Randomised Controlled Trial Of The Effect Of Tai Chi On Postural Balance Of People With Dementia

Samuel R Nyman, Wendy Ingram, Jeanette Sanders, Peter W Thomas, Sarah Thomas, Michael Vassallo, James Raftery, Iram Bibi, Yolanda Barrado-Martín, Samuel R Nyman, Wendy Ingram, Jeanette Sanders, Peter W Thomas, Sarah Thomas, Michael Vassallo, James Raftery, Iram Bibi, Yolanda Barrado-Martín

Abstract

Purpose: To investigate the effect of Tai Chi exercise on postural balance among people with dementia (PWD) and the feasibility of a definitive trial on falls prevention.

Patients and methods: Dyads, comprising community-dwelling PWD and their informal carer (N=85), were randomised to usual care (n=43) or usual care plus weekly Tai Chi classes and home practice for 20 weeks (n=42). The primary outcome was the timed up and go test. All outcomes for PWD and their carers were assessed six months post-baseline, except for falls, which were collected prospectively over the six-month follow-up period.

Results: For PWD, there was no significant difference at follow-up on the timed up and go test (mean difference [MD] = 0.82, 95% confidence interval [CI] = -2.17, 3.81). At follow-up, PWD in the Tai Chi group had significantly higher quality of life (MD = 0.051, 95% CI = 0.002, 0.100, standardised effect size [ES] = 0.51) and a significantly lower rate of falls (rate ratio = 0.35, 95% CI =0.15, 0.81), which was no longer significant when an outlier was removed. Carers in the Tai Chi group at follow-up were significantly worse on the timed up and go test (MD = 1.83, 95% CI = 0.12, 3.53, ES = 0.61). The remaining secondary outcomes were not significant. No serious adverse events were related to participation in Tai Chi.

Conclusion: With refinement, this Tai Chi intervention has potential to reduce the incidence of falls and improve quality of life among community-dwelling PWD [Trial registration: NCT02864056].

Keywords: accidental falls; clinical trial; cognitive impairment; exercise; intervention.

Conflict of interest statement

Dr Samuel R Nyman, Dr Wendy Ingram, Dr Jeanette Sanders, Professor Peter W Thomas, Dr Sarah Thomas, Professor James Raftery, and Dr Yolanda Barrado-Martín report the above grant from the National Institute for Health Research (NIHR) for the conduct of the study. Ms Iram Bibi was funded by Bournemouth University. The authors report no other conflicts of interest in this work.

© 2019 Nyman et al.

Figures

Figure 1
Figure 1
Flow diagram of study participation. Note: See Supplementary Figure S1 for details.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6875562/bin/CIA-14-2017-g0001.jpg

References

    1. World Health Organization. WHO Global Report on Falls Prevention in Older Age. Geneva: World Health Organization; 2007.
    1. Taylor M, Delbaere K, Close J, Lord S. Managing falls in older people with cognitive impairment. Ageing Health. 2012;8(6):573–588. doi:10.2217/ahe.12.68
    1. Meuleners L, Hobday M. A population-based study examining injury in older adults with and without dementia. J Am Geriatr Soc. 2017;65(3):520–525. doi:10.1111/jgs.14523
    1. Dramé M, Fierobe F, Lang P, et al. Predictors of institution admission in the year following acute hospitalisation of elderly people. J Nutr Health Aging. 2011;15(5):399–403. doi:10.1007/s12603-011-0004-x
    1. Watkin L, Blanchard M, Tookman A, Sampson E. Prospective cohort study of adverse events in older people admitted to the acute general hospital: risk factors and the impact of dementia. Int J Geriatr Psychiatry. 2012;27(1):76–82. doi:10.1002/gps.2693
    1. El-Khoury F, Cassou B, Charles M-A, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347(f6234):Published online 29 October. doi:10.1136/bmj.f6234
    1. Sherrington C, Michaleff ZA, Fairhall N, et al. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med. 2017;57:1750–1758. doi:10.1136/bjsports-2016-096547
    1. Sherrington C, Fairhall N, Wallbank G, et al. Exercise for preventing falls in older people living in the community (Review). Cochrane Database Syst Rev. 2019;1:Art. No.: CD012424. doi: 012410.011002/14651858.CD14012424.pub14651852. doi:10.1002/14651858.CD012424.pub2
    1. Pitkälä KH, Pöysti MM, Laakkonen ML, et al. Effects of the Finnish Alzheimer Disease Exercise Trial (FINALEX): a randomized controlled trial. JAMA Intern Med. 2013;173(10):894–901. doi:10.1001/jamainternmed.2013.359
    1. Suttanon P, Hill K, Said C, et al. Feasibility, safety and preliminary evidence of the effectiveness of a home-based exercise programme for older people with Alzheimer’s disease: a pilot randomized controlled trial. Clin Rehabil. 2013;27(5):427–438. doi:10.1177/0269215512460877
    1. Wesson J, Clemson L, Brodaty H, et al. A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia. BMC Geriatr. 2013;13:e89. doi:10.1186/1471-2318-13-89
    1. Lee LY, Lee DT, Woo J. The psychosocial effect of Tai Chi on nursing home residents. J Clin Nurs. 2010;19(7–8):927–938. doi:10.1111/j.1365-2702.2009.02793.x
    1. Li J, Hong Y, Chan K. Tai chi: physiological characteristics and beneficial effects on health. Br J Sports Med. 2001;35(3):148–156. doi:10.1136/bjsm.35.3.148
    1. Tadros G, Ormerod S, Dobson-Smyth P, et al. The management of behavioural and psychological symptoms of dementia in residential homes: does Tai Chi have any role for people with dementia? Dementia. 2013;12(2):268–279. doi:10.1177/1471301211422769
    1. Solloway M, Taylor S, Shekelle P, et al. An evidence map of the effect of Tai Chi on health outcomes. Syst Rev. 2016;5(1):e126. doi:10.1186/s13643-016-0289-2
    1. Rogers C. Tai Chi to promote balance training. Annu Rev Gerontol Geriatr. 2016;36:229–249. doi:10.1891/0198-8794.36.229
    1. Lomas-Vega R, Obrero-Gaitán E, Molina-Ortega F, Del-Pino-Casado R. Tai Chi for risk of falls. A meta-analysis. J Am Geriatr Soc. 2017;65(9):2037–2043. doi:10.1111/jgs.15008
    1. Del-Pino-Casado R, Obrero-Gaitán E, Lomas-Vega R. The effect of Tai Chi on reducing the risk of falling: a systematic review and meta-analysis. Am J Chin Med. 2016;44(5):895–906. doi:10.1142/S0192415X1650049X
    1. Winser S, Tsang W, Krishnamurthy K, Kannan P. Does Tai Chi improve balance and reduce falls incidence in neurological disorders? A systematic review and meta-analysis. Clin Rehabil. 2018;32(9):1157–1168. doi:10.1177/0269215518773442
    1. Barrado-Martín Y, Heward M, Polman R, Nyman S. Acceptability of a dyadic Tai Chi intervention for older people living with dementia and their informal carers. J Aging Phys Act. 2019;27(2):166–183. doi:10.1123/japa.2017-0267
