Tai Chi for the older adult

**PURPOSE:**The purpose of this page is to provide a beginning knowledge of Tai Chi by outlining what it is, who can do it, what the benefits are, and how to implement itin the clinic. This page will be tailored specifically to the geriatric popultion.

**LEARNING OBJE**

   **CTIVES:**

1. Develop an understanding of what Tai Chi is.

2. Learn who can benefit from Tai Chi.

3. Learn what the benefits of Tai Chi are.

4. Gain insight on how to bring Tai Chi to the clinic.

**WHAT IS TAI CHI**

Tai Chi was originally developed by Chinese martial artists nearly 2,500 years ago.1 It is known for its slow, purposeful body movements which align with the initial goal of promoting inner peace and calm.1 Considering this exercise consists of slow continuous movements, it is also low-impact which makes it a perfect intervention for our geriatric patients. Tai Chi is great for balance due to the implementation of weight shifting, body rotations, and semi-squat positions.3 These movements target the core and lower extremity strength while challenging balance by introducing single leg stance and upper extremity reaching outside of the base of support. Another important piece of Tai Chi is the mental focus. Tai Chi incorporates a mind-body interaction by focusing on meditation, breathing regulation, and hand-eye coordination.4

**WHO CAN DO TAI CHI**

Tai Chi is an excellent form of exercise for all populations from geriatrics to amputees. It can be tailored to any skill level which makes it a great approach to challenging balance for any patient. By combining breathing exercise and relaxation, Tai Chi is not only used for those with balance deficits but can be used for patients with chronic pain conditions or for general lower extremity and core strengthening.

Tai Chi is commonly used in the treatment of older adults. This is due to the significant fall risk and fall injury risk that this population faces. It has been found that roughly 1/3 of adults fall each year and of those greater than 85, the fall prevalence jumps to 50%.2 These falls do not come without injury. Fall-related injuries are the primary cause of hospitalization in geriatric trauma cases.3 Falls are the leading cause of injury-related death and the 5th leading cause of death in older adults. It has been proposed that by 2050, 1/5th of the world population will be over 60 years old. 2 With this comes the demand to treat this patient population and raises the question of how to best treat them. Tai Chi is one possible intervention to implement with these patients.

**BENEFITS OF TAI CHI**

Tai Chi has many proposed benefits for our patients. The two categories of benefits that will be discussed further are physical and mental well-being. Physical well-being consists of strength, cardio respiratory fitness, and balance improvement. Mental well-being consists of improvements for depression, and anxiety.

Tai chi has been shown to improve many aspects of physical well-being. It has been shown time and time again, that Tai Chi has great fall reduction capabilities.1,3,4 Specifically, it has been found that Tai Chi can improve balance scores including single leg stance duration.4 Hong et al4 proposed that Tai Chi has the ability to improve balance and postural control in the long term. Balance while standing is important but is not all that Tai Chi can improve. Manor et al5 discussed findings that Tai Chi could help improve dual task walking in older adults which is crucial when the goal is to keep our older adults as independent for as long as possible. Hong et al4 also found that in patients who had been participating in Tai Chi, flexibility measures improved significantly when compared to control groups. Lastly, it has been shown in research that Tai Chi has several cardio respiratory benefits including the delay of cardiovascular function decline and improving systolic and diastolic blood pressure.4 As you can see, Tai Chi has numerous physical benefits for all patients.

Not only does Tai Chi have great physical benefits, but it can help support great mental health as well. It is known that nearly 2/3 of older adults who are treated for depression do not achieve remission of symptoms with medication alone.6 Research has shown that in combination with medication, Tai Chi had greater improvement in symptoms of depression as compared to medication alone.6 Wang et al7 found that Tai Chi had great improvement on scores pertaining to depression, anxiety, general stress reduction, and exercise self efficacy. Tai Chi is a great exercise for overall mind and body health and wellness.

**HOW TO BRING TAI CHI TO THE CLINIC**

Tai Chi has the ability to be a great component of an exercise program for any and all patients. The last question is how to implement it. There are numerous resources, such as the ones listed below, for continuing edcation about Tai Chi and how to use it as a treatment intervention for patients. Perhaps the best way to have an idea about how to implement this in your clinic would be to participate in a class yourself. Listed below in the additional resources is a link to a program outline that the YMCA provides. Find your local YMCA and enjoy a Tai Chi class!

https://www.educata.com/courseprofile.aspx?c=137

https://summit-education.com/course/GFALBT.1/fall-prevention-strategies#/onlinevideo/6-ceus

https://www.instituteforrehabilitativeqigongandtaichi.org/continuing-education-approvals/

**ADDITIONAL RESOURCES FOR PATIENTS AND PTs:**

1. Tai Chi Videos

2. Tai Chi for Seniors

3. Basic Tai Chi exercises

4. PT Viewpoint

5. Tai Chi and PT

6. YMCA Moving for Better Balance

**REFERENCES:**

1 . Weil R. Tai Chi. MedicineNet.com. Retrieved from https://www.medicinenet.com/tai\_chi/article.htm#introduction\_to\_tai\_chi.

2. Hefny A, Abbas A, Abu-Zidan F. Geriatric fall-related injuries. African Health Sciences. (2016);16:554-559.

3. Hu YN, Chung YJ, Yu HK, Chen YC, Tsai CT, Hu GC. Effect of Tai Chi Exercise on Fall Prevention in Older Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials. International Journal of Gerontology. (2016);10:131-136.

4. Hong Y, Li JX, Robinson PD. Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners. Br Journal of Sports Medicine. (2000);34:29-34.

5. Manor B, Lough M, Gagnon M, Cupples A, Wayne P, Lipsitz L. Functional benefits of Tai Chi training with senior housing facilities. Journal of American Geriatric Soc. (2014);62(8):1484-1489.

6. Lavretsky H, Altstein M, Olmstead R, Ercoli L, Riparetti-Brown M, Cyr N, Irwin M. Complementary Use of Tai Chi Chih Augments Escitalopram Treatment of Geriatric Depression: A Randomized Controlled Trial.  American Journal of Geriatric Psychiatry. (2011);19(10):839-850.

7. Wang F, Lee EK, Wu T, Benson H, Fricchione G, Wang W, Ywung A. The Effects of Tai Chi on Depression, Anxiety, and Psychological Well Being: A Systematic Review and Meta-Analysis. International Journal of Behavioral Medicine. (2014);21:605-617.

8. Google Images. Retrieved from https://www.google.com/search?q=tai+chi&source= lnms&tbm=isch&sa=X &ved=0ahUKEwjKv8bV-pvcAhWBY98KHQH6AcEQ\_ AUICigB&biw=1366&bih=662#imgrc=emd4hksK11efvM: