Tai Chi Intervention for Balance Function in Older Adults: Predictive and Modifying Roles of Circadian Age

Effects of Tai Chi on Balance Function in Community-Dwelling Older Adults: A Randomized Controlled Trial Examining the Predictive and Modifying Roles of Circadian Age, With Multi-Omics and Brain Function Assessments

This study investigates the effects of a 12-week Tai Chi intervention on balance function in community-dwelling older adults. Participants are randomly assigned to either a Tai Chi exercise group or a health education control group. The primary outcome is balance function measured by the Berg Balance Scale. Secondary outcomes include physical function, psychological well-being, cognitive function, and sleep quality. The study also explores the predictive and modifying roles of baseline circadian age on intervention outcomes.

Study Overview

• Status: Not yet recruiting
• Conditions: Aging; Accidental Falls; Postural Balance
• Intervention / Treatment: Behavioral: Tai Chi Exercise; Behavioral: Health Education

Detailed Description

BACKGROUND AND RATIONALE Falls are a leading cause of injury and disability in older adults, and balance dysfunction is a key modifiable risk factor. Tai Chi, a traditional Chinese mind-body exercise, has been shown to improve balance, reduce fall risk, and benefit cognitive health in older populations. However, individual variability in response to Tai Chi remains poorly understood, and the biological mechanisms underlying its benefits are incompletely characterized.

Circadian rhythm disruption has emerged as a hallmark of biological aging. The investigators have developed and validated a circadian age (CircAge) assessment system based on the UK Biobank cohort (N>90,000), which independently predicts mortality risk. Whether individuals with accelerated circadian aging benefit more from Tai Chi intervention is unknown. This trial addresses this gap by integrating circadian age assessment with multi-modal outcome evaluations.

OBJECTIVES The primary objective is to evaluate the effect of a 12-week Tai Chi intervention on balance function in community-dwelling older adults. Secondary objectives are to assess effects on physical function, psychological health, cognitive function, and sleep quality. Exploratory objectives are to examine the predictive and modifying roles of baseline circadian age acceleration on intervention outcomes.

STUDY DESIGN This is a two-arm parallel, single-blind (assessor-blinded) randomized controlled trial. Ninety community-dwelling older adults are randomly allocated 1:1 to a Tai Chi group or a health education control group. Randomization is computer-generated using variable block sizes, stratified by sex and baseline Berg Balance Scale score (≤45 vs >45). Allocation concealment is maintained via sequentially numbered opaque sealed envelopes. Outcome assessors are blinded to group allocation. After the 12-week intervention, the control group is offered free Tai Chi classes to ensure ethical equipoise.

ASSESSMENT SCHEDULE Wrist-worn accelerometer (ActiGraph) recordings are collected at baseline over 7 consecutive days for circadian age computation. All baseline accelerometer recordings are completed prior to randomization. Full outcome assessments are conducted at baseline (week 0) and at the end of intervention (week 12). A streamlined midpoint assessment (week 6) includes only the Berg Balance Scale and Timed Up and Go test. Fasting blood samples for routine clinical chemistry are collected at week 0 and week 12.

STATISTICAL ANALYSIS A sample size of 90 (45 per group) provides >80% power to detect a standardized effect size of d=0.50 in Berg Balance Scale change at week 12, assuming α=0.05 (two-sided) and 20% attrition. The primary analysis follows the intention-to-treat principle using linear mixed-effects models adjusted for baseline score, age, sex, and circadian age acceleration, with class as a random effect for the Tai Chi group. Exploratory analyses include circadian age × group interaction terms.

LONG-TERM FOLLOW-UP After the 12-week intervention, participants are invited to enter a long-term health database with periodic follow-ups tracking balance function, fall events, and overall health status.

