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Am Fam Physician. 2007;76(2):287-290

Background: Tai chi is a martial art that uses slow, rotational movement. Several trials have shown that it reduces fall risk in older persons. However, fall recovery typically requires the ability to take a rapid, long stride in the direction of the imminent fall. For this reason, it is possible that a training program emphasizing step length and speed could decrease fall risk even further. Nnodim and colleagues compared a Combined Balance and Stepping Training (CBST) program with tai chi to examine their relative effects on balance, stepping, and functional gait.

The Study: Participants 65 years or older who had mild balance impairment were recruited for the study. A total of 213 participants were randomized to a tai chi or CBST program; each program was made up of three one-hour sessions per week and lasted 10 weeks. Tai chi training focused on body alignment, weight shifts, and reciprocal arm movements. Components of the CBST program are listed in the accompanying table.

Bending
Changing speed
Functional lower extremity strengthening
Increasing complexity of ambulatory tasks
Moving from symmetrical to asymmetrical base of support
Narrowing the base of support
Stepping on and off curbs
Stepping over obstacles
Turning
Walking with reduced base of support

Outcome measures were timed performance on static balance measures and stepping measures. These included Maximum Step Length, Rapid Step Test, and a Timed Up and Go test (rising from a chair, walking 3 meters [about 10 feet], turning, and returning to the chair).

Results: Of the 213 participants enrolled, 162 (76 percent) completed the study, with 81 in each group. Early dropouts from the CBST group were older than the dropouts from the tai chi group. Mean number of sessions attended were 25.7 for CBST and 25.0 for tai chi (86 and 83 percent of sessions, respectively). There was a 9.4 percent greater improvement in up-and-go times, a 5.4 percent improvement in rapid step times, and a 9.8 percent greater improvement in maximum step length in the CBST group compared with the tai chi group. Statistical significance favoring CBST over tai chi was reached in the ability to perform tandem stance.

Conclusion: A 5 to 10 percent improvement in performance was found in CBST compared with tai chi training. One strength of the study was its direct comparison of two types of training. Although the CBST program did not involve the specfic tests used as outcome measures, it taught skills that were more relevant to the tests than the tai chi training was. The authors conclude that identified improvements may lead to fall risk reduction, but future research is still needed.

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