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Tai Chi: Moving for Better Balance

Program Description

Tai Chi: Moving for Better Balance is designed to improve the strength, balance, and physical functioning of 

individuals with diminished physical abilities, including older adults and those with Parkinson’s disease. The 

focus of the program is Tai Chi, a nontraditional form of exercise, which is used to help participants improve 

postural stability, control of body positioning, gait initiation and locomotion, movement symmetry, and 

coordination; increase the range of motion around ankle joints; and build strength in lower extremities. Tai Chi 

also can be used to enhance mental health, improve sleep quality, and reduce blood pressure.

The Tai Chi program is community based and implemented through instructor-led group sessions that are held 

two or three times per week for approximately 6 months, with the ultimate goals of improving participants’ 

functional balance, increasing their mobility, and reducing the incidence of falls. The program consists of a core 

eight-form routine with built-in exercise variations and a subroutine of eight integrated therapeutic activities, 

which, collectively, involve a set of simple, continuous, rhythmic, and functional Tai Chi–based actions. The 

sessions focus on stimulating participants’ musculoskeletal and sensory systems via self-initiated movements, 

such as body weight shifting, unilateral weight-bearing trunk rotation, ankle sways, and coordinated eye-headhand movements. To meet the specific needs and performance capabilities of the participants, the program 

includes chair-supported progressions, from completely assisted to unassisted. Participants are also taught 

exercises that they can perform at home for additional, out-of-class practice. Before delivering the program, Tai 

Chi instructors must receive training and certification through a 2-day instructional workshop.

Descriptive Information

Areas of Interest Health and wellness

Outcomes

Review Date: June 2012

 Functional balance

 Mobility

 Number of falls

Ages 

 26–49 (Adult)

 50–60 (Older adult)

 61–74 (Older adult)

 75–84 (Older adult)

 85+ (Older adult)

Genders  Female

 Male

Races/Ethnicities

 American Indian or Alaska Native

 Asian

 Hispanic or Latino

 White

 Race/ethnicity unspecified
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Settings  Community-based organization

 Other community settings

Geographic Locations Urban

Funding/CER Studies  Partially/fully funded by National Institutes of Health

 Evaluated in comparative effectiveness research studies

Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the 

developer.

Implementation History

Tai Chi: Moving for Better Balance was first implemented in 2001 at the Oregon 

Research Institute and the Legacy Health System in Eugene, Oregon. Since then, the 

program has been implemented in more than 10 cities in Oregon, reaching more than 

1,000 community-dwelling older adults. In addition to Oregon, the program has been 

implemented by State-level injury prevention and aging services agencies in California, 

Colorado, Connecticut, Florida, Maryland, Nebraska, New Hampshire, New Mexico, 

and New York.

Adaptations No population- or culture-specific adaptations were identified by the developer. 

Quality of Research

Review Date: June 2012 

Documents Reviewed 

The documents below were reviewed for Quality of Research. The research point of contact can provide 

information regarding the studies reviewed and the availability of additional materials, including those from 

more recent studies that may have been conducted. 

Study 1

Li, F., Harmer, P., Fisher, K. J., McAuley, E., Chaumeton, N., Eckstrom, E., & Wilson, N. L. (2005). Tai Chi and fall 

reductions in older adults: A randomized controlled trial. Journal of Gerontology: Medical Sciences, 60A(2), 187–

194. PubMed abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15814861

Study 2

Li, F., Fisher, K. J., Harmer, P., Irbe, D., Tearse, R. G., & Weimer, C. (2004). Tai Chi and self-rated quality of sleep 

and daytime sleepiness in older adults: A randomized controlled trial. Journal of the American Geriatrics Society, 

52(6), 892–900. PubMed abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15161452

Study 3

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. PubMed 

abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22316445
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Supplementary Materials

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 [Online supplementary appendix]. New England Journal of 

Medicine, 366(6), 511–519. PubMed abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22316445

Outcomes 

Outcome 1: Functional Balance 

Description of Measures

Functional balance was assessed in each study using at least one of two tests:

 The functional reach test, which measures the maximal distance a participant can 

reach forward beyond arm’s length while maintaining a fixed base of support in a 

standing position. Longer reaches indicate better balance. 

 The single-leg standing test, which measures how long a participant can stand on 

his or her left or right leg, up to a maximum of 60 seconds. One study conducted 

this test when the participant’s eyes were open and when they were closed, and 

the other study conducted the test when the participant’s eyes were open. For 

each leg test, three trials were allowed, with scores averaged across the final two 

trials. Longer times standing on one leg indicate better balance.

Key Findings

In one study, older adults were randomly assigned to the intervention group, which 

practiced Tai Chi, or the comparison group, which practiced low-impact seated 

exercises (i.e., stretches, controlled breathing, and relaxation). Both groups met for 

1-hour sessions three times per week for 6 months. Data were collected at baseline, 

3 months, 6 months (intervention completion), and 6 months after intervention 

completion. At intervention completion, participants in the Tai Chi group had a longer 

functional reach (p < .001) and longer average times standing on one leg, both left 

and right with eyes open and closed (p < .001 for all four conditions), relative to 

participants in the comparison group. 

In another study, older adults were randomly assigned to the intervention group, 

which practiced Tai Chi, or the comparison group, which practiced low-impact seated 

exercises (i.e., stretches, controlled breathing, and relaxation). Both groups met for 

1-hour sessions three times per week for 24 weeks. Data were collected at baseline, 

3 months, and 6 months (intervention completion). At intervention completion, 

participants in the Tai Chi group had longer average times standing on one leg, both 

left (p = .001) and right (p < .001), relative to participants in the comparison group. 

In a third study, patients with Parkinson’s disease were randomly assigned to the 

intervention group, which practiced Tai Chi; the resistance training comparison group, 

which practiced exercises for strengthening muscles important for posture, balance, 

and gait; or the stretching comparison group, which practiced low-impact seated and 

standing exercises (i.e., stretches, controlled breathing, and relaxation). All groups met 

for 1-hour sessions twice weekly for 24 weeks. Data were collected at baseline, 

3 months, 6 months (intervention completion), and 3 months after intervention 

completion. From baseline to intervention completion, participants in the Tai Chi group 

had a greater increase in functional reach relative to participants in the resistance 

training comparison group (p < .01) and the stretching comparison group (p < .001). 
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Studies Measuring 

Outcome Studies 1–3 

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.5

Outcome 2: Mobility 

Description of Measures

Mobility was assessed in each study using at least one of two tests:

 The up-and-go test, which measures the time it takes to rise from a chair, walk 

3.1 meters (10 feet), return, and sit down. Shorter times indicate better mobility. 

 The 50-foot speed walk, which measures the time it takes to walk 50 feet. Shorter 

times indicate better mobility. 

Key Findings

In one study, older adults were randomly assigned to the intervention group, which 

practiced Tai Chi, or the comparison group, which practiced low-impact seated 

exercises (i.e., stretches, controlled breathing, and relaxation). Both groups met for 

1-hour sessions three times per week for 6 months. Data were collected at baseline, 

3 months, 6 months (intervention completion), and 6 months after intervention 

completion. At intervention completion, participants in the Tai Chi group had shorter 

times relative to the comparison group for both the up-and-go test (p < .001) and the 

50-foot speed walk (p < .001). At 6 months after intervention completion, participants 

in the Tai Chi group maintained shorter times relative to the comparison group for 

both the up-and-go test (p < .001) and the 50-foot speed walk (p < .006). 

In another study, older adults were randomly assigned to the intervention group, 

which practiced Tai Chi, or the comparison group, which practiced low-impact seated 

exercises (i.e., stretches, controlled breathing, and relaxation). Both groups met for 

1-hour sessions three times per week for 24 weeks. Data were collected at baseline, 

3 months, and 6 months (intervention completion). At intervention completion, 

participants in the Tai Chi group had a shorter time on the 50-foot speed walk relative 

to the comparison group (p = .009). 

