TAI CHI and DYNAMIC BALANCE

Balance is a vital health concern and the effects of falls and fractures are devastating:

▪    Every year 30% of people over the age of 65 will sustain a fall. Half are repeat fallers. This equals 13.4 million falls a year with 2.5 million emergency room visits, an increase of almost 50% in one decade.

▪    55-70% of these result in physical injury, about half of them serious­–hip fractures, traumatic brain injury, or other head trauma–that reduce mobility and independence and increase the likelihood of premature death. 90% of hip fractures are associated with a fall. In 2012, more than 24,000 people over the age of 65 died as a result of a fall, over double the amount just a decade earlier and the leading cause of death in that age group. Men are 34% more likely to die from a fall than women but hip fracture rates in women is triple that of men.

▪    67% of fall fatalities are among people aged 75 years or older.

▪    People over the age of 85 are 10-15 times more likely to experience a hip fracture than are people aged 60-65 years. Half of those who suffer a hip facture never return home or live independently. 80% are no longer able to walk a block. Only 25% ever fully recover; the same number who will die within the first year due to complications.

▪    Over 60% of nursing home residents will fall each year.

▪    Half of all accidental deaths in the home are caused by a fall. Most fall injuries in the home happen at ground level, from slipping, tripping, or stumbling, not from an elevation.

▪    In 2010, the cost attributed to falls in the USA was $30 billion.

▪    73 million Americans are “baby boomers,” born between 1946 and 1964. By 2040, there will be 77 million over 65 years of age. This means that 25 million are likely to fall and incur 8 million injuries, with 25,000 fall-related deaths each year.

Balance problems and fear of falling can also result in prolonged inactivity, even further reducing one’s ability to deal with a balance disorder and, in turn, contribute to other problems, including loss of bone and muscle mass, heart disease, and obesity. The emotional pain of social isolation and the loss of formerly enjoyed activities can be no less profound.

The good news is that most balance problems are fixable and falls preventable, beginning with modifications of the living environment. Most importantly, exercise and specific training of balance and/or strength, that focuses on postural orientation (positioning the trunk and head in alignment to each other as well as to the ground and to the visual field) and postural equilibrium (coordinating movement strategies to center and stabilize the body) help recalibrate the complex interaction of sensory and motor functions. Based on systematic reviews of varying approaches, Tai Chi is one of the better exercise choices for this purpose. Several randomized clinical trials have found a 45% reduction in the number of falls with 4-6 months of Tai Chi training. The four body systems effecting balance are: musculoskeletal, sensory, neuromuscular, and cognitive. Tai Chi addresses all of these simultaneously and, because of its gentleness, is accessible for people of all ages and levels of fitness. Here’s how Tai Chi affects these four systems:

Musculoskeletal: Tai Chi is weight bearing and the constant shifting from one leg to another increases leg strength. The time spent on each leg during this weight shifting is much greater than during walking. Tai Chi also improves torso and limb range of motion and flexibility, core strength, and vertical alignment to gravity, all essential for a stable, grounded, and less top-heavy posture.

Sensory: The slow, continuous tempo of Tai Chi coupled with the emphasis on moving the body as a unit enhances awareness of the speed, trajectory, and force of executing movements as well as the external environment. In one long-term study, Tai Chi improved joint proprioception (awareness of position in space) of the knees and ankles better than swimming or running. The Tai Chi group was also more sensitive to small movements in their joints, suggesting quicker, more accurate feedback for balance and posture. Those in the Tai Chi group could lean further in any direction before losing their balance.

Decreased sensation in the feet due to peripheral neuropathy from diabetes and other conditions obviously impacts balance. A six-month program of Tai Chi with such subjects at Louisiana State University resulted in increased sensitivity in the soles of the feet, improved balance and a faster walking speed. Another 12-week study reported increased nerve conduction velocity in the peripheral nerves to the feet in a group of diabetics practicing Tai Chi. The hands and fingers, not just the feet, become more sensitive with Tai Chi practice. A comparison study of fingertip sensitivity in older subjects showed an increase in the Tai Chi group equivalent to blind people who read Braille.

