Yang Style Tai Chi Exercises Combined With Mental Imagery Training On Balance and Fall Prevention in Older Adults
Condition: Elderly Population
Study type: Interventional

Summary: 
      Aging process and the chronic diseases that affect older adults lead to balance disorders,
      which makes these individuals more susceptible to falls. However, currently there is no
      evidence available to support effects of Yang Style Tai Chi exercises combined with mental
      imagery training on balance and fall prevention in older adults. Because separately Tai Chi
      training techniques having good effects according to evidence .So in this study we will be
      find out the effects of Tai chi with mental imagery training for the selection of most
      appropriate treatment method.
    

Detailed description: 
      Fall is defined as any unintentional positional change that results in a person coming to
      rest on the ground, floor, or other lower surface. The risk of fall increase dramatically
      with age. In older adults unintentionally injuries are the fifth leading cause of death, and
      falls constitute two thirds of these days.

      Falls are most serious common condition present in older adults. Falls and balanced problem
      are more common in elder population, causing injuries, social isolation, and psychological
      difficulties. Proper balance is imperative for the performance of functional activities. Any
      deficiency or impairment in balance increases the risk of fall thus making it difficult to
      perform functional activities. Balance is defined as exertion of postural control that
      provides a stable base of support while remaining stationary or during movement. Decrease in
      balance ability resulting from aging triggers motor and gait disabilities in elderly people,
      which greatly affects their mobility in day-to-day life. They are the serious cause of
      mortality and morbidity which leads to immobility and premature nursing care.

      As life expectancy increases, the problem of falls among the elderly will become more
      pertinent. Falls occurred in more than one third of the elderly aged 65 years and older
      annually. The incidence of falls rises steadily from Middle age and peaks in persons older
      than 80 years. The frequency of falls increases with age and frailty level. Older people who
      are living in nursing homes fall more often than those who are living in the community.
      Approximately 30-50% of people living in long term care institutions fall each year, and 40%
      of them experienced recurrent fall. Approximately 25% to 35% of people over age 65 years
      experiences more falls every year. Older people have stiffer, less coordinated and more
      dangerous gaits than younger people. Risk factors for falls among elderly people include
      environmental hazards and housing characteristic. There are several factors that may
      influence the fall risk in the elderly to a great extent. Environmental hazards are the
      leading cause of falls, accounting for about 25 to 45 percent in most studies. Major risk
      factor of fall among elderly population weakness, mobility impairment, balance and gait
      disturbance, Dizziness, vertigo, drop attacks, postural hypotension, visual impairment, and
      syncope are known to cause falls. Attention to these factors significantly reduce the risk of
      fall. Lower extremity muscle weakness is a significant risk factor for falls, increasing the
      odds of falling fourfold. A history of fall and gait or balance deficits increases the risk
      threefold.

      Other high-risk situations that can cause or contribute to falls are use of an assistive
      device, visual deficit, arthritis, and impaired activities of daily living, depression,
      cognitive impairment, and age older than 80 years. Use of four or more medications has been
      strongly associated with an increased risk of falls. In particular, use of psychotropic
      medications, cardiac drugs including class 1A antiarrhythmic agents, digoxin, diuretics, and
      anticonvulsants have been Implicated in increasing the risk of falls.

      There is paucity in the literature regarding evidence for the effectiveness of Tai chi
      exercises in older adults Lin YC et al 2019 found that in both cross sectional and
      longitudinal studies that Tai Chi exercises has more effectiveness in balance control,
      psychological wellbeing ,cardiovascular fitness and postural stability than other exercises.
      These findings shows that Tai chi exercises has more beneficial and health effective to
      maintain the good, physical, psychological conditions in older adults.In previous studies
      have shown beneficial effects of Tai Chi on cardiorespiratory system ,flexibility, Muscle
      strength, and body fat composition in middle aged and elderly individuals. Likewise, Hong and
      colleagues found that older adults who had been practicing Tai Chi Chuan for an average of
      13.2 years had better balance and functional fitness compared to sedentary older adults. In
      2015 Rahal et al in this study 76 elderly individuals who were divided into two groups: the
      Tai Chi Chuan Group and the Dance Group. The subjects were tested using the Neuro Com Balance
      MasterH force platform system with the following protocols: static balance testsand dynamic
      balance tests and found that older expert Tai Chi Chuan practitioners had better bilateral
      static balance with eyes open on firm and foam surfaces compared to dancers.

      A study was done by Cho HY, et al. with the title of Effects of motor imagery training on
      balance and gait abilities in post-stroke patients published in 2013 and concluded that
      Adding motor imagery training to gait training produced more significant improvements in the
      balance and gait abilities than gait training in stroke subjects.

      Another study was done by Hamel MF, et al. in 2005 and concluded that the link between
      attentional demands, postural oscillations, static balance and the prevention of falls among
      the elderly is of importance. The reduction of attentional demands reflects the automaticity
      of a task. Therefore, when attentional demands are reduced, more attentional resources are
      unbound to avoid, among other things, the environmental risk factors that can lead to falls.
      It has been shown that mental imagery is an effective technique, not only in reducing
      antero-posterior postural oscillations, but also in interpreting the postural control tasks
      more automatic. Therefore, this technique may be considered effective among the elderly
      population, in order to contribute to improving their static balance and preventing falls.

      A study was done by Page SJ, et.al with the title of a randomized efficacy and feasibility
      study of imagery in acute stroke. Published in 2001 and concluded that Imagery technique is a
      clinically feasible intervention and Imagery, in association with therapy, appears to be a
      noninvasive, efficacious complement to traditional therapy
    

Intervention name(s): Group I; Group II
Intervention type(s): Other; Other
Intervention description(s): Group I will receive yang style Tai chi exercises combined with mental imagery training; Group II will receive yang style Tai chi exercise which consist of 10 positions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Balance; Yang Style Tai Chi Exercises; mental imagery training; elderly population