In a third study, patients with Parkinson’s disease were randomly assigned to the 

intervention group, which practiced Tai Chi; the resistance training comparison group, 

which practiced exercises for strengthening muscles important for posture, balance, 

and gait; or the stretching comparison group, which practiced low-impact seated and 

standing exercises (i.e., stretches, controlled breathing, and relaxation). All groups 

met for 1-hour sessions twice weekly for 24 weeks. Data were collected at baseline, 

3 months, 6 months (intervention completion), and 3 months after intervention 

completion. From baseline to intervention completion, participants in the Tai Chi 

group had a shorter time for the up-and-go test relative to participants in the 

stretching comparison group (p < .001); however, times did not differ significantly 

between the Tai Chi group and the resistance training comparison group. 

Studies Measuring 

Outcome Studies 1–3 
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Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.6

Outcome 3: Number of Falls 

Description of Measures

Number of falls was assessed using fall counts, as recorded daily in a ‘‘fall calendar’’ 

by participants, who documented each fall experienced and whether it required 

medical attention. A fall was defined as landing on the floor or the ground, or falling 

and hitting objects such as stairs or pieces of furniture, by accident. Fall calendars 

were collected monthly throughout the intervention and postintervention periods or 

until a participant withdrew from the study.

Key Findings

In one study, older adults were randomly assigned to the intervention group, which 

practiced Tai Chi, or the comparison group, which practiced low-impact seated 

exercises (i.e., stretches, controlled breathing, and relaxation). Both groups met for 

1-hour sessions three times per week for 6 months. At 6 months after intervention 

completion, the average number of falls reported by participants in the Tai Chi group 

was lower than that reported by participants in the comparison group (p < .001). The 

incidence rate of falls per 100 participant-months of observation was lower for the Tai 

Chi group than the comparison group (3.16 falls vs. 8.96 falls; p < .001). 

In another study, patients with Parkinson’s disease were randomly assigned to the 

intervention group, which practiced Tai Chi; the resistance training comparison group, 

which practiced exercises for strengthening muscles important for posture, balance, and 

gait; or the stretching comparison group, which practiced low-impact seated and 

standing exercises (i.e., stretches, controlled breathing, and relaxation). All groups met 

for 1-hour sessions twice weekly for 24 weeks. Over the intervention period, participants 

in the Tai Chi group had 67% fewer falls than participants in the stretching comparison 

group (incidence-rate ratio, 0.33; 95% confidence interval [CI], 0.16–0.71) and 53% fewer 

falls than participants in the resistance training comparison group (incidence-rate ratio, 

0.47; 95% CI, 0.21–1.00), even after adjustment for baseline and time-varying covariates. In 

addition, over the 3 months after intervention completion, participants in the Tai Chi 

group had fewer falls than participants in the stretching comparison group (incidencerate ratio, 0.31; 95% CI, 0.14–0.67; p = .003) and the resistance training comparison group 

(incidence-rate ratio, 0.40; 95% CI, 0.18–0.88; p = .02). 

Studies Measuring 

Outcome Studies 1 and 3

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.5
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Study Populations 

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity 

Study 1

 61–74 (Older adult)

 75–84 (Older adult)

 85+ (Older adult)

 70% Female

 30% Male

 90% White

 10% Race/ethnicity 

unspecified

Study 2

 61–74 (Older adult)

 75–84 (Older adult)

 85+ (Older adult)

 81.4% Female

 18.6% Male

 94.9% White

 5.1% Race/ethnicity 

unspecified

Study 3

 26–49 (Adult)

 50–60 (Older adult)

 61–74 (Older adult)

 75–84 (Older adult)

 85+ (Older adult)

 62.6% Male

 37.4% Female

 91.3% White

 6.7% Hispanic or Latino

 1.0% Asian

 0.5% American Indian or 

Alaska Native

 0.5% Race/ethnicity 

unspecified

Quality of Research Ratings by Criteria (0.0–4.0 scale) 

Criterion 

Ratings 

Outcome 1 Outcome 2 Outcome 3 

Reliability of Measures 3.5 3.6 2.9

Validity of Measures 3.1 3.1 3.1

Intervention Fidelity 3.7 3.7 3.7

Missing Data and Attrition 3.5 3.7 3.7

Potential Confounding 

Variables 3.7 3.7 3.7

Appropriateness of Analysis 3.9 3.9 3.9

Overall Rating 3.5 3.6 3.5
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Study Strengths 

The functional balance and mobility measures have good reliability and have been widely used with populations 

similar to those in the three studies. The Tai Chi program is standardized, and study participants were asked not to 

engage in any other physical activity during the study period. Attendance across intervention and comparison groups 

was comparable for all studies. Missing data were reported in all studies, and explanations were provided for 

participants who withdrew from the studies. For each study, no statistical differences were found between those 

who discontinued participation and those who remained. Statistical power to detect between-group differences, with 

appropriate participant attrition estimates, ensured sufficient sample sizes were available to conduct all planned 

outcome comparisons. Analyses addressed potential confounding variables by controlling for baseline and timevarying covariates. All analyses were appropriate and used an intent-to-treat statistical approach.