• Study Type: Interventional
• Enrollment (Estimated): 90
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Zhide Liang, MS; Phone Number: 0853-65597656; Email: p2516238@mpu.edu.mo

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Aged 55 years or older
• Community-dwelling
• Able to walk independently (assistive devices such as canes are permitted)
• Berg Balance Scale (BBS) score ≤52 at screening
• Able to understand and follow verbal instructions
• Willing to wear a wrist accelerometer continuously for 7 days at baseline
• Willing to accept random group assignment
• Willing to undergo blood collection during the study
• Provides written informed consent

Exclusion Criteria:

• Regular Tai Chi or yoga practice (more than once per week) within the past 6 months
• Severe cognitive impairment (Montreal Cognitive Assessment [MoCA] score <20 at screening, or previously diagnosed dementia)
• Unstable cardiovascular disease (myocardial infarction, stroke, or hospitalization within the past 3 months)
• Severe musculoskeletal disease that limits exercise participation
• Neurological diseases affecting balance (e.g., Parkinson's disease, severe peripheral neuropathy)
• Currently participating in another exercise intervention study
• Planned surgery or extended absence during the study period
• Contraindications to functional near-infrared spectroscopy (fNIRS) examination (e.g., scalp injury, metallic implants in the head region)
• Severe psychiatric illness (e.g., schizophrenia, bipolar disorder)
• Considered unable to safely participate in moderate-intensity physical activity as judged by the study physician or attending healthcare provider

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Tai Chi Group; Participants in this group receive instruction in Yang-style 24-form Tai Chi from a nationally certified master coach. Tai Chi classes are offered five days per week, and participants are required to attend at least three sessions per week. Each session lasts 60 minutes, including warm-up, Tai Chi practice, cool-down, and Q&A. The intervention duration is 12 weeks. Class size is limited to 10-15 participants to ensure individualized guidance.	Behavioral: Tai Chi Exercise; Yang-style 24-form Tai Chi taught by a nationally certified master coach. Classes are offered five days per week, with participants required to attend at least three sessions per week, for a total of 12 weeks (target: ≥36 sessions). Each 60-minute session includes a 10-minute warm-up, 35 minutes of Tai Chi practice, 10 minutes of cool-down (including standing meditation and breathing exercises), and 5 minutes for questions and home practice reminders. Class size is limited to 10-15 participants.
Active Comparator: Health Education Control Group; Participants in this group attend health education seminars led by professional medical and health management staff. Seminar topics include nutrition, chronic disease management, fall prevention, and safe medication use. The intervention duration is 12 weeks. After the intervention ends, this group is offered free Tai Chi classes to ensure ethical equipoise.	Behavioral: Health Education; Structured health education program delivered by professional medical and health management staff. Seminars cover topics including nutrition and dietary guidance, chronic disease management (hypertension, diabetes), fall prevention strategies, safe medication use, and general health literacy for older adults. The intervention runs for 12 weeks. Participants receive the same health screening, evaluation, and feedback benefits as the Tai Chi group. Free Tai Chi classes are offered to this group after the intervention period ends.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Berg Balance Scale (BBS) Score	The Berg Balance Scale (BBS) is a 14-item performance-based measure of static and dynamic balance. Each item is scored 0-4 based on the participant's ability to perform tasks such as sitting to standing, transfers, standing unsupported with eyes closed, turning, and single-leg stance. Total scores range from 0 to 56, with higher scores indicating better balance function. Lower scores are associated with increased fall risk.	Change from baseline to end of intervention, up to 12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Single-Leg Eye-Closed Standing Time	Static balance is assessed by measuring the time (in seconds) participants can maintain single-leg standing with eyes closed. Both legs are tested. Longer times indicate better static balance and proprioception.	Change from baseline to end of intervention, up to 12 weeks
Change in Vertical Jump Height	Vertical jump test measures lower-extremity power and neuromuscular function. Participants perform three consecutive jumps, and the maximum jump height (in centimeters) is recorded.	Change from baseline to end of intervention, up to 12 weeks
Change in Reaction Time	Reaction time test measures central nervous system processing speed using a portable reaction time device. Faster reaction times are associated with lower fall risk and better cognitive processing.	Change from baseline to end of intervention, up to 12 weeks