    1. Nyman S, Hayward C, Ingram W, et al. A randomised controlled trial comparing the effectiveness of Tai Chi alongside usual care with usual care alone on the postural balance of community-dwelling people with dementia: protocol for The TACIT Trial (TAi ChI for people with demenTia). BMC Geriatr. 2018;18:e263. doi:10.1186/s12877-018-0935-8
    1. Hsieh S, McGrory S, Leslie F, Dawson K, Ahmed S, Butler C. The mini-addenbrooke’s cognitive examination: a new assessment tool for dementia. Dement Geriatr Cogn Disord. 2015;39(1):1–11. doi:10.1159/000366040
    1. Yao L, Giordani B, Alexander NB. Developing a Positive Emotion-Motivated Tai Chi (PEM-TC) exercise program for older adults with dementia. Research Theory Nurs Pract. 2008;22(4):241–255. doi:10.1891/1541-6577.22.4.241
    1. Podsiadlo D, Richardson S. The timed up and go – a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–148. doi:10.1111/j.1532-5415.1991.tb01616.x
    1. Berg K, Wood-Dauphine S, Williams JI, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can. 1989;41(6):304–311. doi:10.3138/ptc.41.6.304
    1. Taylor M, Delbaere K, Lord S, Mikolaizak A, Brodaty H, Close J. Neuropsychological, physical, and functional mobility measures associated with falls in cognitively impaired older adults. J Gerontol. 2014;69(8):987–995. doi:10.1093/gerona/glt166
    1. Delbaere K, Smith ST, Lord SR. Development and initial validation of the iconographical falls efficacy scale. J Gerontol. 2011;66(6):674–680. doi:10.1093/gerona/glr019
    1. Coast J, Flynn T, Natarajan L, et al. Valuing the ICECAP capability index for older people. Soc Sci Med. 2008;67(5):874–882. doi:10.1016/j.socscimed.2008.05.015
    1. Lamb S, Jørstad-Stein E, Hauer K, Becker C. Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus. J Am Geriatr Soc. 2005;53(9):1618–1622. doi:10.1111/j.1532-5415.2005.53455.x
    1. Zieschang T, Schwenk M, Becker C, Oster P, Hauer K. Feasibility and accuracy of fall reports in persons with dementia: a prospective observational study. Int Psychogeriatr. 2012;24(4):587–598. doi:10.1017/S1041610211002122
    1. Schwenk M, Lauenroth A, Stock C, et al. Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: a systematic review. BMC Med Res Methodol. 2012;12:e50. doi:10.1186/1471-2288-12-50
    1. Bedard M, Molloy DW, Squire L, Dubois S, Lever JA, O’Donnell M. The Zarit burden interview: a new short version and screening version. Gerontologist. 2001;41(5):652–657. doi:10.1093/geront/41.5.652
    1. Ries J, Echternach J, Nof L, Gagnon Blodgett M. Test-retest reliability and minimal detectable change scores for the timed “up & go” test, the six minute walk test, and gait speed in people with Alzheimer disease. Phys Ther. 2009;89(6):569–579. doi:10.2522/ptj.20080258
    1. Blankevoort C, van Heuvelen M, Scherder E. Relibility of six physical performance tests in older people with dementia. Phys Ther. 2013;92(1):69–78. doi:10.2522/ptj.20110164
    1. Huang Y, Liu X. Improvement of balance control ability and flexibility in the elderly Tai Chi Chuan (TCC) practitioners: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2015;60(2):233–238. doi:10.1016/j.archger.2014.10.016
    1. Song R, Ahn S, So H, Lee E, Chung Y, Park M. Effects of t’ai chi on balance: a population-based meta-analysis. J Altern Complement Med. 2015;21(3):141–151. doi:10.1089/acm.2014.0056
    1. Schoene D, Wu SM, Mikolaizak AS, et al. Discriminative ability and predictive validity of the timed up and go test in identifying older people who fall: systematic review and meta-analysis. J Am Geriatr Soc. 2013;61(2):202–208. doi:10.1111/jgs.12106
    1. Donoghue D, Stokes EK. How much change is true change? The minimum detectable change of the berg balance scale in elderly people. J Rehabil Med. 2009;41(5):343–346. doi:10.2340/16501977-0337
    1. Li F, Harmer P, Fitzgerald K, et al. Effectiveness of a therapeutic Tai Ji Quan intervention vs a multimodal exercise intervention to prevent falls among older adults at high risk of falling: a randomized clinical trial. JAMA Intern Med. 2018. Published online September 10. doi:10.1001/jamainternmed.2018.3915
    1. Iliffe S, Kendrick D, Morris R, et al. Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care. Health Technol Assess (Rockv). 2014;18(49):1–105. doi:10.3310/hta18490