Study Weaknesses 

Reliability of the fall calendar was unclear since there was no evidence of monitoring to ensure that accurate data 

were reported by participants, with the exception of injurious falls captured in the medical record. None of the 

studies discussed face validity or criterion-related validity in regard to functional balance or mobility, although there 

was some support for the face validity of the fall calendar, which was presented as the gold standard. In all studies, 

participants were aware of their intervention assignments, which may have introduced bias about the benefits of 

such exercise.

Readiness for Dissemination

Review Date: June 2012 

Materials Reviewed 

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can 

provide information regarding implementation of the program and the availability of additional, updated, or 

new materials.

Oregon Research Institute. (2009). Tai Chi: Moving for Better Balance, step-by-step guide and DVD (Version 6.2). 

Eugene, OR: Author.

Oregon Research Institute. (2012). Tai Chi: Moving for Better Balance: Class teaching fidelity checklist. Eugene, 

OR: Author.

Oregon Research Institute. (2012). Tai Chi: Moving for Better Balance: Teaching timetable—Guidelines. Eugene, 

OR: Author.

Oregon Research Institute. (n.d.). Home-based exercises: An accompanying subroutine for Tai Chi: Moving for 

Better Balance (Version 1.0—Draft). Eugene, OR: Author.

Oregon Research Institute. (n.d.). Mini therapeutic movements: An accompanying subroutine for Tai Chi: Moving 

for Better Balance (Version 1.4—Draft). Eugene, OR: Author.
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Oregon Research Institute. (n.d.). Tai Chi: Moving for Better Balance, instruction pamphlet (general teaching 

guidelines for instructors) (Version 2.1). Eugene, OR: Author.

Oregon Research Institute. (n.d.). Tai Chi: Moving for Better Balance, transforming tradition into therapeutic 

exercise and rehabilitation (Version 1.0). Eugene, OR: Author.

Readiness for Dissemination Ratings by Criteria (0.0–4.0 scale) 

Criterion Rating 

Implementation Materials 3.9

Training and Support 3.3

Quality Assurance 3.8

Overall Rating 3.6

Dissemination Strengths 

The implementation guide is clearly and concisely written and provides a step-by-step demonstration of each Tai Chi 

movement. The guide is accompanied by an instructional DVD (used for training and implementation), which features 

appropriately paced demonstrations for older adults. An instructional document for establishing a Tai Chi routine at 

home is also available for participants. Instructor training and certification are required by the developer. The general 

teaching guidelines are concise and provide helpful resources for instructor reference. The 2-day training session 

concludes with instructor certification, and refresher courses are provided by the developer, which bolster ongoing 

support and fidelity. Standards and quality assurance for instructors and participants are embedded throughout the 

program materials; for example, elements of each routine are clearly described in the written materials, depicted in 

pictures, and modeled in the video. The Class Teaching Fidelity Checklist is user friendly, thorough, and succinct.

Dissemination Weaknesses 

Training and refresher courses are limited in that they are offered only by the developer, and program accessibility is 

limited by the number of trainers available to conduct the training and refresher courses. There is very little 

information readily available about when trainings occur; instead, interested implementers are encouraged to contact 

the developer to make training arrangements. No fidelity materials are available for assessing the performance or fall 

risk outcome of older adults participating in the program.

