The ancient Chinese martial art of tai chi may improve balance in people with Parkinson’s disease (PD), according to research published February 9, 2012, in The New England Journal of Medicine. In comparison with other forms of exercise, tai chi improved other activities of daily living and reduced the number of falls in people with Parkinson’s.
In tai chi, participants perform a series of postures that flow from one to the next in a slow, graceful manner. Many of these controlled movements challenge a person’s balance and stability. People with Parkinson’s often suffer from impaired balance, limiting their daily activities and increasing their risk of falling.
Researchers led by Fuzhong Li, Ph.D., at the Oregon Research Institute in Eugene, Oregon, questioned whether tai chi could improve postural stability — the ability to maintain balance while standing — in people with Parkinson’s. They recruited 195 people with mild-to-moderate Parkinson’s and randomly assigned them to one of three exercise groups: tai chi, resistance training, or stretching. Each group attended a 60-minute exercise class that met twice weekly for 24 weeks.
The tai chi group performed six movements that challenge balance and gait, such as weight shifting, ankle sways, and front-to-back or side-to-side stepping. The resistance-training group wore weighted vests and ankle weights to perform exercises that strengthen muscles important for posture, balance, and gait. These exercises included forward and side steps, squats, lunges, and heel and toe raises. Finally, the stretching group performed various seated and standing stretches of the upper body and lower extremities. After completion of the 24-week exercise programs, researchers assessed study participants’ improvement from baseline in tests of a) postural stability and b) other characteristics such as gait, strength, and number of falls.
- The tai chi group outperformed the resistance-training and stretching groups in two key indicators of postural stability: maximum excursion (how far a participant could lean in each of eight directions without falling) and directional control (how efficiently they could move toward a target).
- The tai chi group performed better than the stretching group in other activities, such as gait, strength, and a timed up-and-go test (how fast a person could rise from a chair, walk 10 feet, return, and sit down).
- Although similar to the resistance-training group in many measures, the tai chi group performed better than this group in stride length and functional reach (how far a person could reach forward beyond arm’s length while standing at a fixed position).
- Participants in the tai chi group had fewer falls than those in the stretching group. They also had a lower incidence of falls than people in the resistance-training group, but the difference was not statistically significant.
- Three months after the exercise programs ended, people in the tai chi group maintained the benefits of the exercise and had fewer falls than people in the stretching and resistance-training groups.
What Does It Mean?
This study demonstrates that tai chi is more effective than stretching or resistance-training programs in improving postural stability and activities of daily living in people with mild-to-moderate Parkinson’s. These benefits may be long-lasting, since people in the tai chi group still showed improved balance and reduced falls three months after they completed the exercise program.
The researchers suggest that tai chi improves postural stability by increasing a person’s ability to sway at the ankle or hip to correct imbalances, or by improving their movement control as they approach their limit of stability. These improvements likely enhance a person’s ability to perform activities of daily living, such as reaching for objects in a cabinet or rising from a seated to a standing position, and reduce their chance of falling.
Although this research provides compelling evidence that tai chi can improve balance in people with PD, like most studies, it does have some limitations. For example, the participants were aware of their exercise group assignment, so their perceptions of that form of exercise may have influenced the outcome. Also, the researchers did not include a nonexercise control group, so they could not assess the net gain of tai chi training (i.e., they may have underestimated the benefit one can gain from tai chi because the control groups practiced other forms of exercise).
Although tai chi is considered a generally safe form of exercise, and none of the study participants experienced any severe injuries or other adverse effects, you should check with your doctor before beginning this or any exercise program. You may require special supervision from a tai chi instructor familiar with the postural and balance challenges of Parkinson’s. For reference, a full list of the actual interventions used in this study are included below.
Dr. Christopher Goetz, Chair of the Parkinson’s Disease Foundation (PDF) Medical Policy Committee and member of PDF’s Scientific Advisory Board commented on this story, saying, "This report, specifically focused on balance, is encouraging, because it directs clinicians and people with Parkinson’s to advocate Tai Chi for those individuals with balance deficits. That said, trainers must be vigilant to the postural and balance challenges that people with Parkinson's disease endure, so that the exercises and maneuvers that are part of the program must be carefully individualized to the patient."
References: Li, F., Harmer, P., Fitzgerald, K., Eckstrom, E., Stock, R., Galver, J., Maddalozzo, G., et al. (2012). Tai chi and postural stability in patients with Parkinson's disease. The New England journal of medicine, 366(6), 511–519. doi:10.1056/NEJMoa1107911
The protocol will ensure that each exercise group has a consistent intervention schedule on key training parameters involving duration (60 minutes per session), frequency (2 times per week), and training structure (i.e., a 5-to 10-minute warm-up, core activities, and a 5-minute cool-down). Participants in all three conditions will be instructed not to engage in any additional home practice.
Tai Chi. The protocol consists of six Tai Chi forms,2 integrated into an 8-form routine (a well-established program from our prior work1,7) in the late stages of the study. The names of six forms are as follows:
- Form One: Wave Hands like Clouds (Stepping sideways: left and right);
- Form Two: Part the Wild Horse’s Mane (Stepping diagonally forward: left and right);
- Form Three: Hold a Ball (Stepping diagonally forward: left and right);
- Form Four: Repulse Monkey (Stepping diagonally backward: left and right);
- Form Five: Fair Lady Works at Shuttles (Stepping diagonally forward: left and right);
- Form Six: Grasp the Peacock’s Tail (Stepping diagonally forward: left and right).
After 3-4 months of training, the protocol will proceed to the integration of the 8-form routine with the names listed below:
- Form One: Hold a Ball (Stepping sideways: left and right);
- Form Two: Part the Wild Horse’s Mane (Stepping diagonally forward: left and right);
- Form Three: Single Whip (Stepping sideways: left and right);
- Form Four: Wave Hands like Clouds (Stepping sideways: left and right);
- Form Five: Repulse Monkey (Stepping diagonally backward: left and right);
- Form Six: Brush Knees (Stepping diagonally forward: left and right).
- Form Seven: Fair Lady Works at Shuttles (Stepping diagonally forward, left and right)
- Form Eight: Grasp the Peacock’s Tail (Stepping diagonally forward, left and right)
Because the goal of the protocol is to assist patients in retraining balance and postural stability, the protocol is specifically designed to challenge balance control and train gait patterns. Exercising forms and movements will be integrated therapeutically by performing symmetrical and coordinated movements such as trunk rotation and weight shifting from foot to foot, controlled and coordinated displacement of the body’s center of mass over the base of support, ankle sway toward and around the perimeter of the base of support, dynamic eye and head movements, and anterior-posterior and medial-lateral stepping with rhythmical weight shifting. The early stage of the program (i.e., the first 10 weeks) will emphasize primarily learning and practicing single forms with multiple repetitions, whereas the later stage will focus on performing individual forms to strengthen postural balance and increase locomotion. Natural breathing will also be emphasized as part of the exercise and integrated into the Tai Chi movement routine. Instruction will cover learning new forms and reviewing and practicing forms learned in previous sessions.
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