Available online at www.sciencedirect.com
Journal of Sport and Health Science 1 (2012) 57e60
www.jshs.org.cn
Original article
The effect of Tai Chi intervention on balance in older males
Ding-Hai Yu a,*, Hui-Xin Yang b
b
a
Wushu Department, Shanghai University of Sport, Shanghai 200438, China
Department of Traditional Sports, Harbin Institute of Physical Education, Harbin 150008, China
Received 9 December 2011; revised 25 January 2012; accepted 26 March 2012
Abstract
Purpose: The purpose of the present study was to examine the effects of a 24-week Tai Chi exercise intervention on balance and other physical
changes such as flexibility and reaction time (RT) among healthy older males.
Methods: Thirty-eight male subjects aged 55e65 years without prior Tai Chi experience were recruited from a local community in Shanghai,
China. A 60-min Tai Chi exercise session was performed three times a week for 24 weeks. Changes in RT, sit-and-reach flexibility and balance
(static balance with eyes open and closed respectively) were measured before and after the Tai Chi intervention.
Results: After the 24-week Tai Chi intervention, the choice RT ( p < 0.05) decreased, and sit-and-reach flexibility improved ( p < 0.01) over the
pre-test (7.8 6.2 vs. 7.1 3.0 cm). Sway length, area, X-axis deviation amplitude and Y-axis deviation amplitude performance decreased
significantly after the intervention with a double-foot stance with eyes open ( p < 0.05). Sway length, area and average sway speed showed
a statistically significant decrease after the intervention with the double-foot stance with eyes closed. In the single-foot stance with eyes open
condition, sway length and average sway speed showed a statistically significant decrease ( p < 0.05).
Conclusion: The 24-week Tai Chi exercise intervention had a positive influence on balance control in older males.
Copyright Ó 2012, Shanghai University of Sport. Production and hosting by Elsevier B.V. All rights reserved.
Keywords: Balance; Exercise intervention; Older males; Tai Chi
1. Introduction
Falls are defined as an individual “inadvertently coming to
rest on the ground, floor or other lower level, excluding
intentional change in position to rest in furniture, wall or other
objects”.1 The direct consequences of falls include devastating
injuries and fractures that may lead to decreased mobility,
functional decline, depressive symptoms, decreased social
activity, and a decline in the quality of life.2 Decreases in
balance function are intrinsic factors that can cause falls.3
* Corresponding author.
E-mail address: [email protected] (D.-H. Yu)
Peer review under responsibility of Shanghai University of Sport
Production and hosting by Elsevier
Many factors contribute to poor balance, including reduced
strength, flexibility, and sensorimotor coordination as well
as delayed information processing. Oakley et al.4 collected
information confirming that physical exercise reduces the risk
of falls and may be a significant element in a more extensive
program of preventive activities. One method of fall prevention consists of increasing muscular strength and improving
body balance.5 Tai Chi, a Chinese martial art, has been used
for centuries as a fitness exercise and is particularly popular
among the elderly. It offers substantial potential benefits by
reducing the incidence of falls among the elderly population.6
A number of cross-sectional and longitudinal studies have
shown that Tai Chi practitioners exhibit better balance control
than matched older adults from the general population.7,8 In
2001, Wong et al.9 compared the postural stability of older Tai
Chi practitioners whose experience ranged from 2 to 35 years
with that of healthy non-practitioners of similar ages. They
found that elderly Tai Chi practitioners had better postural
2095-2546/$ - see front matter Copyright Ó 2012, Shanghai University of Sport. Production and hosting by Elsevier B.V. All rights reserved.
doi:10.1016/j.jshs.2012.03.001
58
stability than non-practitioners when faced with disturbed
somatosensory and visual input. Li et al.10 found that the Tai
Chi group performed significantly better than the non-practitioner group on all functional balance measures. Both groups
exhibited deterioration in functional balance measures during
post-intervention follow-up. However, the Tai Chi group
showed a significantly slower decrease. The results of more
recent studies suggest that Tai Chi training may improve
strength and flexibility,11,12 balance,13 blood pressure,14 and
cardiorespiratory function15 in older adults. These findings
support the benefits of Tai Chi as an exercise form for elderly
men and women. Studies have focused on balance tests, in
spite of other physical changes, such as impairments to reaction time (RT) and flexibility due to aging, may affect
balance.16,17
The purpose of this study was to assess the effect of
a 24-week Tai Chi training program on RT, sit-and-reach
flexibility and static balance among older males. We hypothesised that the 24-week Tai Chi intervention, conducted three
times a week for 60 min per session, was sufficient to produce
positive changes in balance, RT and flexibility.
2. Methods
2.1. Subjects and study design
Thirty-eight sedentary male subjects aged 55e65 years
(mean age, 59.7 5.6 years; height, 171.2 4.5 cm; weight,
68.3 5.9 kg) were recruited through an advertisement at the
Yang Pu Culture Community Center in Shanghai, China. None
of the subjects had previous Tai Chi experience. All of the
subjects were asked to avoid changing their lifestyles except for
their participation in the Tai Chi intervention. The exclusion
criteria included the presence of severe cognitive impairments,
symptomatic cardiovascular diseases at moderate exertion
levels, poorly controlled hypertension or symptomatic orthostatic hypotension, other neurological disorders, peripheral
neuropathy of the lower extremities, crippling arthritis, and
metastatic cancers. The procedures were fully explained, and
written informed consents were obtained from all of the subjects.
All of the subjects participated in a 24-week exercise class
that was held three times a week (Monday, Wednesday, and
Friday) in the morning. Each exercise session lasted 60 min
and was led by a certified Tai Chi instructor. The session
included 10 min of warm-up exercise (including stretching and
balancing exercises), 40 min of Tai Chi practice, and 10 min of
cool-down exercises. The simplified 24-form and 42-form Tai
Chi movements were used in this study. During the sessions,
the instructor constantly monitored the subjects and corrected
their body positions, joint angles and form-to-form transitions.
2.2. Outcome measures
Three physical variables were measured at the beginning and
the end of the Tai Chi intervention. These variables included (1)
RT, (2) sit-and-reach flexibility, which have been identified as
important factors associated with the increased risk of falls,12
D.-H. Yu and H.-X. Yang
and (3) static balance. Every subject was fully informed about
the nature and procedure of the test prior to the experiment.
2.2.1. Reaction time
Finger choice RT test: the visual choice RT apparatus was
used to measure the four-choice RT of finger response.
Subjects were asked to respond to a light stimulus by pressing
a corresponding key as quickly as possible. Using each finger
three times, subjects completed a total of 12 test trials, which
were conducted in a predetermined random order. Choice RT
was recorded after each of the trials, and the best score for
each subject was used for the data analysis.
2.2.2. Sit-and-reach flexibility
Sit-and-reach flexibility was measured using a sit-and-reach
apparatus. All of the participants were asked to sit on the floor
with their legs stretched out forward and their shoes removed.
Both knees were locked and pressed flat to the floor (the tester
assisted by holding them down). With the palms facing
downward, the subjects reached forward along the measuring
line as far as possible and held that position for one or two
seconds while the distance was recorded in centimetres. The
subjects were tested twice, and the better results were used.
2.2.3. Static balance
The instrument used in this study was the Balance System,
a computerised-force platform system (Medicapteurs, Balma,
French) to assess balance. The Balance System measures
the fluctuation of weight displacement. The sway index in
centimetres was used in all of the analyses. We achieved static
balance conditions by asking the participants to stand on the
force platform on their right feet (with their eyes open and
closed) and on both feet (with their eyes open and closed). The
following posturographic parameters were considered: (1)
sway length (SL); (2) area (A); (3) unit area sway length
(SL/A); (4) average sway speed (SS); (5) X-axis deviation
amplitude (X-DA); (6) Y-axis deviation amplitude (Y-DA). SL
represented the sum total of the movement route length of the
centre of gravity. A was the surface area covered by the
movement route of the centre of gravity and reflected the
degree of the balance disorders. SL/A reflected the proprioception of postural control. SS was the movement speed of the
centre of gravity, which reflected balance stability. X-DA and
Y-DA amplitude represented horizontal and vertical of the
centre of gravity, respectively.18
2.3. Statistical analysis
For each outcome employed, descriptive statistics (such as
mean SD values) were calculated for the subjects for both
pre- and post-test measures. One-way repeated measures
analysis of variance (ANOVA) was conducted to examine the
overall effect of the Tai Chi intervention. When F values were
statistically significant, paired t tests were employed to
determine the effects of the intervention at a specific outcome
measure, and a post hoc test was used to identify the effects of
Tai Chi exercise. Statistical significance was set at p < 0.05.
The effect of Tai Chi intervention on balance
59
3. Results
4. Discussion
Table 1 presents the means SD of the outcome measures
pre- and post-intervention. After the intervention, the choice
RT was statistically significantly improved ( p ¼ 0.027), indicating that the subjects experienced better brain function.19
The data obtained from the sit-and-reach test indicate that
long-term regular Tai Chi practitioners had better flexibility
( p < 0.01) than they experienced in their former sedentary
lifestyles (7.8 6.3 vs. 7.1 3.0 cm).
The data analysis in Tables 2 and 3 summarises the static
balance performance for four conditions: the single-foot stance
with eyes open and closed; the double-foot stance with eyes
open and closed. The results indicated that SL, A, X-DA and
Y-DA performance decreased significantly after the 24-week
Tai Chi intervention for the double-foot stance with eyes open.
SL, A and SS showed a significant decrease after the intervention for the double-foot stance with eyes closed. In the
single-foot stance with eyes open, SL and SS were statistically
decrease, however, they did not decrease in the single-foot
stance with eyes closed.
Balance is a required component in the execution of
postural control. The capacity to maintain balance decreases
with age which results in an increased risk of falls and fractures among the elderly.20 This study shows that Tai Chi
offers potential benefits to the elderly in terms of balance and
other physical functions. Improvements were evident in
flexibility, RT, and the index of static balance in different
conditions. Our results are consistent with the results of
a previous randomised trial of the effect of Tai Chi on
balance21 as well as the findings of another study that showed
the benefits of Tai Chi with respect to physical functions and
quality of life.22 Previous studies found that Tai Chi
had beneficial effects on balance in older adults through
comparisons of experienced Tai Chi practitioners with nonpractitioners in a test involving single-foot standing with eyes
open. However, there was no significant difference between
Tai Chi practitioners and sedentary subjects in single-foot
standing with eyes closed.23 The present study identified an
improvement in balance after a 24-week Tai Chi exercise
intervention for single-foot standing with eyes open. With
eyes open in both double-foot stance and single-foot, SL
decreased significantly after the intervention (Tables 2 and 3).
This decrease also occurred for A, X-DA, and Y-DA in the
double-foot stance, and SS in the single-foot stance. This
finding suggests that maintaining of balance with occluded
vision is not a normal life experience.
The maintenance and development of levels of flexibility
closely related to balance are important components of
a general health enhancement program during the aging
Table 1
Comparison of measures of flexibility and reaction time (RT) before and after
the 24-week Tai Chi intervention (mean SD).
Flexibility (cm)
RT (s)
Before
After
p value
7.1 3.0
0.7 0.2
7.8 6.2
0.6 0.3
0.008
0.027
Table 2
Comparison of measures in the double-foot stance before and after the 24-week Tai Chi intervention (mean SD).
Eyes open
SL (mm)
A (mm2)
SL/A (mm)
SS (mm/s)
X-DA (mm)
Y-DA (mm)
Eyes closed
Before
After
p value
Before
After
p value
292.4 77.8
252.0 104.0
1.3 0.3
8.9 2.3
4.6 1.5
5.3 1.7
261.3 92.3
205.5 108.0
1.5 0.5
8.0 2.8
3.9 1.3
4.4 1.5
0.050
0.050
0.081
0.060
0.031
0.024
391.0 177.3
321.2 219.0
1.4 0.5
12.0 5.4
4.6 1.9
6.1 3.0
349.8 141.3
250.2 128.3
1.6 0.5
10.6 4.3
4.1 1.5
5.1 1.9
0.048
0.047
0.136
0.045
0.218
0.072
Abbreviations: SL ¼ sway length; A ¼ area; SL/A ¼ unit area sway length; SS ¼ average sway speed; X-DA ¼ X-axis deviation amplitude; Y-DA ¼ Y-axis
deviation amplitude.
Table 3
Comparison of measures in the single-foot stance before and after the 24-week Tai Chi intervention (mean SD).
Eyes open
SL (mm)
A (mm2)
SL/A (mm)
SS (mm/s)
X-DA (mm)
Y-DA (mm)
Eyes closed
Before
After
p value
Before
After
p value
488.4 166.2
282.3 134.4
1.9 0.6
44.9 15.5
7.4 2.0
6.9 3.3
421.7 111.6
250.0 132.7
1.9 0.5
38.7 10.6
6.8 2.5
6.6 3.4
0.015
0.337
0.696
0.017
0.149
0.685
637.2 186.3
476.4 250.1
1.5 0.5
57.9 17.3
10.7 3.3
12.2 6.7
632.5 234.9
489.0 250.4
1.5 0.5
57.5 21.6
10.7 3.6
11.3 5.5
0.920
0.809
0.626
0.921
0.972
0.532
Abbreviations: SL ¼ sway length; A ¼ area; SL/A ¼ unit area sway length; SS ¼ average sway speed; X-DA ¼ X-axis deviation amplitude; Y-DA ¼ Y-axis
deviation amplitude.
60
process.12 This study shows that practitioners of Tai Chi for 24
weeks possessed better trunk and hamstring flexibility than they
experienced during their previous sedentary lifestyles. This
finding is confirmed by the findings of Lan et al.,24 who reported
significantly superior performance among older Tai Chi practitioners with more than 10 years of experience than their
sedentary counterparts with respect to hip joint flexibility, as
measured by their stand and reach test scores. The RT of the
subjects decreased significantly after the 24-week Tai Chi
exercise intervention. These findings suggest that Tai Chi
exercise may positively influence balance abilities among older
males during the course of 24 weeks of training. Furthermore,
flexibility and RT are important factors in maintaining balance.
One possible explanation for this finding is that Tai Chi
is a mind-body practice that combines meditation with
slow, gentle, graceful movements. It is considered a complex,
multicomponent intervention that integrates physical, psychosocial, emotional, spiritual, and behavioural elements25 and
features constant swinging, shifting, and turning in all directions, including left, right, forward, and backward. This activity
requires a high degree of concentration and coordination
between mind and body and among the different body parts.
The motor system, the nervous system and the proprioceptive
systems are all mobilised during Tai Chi exercise.
Given the large number of comparisons, some statistically
significant differences in this study may have occurred by
chance. Another limitation of this study is the lack of a control
group, which may affect the interpretation of the results.
Nevertheless, previous short-term (i.e., 4e15 weeks) Tai Chi
intervention studies found positive results in the Tai Chi group in
comparison with a sedentary group.26,27 Therefore, the outcome
pre-test is used as the baseline, and further studies are needed to
understand the mechanisms of the effect of Tai Chi on balance.
5. Conclusion
Our preliminary findings indicate that Tai Chi may be
a positive method for improving balance and other physical
functions, such as RT and flexibility, among the older males.
Longer-term studies involving additional factors related to
balance are needed to improve our understanding of the biological mechanisms by which Tai Chi affects balance.
Acknowledgments
This study was supported by the Major Program of
Shanghai Science Technical Committee, Shanghai (No.
08490512800) and Shanghai Key Disciplinary Areas III of
China (No. S30803).
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