.6 +/- 2.6 | 16.0 +/- 2.5 | 19.4 +/- 2.8 |
| HR Max (beats/min) | 167 +/- 11 | 166 +/- 12 | 165 +/- 13 | 166 +/- 14 |
| Muscle strength- Knee extensor/flexor (ft-lb) | 63.4 +/- 11.2 / 35.2 +/- 11.6 | 61.4 +/- 10.8 / 34.0 +/- 10.4 | 61.2 +/- 12.5 / 34.6 +/- 8.2 | 73.6 +/- 12.1 / 40.1 +/- 7.7 |
| Body Fat (%) | 29.0 +/- 4.6 | 29.5 +/- 5.1 | 28.8 +/- 4.5 | 27.5 +/- 4.8 |
| Thoracolumbar Flexibility (degrees) | 65.2 +/- 7.8 | 64.7 +/- 8.2 | 67.4 +/- 9.2 | 76.2 +/- 9.6 |
As seen above, the TCC intervention group experienced improvements in nearly all categories. The most significant being in VO2 max, muscular strength (knee), and joint mobility (spinal). This study highlights the positive implications Tai Chi can have on elderly health and quality of life.
The study shows major improvements, however, it was conducted with a reasonably small sample. Gathering more volunteers and a larger sample size would provide more accurate results, giving a better reflection on how TCC affects elderly health.

## What conclusions can we take from this research?

Based on this study and available resources, it can be deduced that Tai Chi is an effective form of exercise for an elderly population. This study aligns with similar research, highlighting the importance of PA as individuals age. The results emphasise the importance of active lifestyles for elderly individuals, showing improvements in health can be made late in life, regardless of intensity of exercise.

## Practical Advice

With constant research and study into elderly health, it has been undoubtedly proven that physical activity improves quality of life. Life expectancy and medical advancements continue to dominate societal thinking towards elderly health, however, the impact of consistent physical activity can not be discounted. Before engaging in any PA, individuals should consult with their health practitioner to determine what best suits their needs.

## Further Information/Resources

* Tai Chi Australia
* WHO Physical Activity for Elderly
* Benefits of Tai Chi

## References

* 1 2 3 4 5 6 7 8 L, CHING; L, JIN-SHIN; C, SSU-YUAN; W, MAY-KUEN, (1998), ‘12-month Tai Chi training in the elderly: its effect on health fitness’. Medicine & Science in Sports & Exercise. Vol. 30 (3): pp. 345-351
* ↑ 4364.0.55.001 - National Health Survey: First Results, 2017-18 [Internet]. Abs.gov.au. 2019 [cited 16 September 2019]. Available from:
* 1 2 D, Taylor, ‘Physical activity is medicine for older adults’. Postgraduate Medical Journal. Vol. 90 (1059)
* ↑ A, Balde et al (2003), ‘Physician Advice to the Elderly About Physical Activity’. Journal of Ageing and Physical Activity. Vol 11 (1): pp. 90-97
* ↑ R, Shephard (1990), ‘The Scientific Basis of Exercise Prescribing for the Very Old’. Journal of the American Geriatrics Society. Vol 38 (1)
* 1 2 R, Jahnke et al (2010), ‘A Comprehensive Review of Health Benefits of Qigong and Tai Chi’. American Journal of Health Promotion. Vol 24 (6)
* ↑ M, Setia (2016), ‘Methodology Series Module 3: Cross-sectional Studies’. Indian Journal of Dermatology. Vol. 61 (3): pp. 261-264
* ↑ J, Fries (1996), ‘Physical Activity, the Compression of Morbidity, and the Health of the Elderly’. Journal of the Royal Society of Medicine.
* ↑ N, Garatachea et al. (2009), ‘Feelings of well being in elderly people: Relationship to physical activity and physical function’. Archives of Gerontology and Geriatrics. Vol 48 (3): pp. 306-312