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Am Fam Physician. 2004;70(2):376-378

Studies have demonstrated that general exercise programs and balance-oriented exercises reduce the risk of falling in older adults by 10 percent and 17 percent, respectively. Endurance, resistance, and flexibility training have not shown a significant effect on the risk of falling in the robust elderly. Tai chi, or tai chi chuan, consists of slow, rhythmic movements that emphasize trunk rotation, weight shifting, coordination, and a gradual narrowing of lower extremity stance. Wolf and colleagues compared an intense tai chi exercise program with a wellness education program on fall occurrences in an elderly population who met the criteria for transitional frailty.

Participants 70 years or older residing in one of 20 congregate living facilities were randomized to a tai chi group or wellness education group. Wellness education consisted of instructions about fall prevention, exercise and balance, diet and nutrition, and related behavioral and mental health issues.

Fall events were the primary outcome measure for this prospective, single-blind, randomized study, as measured by self-report. Functional measurements were performed at four-month intervals, as were assessments of fear of falling, quality of life, depression, and cognitive impairment.

The trial lasted 48 weeks and included 311 persons, of which 24 withdrew immediately after randomization for a variety of reasons. The relative risk for falls with tai chi compared with wellness education was 0.75, a rate that was not statistically significant given the power of the study. Almost one half of the participants did not fall at all during the study period. In persons with previous fractures caused by falling, the rate of falling in the tai chi group was slightly higher than it was in the wellness education group, but this difference did not reach statistical significance. Those without previous fall fractures had a significantly lower rate of falling in the tai chi group than in the wellness education group. The tai chi group had a significantly lower risk of falling in a post hoc analysis limited to months 5 through 12 of the study period.

The authors conclude that 48 weeks of tai chi results in no statistically significant reduction in falls compared with wellness education. Given the post hoc analysis, it is thought that tai chi does not begin to show a significant reduction in the risk of falling until after a number of months of regular participation. Fewer falls were observed in a subset of patients doing tai chi who had no history of fall fracture.

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