    1. van Andel S, Cole MH, Pepping GJ. Associations between gait-related falls and gait adaptations when stepping onto a curb: a prospective falls study. J Aging Phys Act. 2019;27(3):309–315. doi:10.1123/japa.2018-0124
    1. Mirelman A, Rochester L, Maidan I, et al. Addition of a non-immersive virtual reality component to treadmill training to reduce fall risk in older adults (V-TIME): a randomised controlled trial. Lancet. 2016;388(10050):1170–1182. doi:10.1016/S0140-6736(16)31325-3
    1. Beauchet O, Annweiler C, Dubost V, et al. Stops walking when talking: a predictor of falls in older adults? Eur J Neurol. 2009;16(7):786–795. doi:10.1111/j.1468-1331.2009.02612.x
    1. Ellmers TJ, Young WR. Conscious motor control impairs attentional processing efficiency during precision stepping. Gait Posture. 2018;63:58–62. doi:10.1016/j.gaitpost.2018.04.033
    1. Kumar A, Delbaere K, Zijlstra G, et al. Exercise for reducing fear of falling in older people living in the community: cochrane systematic review and meta-analysis. Age Ageing. 2016;45(3):345–352. doi:10.1093/ageing/afw036
    1. Wayne P, Walsh J, Taylor-Piliae R, et al. Effect of tai chi on cognitive performance in older adults: systematic review and meta-analysis. J Am Geriatr Soc. 2014;62(1):25–39. doi:10.1111/jgs.12611
    1. Wang F, Lee E, Wu T, et al. The effects of tai chi on depression, anxiety, and psychological well-being: a systematic review and meta-analysis. Int J Behav Med. 2014;21(4):605–617. doi:10.1007/s12529-013-9351-9
    1. Wayne P, Fuerst M. The Harvard Medical School Guide to Tai Chi: 12 Weeks to a Healthy Body, Strong Heart & Sharp Mind. Colorado: Shambhala; 2013.
    1. Wayne P, Berkowitz D, Litrownik D, Buring J, Yeh G. What do we really know about the safety of Tai Chi?: a systematic review of adverse event reports in randomized trials. Arch Phys Med Rehabil. 2014;95(12):2470–2483. doi:10.1016/j.apmr.2014.05.005
    1. Ramulu P, Mihailovic A, West S, Friedman D, Gitlin L. What is a falls risk factor? Factors associated with falls per time or per step in individuals with glaucoma. J Am Geriatr Soc. 2018. Published online 26 October. doi:10.1111/jgs.15609
    1. Vreugdenhil A, Cannell J, Davies A, Razay G. A community-based exercise programme to improve functional ability in people with Alzheimer’s disease: a randomized controlled trial. Scand J Caring Sci. 2012;26(1):12–19. doi:10.1111/j.1471-6712.2011.00895.x
    1. Leung P, Orgeta V, Orrell M. The effects on carer well-being of carer involvement in cognition-based interventions for people with dementia: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2017;32(4):372–385. doi:10.1002/gps.4654
    1. Woods R, Bruce E, Edwards R, et al. REMCARE: reminiscence groups for people with dementia and their family caregivers – effectiveness and cost-effectiveness pragmatic multicentre randomised trial. Health Technol Assess (Rockv). 2012;16(48):1–116. doi:10.3310/hta16480
    1. McPhate L, Simek EM, Haines TP. Program-related factors are associated with adherence to group exercise interventions for the prevention of falls: a systematic review. J Physiother. 2013;59(2):81–92.
    1. Nyman S, Victor C. Older people’s participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review. Age Ageing. 2012;41(1):16–23.
    1. Simek EM, McPhate L, Haines TP. Adherence to and efficacy of home exercise programs to prevent falls: a systematic review and meta-analysis of the impact of exercise program characteristics. Prev Med. 2012;55(4):262–275. doi:10.1016/j.ypmed.2012.07.007
    1. Ginis KA, Heisz J, Spence JC, et al. Formulation of evidence-based messages to promote the use of physical activity to prevent and manage Alzheimer’s disease. BMC Public Health. 2017;17(1):e209. doi:10.1186/s12889-017-4090-5
    1. Nyman S, Szymczynska P. Meaningful activities for improving the wellbeing of people with dementia: beyond mere pleasure to meeting fundamental psychological needs. Perspect Public Health. 2016;136(2):99–107. doi:10.1177/1757913915626193

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa