Tai Chi Reduces Falls Compared to Resistance Training in Patients with Parkinson Disease
DynaMed Weekly Update - Volume 7, Issue 10
Patients with Parkinson disease have a high risk of falling, maybe due to impaired movement and balance. While medication can improve some motor deficits including bradykinesia and rigidity, it may be less effective for improving postural instability. Furthermore, though exercise can improve strength and slow the loss of motor function, exercise programs have shown inconsistent efficacy for preventing falls (J Neurol Neurosurg Psychiatry 2007 Jul;78(7):678, Mov Disord 2010 Jul 15;25(9):1217). A recent randomized trial evaluated the effects of tai chi, a balance-based exercise emphasizing slow mind-focused movements, in 195 patients with Parkinson disease.
Patients (mean age 69 years) with mild to moderate Parkinson disease were randomized to tai chi vs. resistance training vs. stretching for 60-minute sessions twice weekly for 24 weeks. The tai chi group received training in 6 movements specifically designed to improve balance and gait, the resistance training group participated in exercise to strengthen muscles involved in balance, posture and gait, and the stretching group performed low intensity exercise in a group setting as an attention control condition.
At the end of treatment, the rate of falls was significantly lower in the tai chi group (62 total falls corresponding to a rate of 0.22 falls per patient-month) than in either the resistance training group (133 falls, 0.51 falls per patient month, p = 0.05 vs. tai chi), or the stretching group (186 falls, 0.62 falls per patient-month, p = 0.005 vs. tai chi) (level 1 [likely reliable] evidence). Tai chi was also associated with significantly greater improvement in balance compared to both groups and significantly greater improvement in gait, strength, and motor scores compared to stretching. There were no serious adverse events in any group (N Engl J Med 2012 Feb 9;366(6):511).