Costs

The cost information of implementation materials, including off-site training and refresher courses, can be 

obtained by directly contacting the developer.
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Implementation Materials 

Item Description Cost 

Required by 

Developer 

Tai Chi: Moving for Better Balance, Step-by-Step Guide 

and DVD (includes instruction pamphlet)

Contact the 

developer Contact the developer

Mini Therapeutic Movements: An Accompanying 

Subroutine for Tai Chi: Moving for Better Balance

Contact the 

developer Contact the developer

Home-Based Exercises: An Accompanying Subroutine for 

Tai Chi: Moving for Better Balance

Contact the 

developer Contact the developer

Tai Chi: Moving for Better Balance, Transforming 

Tradition Into Therapeutic Exercise and Rehabilitation

Contact the 

developer Contact the developer

Tai Chi: Moving for Better Balance: Teaching Timetable 

and Class Teaching Fidelity Checklist

Contact the 

developer Contact the developer

2-day, off-site training (certification included) Contact the 

developer Yes

Off-site refresher courses Contact the 

developer Contact the developer

Other Citations

Li, F., Fisher, K. J., Harmer, P., & Shirai, M. (2003). A simpler eight-form easy Tai Chi for elderly adults. Journal of 

Aging and Physical Activity, 11, 206–218.

Li, F., Harmer, P., Fisher, K. J., Xu, J., Fitzgerald, K., & Vongjaturapat, N. (2007). Tai Chi–based exercise for older 

adults with Parkinson’s disease: A pilot-program evaluation. Journal of Aging and Physical Activity, 15(2), 139–

151. PubMed abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17556781

Li, F., Harmer, P., Mack, K. A., Sleet, D., Fisher, K. J., Kohn, M. A., ... Tompkins, Y. (2008). Tai Chi: Moving for 

Better Balance—Development of a community-based falls prevention program. Journal of Physical Activity and 

Health, 5(3), 445–455. PubMed abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18579921

Translational Work

Tai Chi: Moving for Better Balance was evaluated in six community centers using the RE-AIM (Reach, Effectiveness, 

Adoption, Implementation, and Maintenance) framework, which was developed for the systematic planning and 

evaluation of interventions intended to produce a public health effect. Results showed that the Tai Chi program 

had a 100% adoption rate at the setting level and a reach of 87% of the study population, which was composed of 

older adults. All six centers implemented the intervention with good fidelity, and participants had significant 

improvements in health-related outcome measures. At the completion of the evaluation, five centers continued to 

offer a Tai Chi class, and the other center was waiting for an available instructor.
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Translational efforts are under investigation in three randomized controlled trials supported by the Centers for 

Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the National Institute on Aging 

(NIA). In the CDC-supported study, investigators are determining whether an evidence-based Tai Chi fall 

prevention program can be disseminated through health care provider referrals of older patients who are at risk 

of falling. In the NCI-supported study with cancer patients, researchers are examining the effects of Tai Chi and 

strength training on improving balance and muscle strength and reducing the risk of falling. In the NIAsupported study, investigators are working to determine whether an evidence-based Tai Chi fall prevention 

program can be disseminated through a broad spectrum of community-based senior service providers that often 

cater to low-income, underserved, community-dwelling older adults at risk of falling. The impact of these 

translations will be determined once evaluation efforts have been concluded and findings have been published.

The American Geriatric Society and the British Geriatric Society recommend Tai Chi as a fall prevention exercise 

program for older adults, and the Tai Chi program is recommended by the Administration on Aging and CDC. Also, 

10 States have implemented the Tai Chi program through State-level injury prevention and aging services agencies.

Site With 

Translational 

Work 

Articles Describing Site’s Translational Work, by Category 

Planning/ 

Partners Adoption 

Reach/ 

Recruitment Implementation Effectiveness Maintenance 

6 community 

centers — Article 1 Article 1 Article 1 Article 1 Article 1

Article 

Number Article Reference 

1 

Li, F., Harmer, P., Glasgow, R., Mack, K. A., Sleet, D., Fisher, K. J., ... Tompkins, Y. (2008). 

Translation of an effective Tai Chi intervention into a community-based falls-prevention program. 

American Journal of Public Health, 98(7), 1195–1198. PubMed abstract available at 

http://www.ncbi.nlm.nih.gov/pubmed/18511723

Contacts

To learn more about implementation or research, contact:

Fuzhong Li, Ph.D. 

Oregon Research Institute

(541) 484-2123

fuzhongl@ori.org