Change in Activities-Specific Balance Confidence (ABC) Scale	The ABC Scale is a 16-item self-report measure of balance confidence during specific activities (e.g., walking, reaching, climbing stairs). Each item is rated 0-100%, with higher scores indicating greater balance confidence.	Change from baseline to end of intervention, up to 12 weeks
Change in Geriatric Depression Scale (GDS-15) Score	The 15-item Geriatric Depression Scale (GDS-15) screens for depressive symptoms in older adults. Total scores range from 0 to 15, with scores ≥5 suggesting depression.	Change from baseline to end of intervention, up to 12 weeks
Change in Generalized Anxiety Disorder Scale (GAD-7) Score	The 7-item Generalized Anxiety Disorder Scale (GAD-7) measures anxiety severity. Total scores range from 0 to 21, with scores ≥10 indicating moderate-to-severe anxiety.	Change from baseline to end of intervention, up to 12 weeks
Change in Montreal Cognitive Assessment (MoCA) Score	The Montreal Cognitive Assessment (MoCA) is a 30-point cognitive screening tool covering visuospatial/executive function, naming, memory, attention, language, abstraction, delayed recall, and orientation. Scores ≥26 are considered normal cognitive function.	Change from baseline to end of intervention, up to 12 weeks
Change in Pittsburgh Sleep Quality Index (PSQI) Score	The Pittsburgh Sleep Quality Index (PSQI) is a 19-item self-report questionnaire assessing sleep quality over the past month. Total scores range from 0 to 21, with scores >5 indicating poor sleep quality.	Change from baseline to end of intervention, up to 12 weeks
Change in Timed Up and Go (TUG) Test	Functional mobility and dynamic balance test. Participants stand from an armed chair, walk 3 meters, turn, walk back, and sit down. Time to complete the task is recorded in seconds. Longer times indicate poorer mobility and higher fall risk.	Change from baseline to end of intervention, up to 12 weeks
Change in Grip Strength	Maximum grip strength measured using a handheld dynamometer, in kilograms. Three trials per hand; maximum value recorded. Higher values indicate greater muscle strength. Time Frame: Change from baseline to 12 weeks	Change from baseline to end of intervention, up to 12 weeks
Change in Balance Performance Measured by InBody Balance Trainer	Static balance assessed via center-of-pressure trajectory recorded by the InBody Balance Trainer during quiet standing, reported in millimeters. Shorter path length indicates better postural control.	Change from baseline to end of intervention, up to 12 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in Blood Metabolomic and Proteomic Profiles	Targeted and untargeted metabolomics analysis of serum and plasma samples; proteomics analysis (Olink/SomaScan platform) including inflammatory markers (IL-6, TNF-α, hs-CRP), aging-related proteins (GDF-15), and neurotrophic factors (BDNF).	Change from baseline to end of intervention, up to 12 weeks
Baseline Circadian Age Acceleration (AgeAccel_z)	Circadian age acceleration is derived from 7-day wrist-worn accelerometer (ActiGraph) data processed using the GGIR R package. AgeAccel_z is the standardized residual of circadian age regressed on chronological age, reported in standard deviation units (z-score). Positive values indicate accelerated circadian aging relative to chronological age.	Baseline
Changes in Serum Metabolomic Profiles	Targeted and untargeted metabolomics analysis of serum samples. Differential metabolites between groups are identified using fold change (|FC|>1.2) and false discovery rate (FDR<0.1). Results are reported as the number of significantly altered metabolites and enriched metabolic pathways.	Change from baseline to 12 weeks
Changes in Serum Proteomic Profiles	Proteomic analysis using Olink or SomaScan platform measuring inflammation-related proteins (IL-6, TNF-α, hs-CRP, IL-1β), aging-related proteins (GDF-15, IGFBP-3), and neurotrophic factors (BDNF, NGF). Differential proteins between groups are identified using fold change (|FC|>1.5) and false discovery rate (FDR<0.1). Results are reported as the number of significantly altered proteins.	Change from baseline to 12 weeks

Collaborators and Investigators

• Sponsor: Zhide Liang
• Collaborators: Macao Polytechnic University
• Investigators: Study Director: Baichao Xu, PhD, Hainan Medical College; Study Director: Ziheng Ning, PhD, Macao Polytechnic University

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): March 1, 2027
• Study Completion (Estimated): March 1, 2027

Study Registration Dates

• First Submitted: April 28, 2026
• First Submitted That Met QC Criteria: April 28, 2026
• First Posted (Actual): May 5, 2026

Study Record Updates

• Last Update Posted (Actual): May 28, 2026
• Last Update Submitted That Met QC Criteria: May 26, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Older Adults; Tai Chi; Circadian Rhythm; Fall Prevention; Tai Ji Quan; Mind-Body Exercise
• Additional Relevant MeSH Terms: Therapeutics; Physical Therapy Modalities; Rehabilitation; Hydrotherapy; Aquatic Therapy
• Other Study ID Numbers: HainanMC-TaiChi-2026-001

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No