A Harvard study of vestibular (inner ear) balance problems compared 10 weeks of Tai Chi versus traditional rehabilitation exercises. Both groups improved their dynamic balance control but, overall, Tai Chi was more effective. While the non-Tai Chi group did better with improved “eye gaze stability,” other studies show Tai Chi practitioners are better equipped to maintain balance if the vestibular, visual, or proprioceptive inputs are purposely reduced or made confusing; equivalent, in fact, to healthy, young subjects during these experimental challenges. Since most falls occur in a difficult or challenging situation, this finding is extremely noteworthy.

Neuromuscular: We move in patternsof action, not by isolated muscular contraction. Muscles, joints, ligaments, etc. must work in coordination with each other to accomplish even the simplest of movements. The slow, purposeful movements of Tai Chi and the sequencing and timing of different muscle groups under close attention by the practitioner is ideal training of neuromuscular patterns and greatly improves balance. Several studies involving induced slips during walking have shown Tai Chi effective in improving muscular coordination, ankle reactive time, gait initiation, and lower extremity synergies, all resulting in a faster, more stable gait.

Even Parkinson’s disease, a neuromuscular disorder, responds to Tai Chi training. A study in the New England Journal of Medicine, showed improvements in balance and movement control in people with mild-to-moderate Parkinson’s after just six months of twice weekly training. In fact, their balance improvement was four times that of the stretching group and twice the conventional muscle-strengthening group.

Cognitive: Fear of falling is one of the biggest predictors of falling. Those with a history of falls or impaired balance walk in a tentative, rigid, guarded and top-heavy manner because they are more fearful and “in their heads” because of that anxiety. They are less aware of their connection to the earth. The “grounding” training central to Tai Chi increases one’s connection to the earth, creating a more stable feeling when weight-bearing. This “rooted,” relaxed, sinking feeling is called “sung” (pronounced soong) in Chinese and being “sung” increases connectedness to the earth and balance confidence. One study found that Tai Chi training significantly reduced the fear of falling, even compared with computerized balance training, reducing the fall rate by half.

Tai Chi’s emphasis on integrated, continuous, and simultaneous movements of the arms, legs and waist, controlled directional changes, memorization of sequences, coupled with a heightened awareness of breathing, posture, and inner sensations of weight shifts all contribute to its efficacy in improving dynamic balance. But it has also been shown to improve bone density, obviously an important factor in fall outcomes. Studies have found that high-intensity resistance and strength training is not an absolute necessity to increase bone health. Low-impact exercises like Tai Chi may reduce bone loss as well, especially in women with osteopenia or osteoporosis, a group less likely to do other, more demanding, high-impact exercises. Several studies have compared people who had been doing Tai Chi for at least seven years to the same age individuals in the same community who had not. The Tai Chi groups have greater bone density of the spine and hips, and the rate of decline in bone density at increasing age is slower. These improvements in bone density were also seen in other studies after only 6-9 months of Tai Chi practice.

Conclusion: Tai Chi is an effective and accessible method for the improvement of dynamic balance and reduction of the incidence and disabling consequences of falls and their financial impact on the sufferer and the healthcare system as a whole.

References for all the statistics and studies noted above and further information can be found at the following:

The Importance of Fall Prevention, Especially Among the Elderly by William Dizon

Falls Among Older Adults: An Overview by The Centers forDisease Control and Prevention

Broken Hips: Preventing A Fall Can Save Your Life by Lauren Silverman, NPR

Improving Balance with Tai Chi by Gaye Cronin, OTD, OTR

The Harvard Medical School Guide to Tai Chi by Peter Wayne, PhD

Translation of an Effective Tai Chi Intervention Into a Community-Based Falls-Prevention Program

Steps to Avoid an Accident by Katie Hafner (NY Times)

Bracing for the Falls of an Aging Nation by Katie Hafner (NY Times)

Tai Ji Quan: Moving for Better Balance

Transforming traditional Tai Ji Quan techniques into integrative movement therapy

fall preventioninc.com

Preventing Falls: What Works

Tai Chi and fall reductions in older adults: a randomized controlled trial