The effects of a Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults living in long-term care facilities: a single group design with multiple time points

BACKGROUND: Studies support the positive effects that Tai Chi has on the physical health of older adults. However, many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred. OBJECTIVE: To test the effects of a newly-developed, Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults who resided in long-term care facilities. DESIGN: A single group design with multiple time points: three pre-tests, one month apart; four post-tests at one month, two months, three months, and six months after intervention started. SETTINGS: Two 300-400 bed veteran homes in Taiwan. PARTICIPANTS: The 51 male older adults were recruited through convenience sampling, and 41 of them completed six-month study. Inclusion criteria included: (1) aged 65 and over; (2) no previous training in Tai Chi; (3) cognitively alert and had a score of at least eight on the Short Portable Mental Status Questionnaire; (4) able to walk without assistance; and (5) had a Barthel Index score of 61 or higher. Participants who had dementia, were wheel-chair bound, or had severe or acute cardiovascular, musculoskeletal, or pulmonary illnesses were excluded. METHODS: The STEP was implemented three times a week, 50 min per session for six months. The outcome measures included cardio-respiratory function, blood pressure, balance, hand-grip strength, lower body flexibility, and physical health actualization. RESULTS: A drop in systolic blood pressure (p=.017) and diastolic blood pressure (p<.001) was detected six months after intervention started. Increase in hand-grip strength from pre to post intervention was found (left hand: p<.001; right hand: p=.035). Participants also had better lower body flexibility after practicing STEP (p=.038). CONCLUSIONS: Findings suggest that the STEP be incorporated as a floor activity in long-term care facilities to promote physical health of older adults.     

Tai Chi and Health-Related Quality of Life in Nursing Home Residents

Purpose: Health-related quality of life (HRQOL) that is good is regarded as the goal of elderly residential care. However, limited evidence exists indicating a promising intervention that can achieve this goal. The aim of this study is to examine the effect of Tai Chi on HRQOL in nursing home residents.
Design: A nonequivalent pretest-posttest control-group design.
Methods: A convenience sample of 139 residents from six nursing homes in Hong Kong was used. The experimental group ( n =66) joined a 26-week Tai Chi program, while the control group ( n =73) continued with usual daily activities. The physical and mental components of HRQOL were designated as the dependent variables. Resident satisfaction was considered as a covariate. Doubly multivariate repeated measures analysis of covariance was done to examine the intervention effect.
Findings: After adjusting for the confounding effect of resident satisfaction, a statistically significant difference ( p <0.05) in the physical and mental components of HRQOL between the experimental and control groups was found. Findings showed significant improvement in HRQOL after residents practiced Tai Chi.
Conclusions: These investigators contribute additional knowledge about the health benefits of Tai Chi among nursing home residents and indicates support for its use in this population to improve HRQOL.
Clinical Relevance: Tai Chi has unique characteristics as a health exercise that is particularly suitable for nursing home residents. The inclusion of Tai Chi exercise in elderly residential care practice is recommended.     

Development of the simplified Tai Chi exercise program (STEP) for frail older adults

OBJECTIVE: To develop a simplified Tai Chi exercise program for frail older adults. DESIGN: For phase I, using a focus group, 40 frail Taiwanese older adults were interviewed to explore their viewpoints on Tai Chi and have been reported elsewhere. This paper emphasized on the phase II of the study in which the older adults' perspectives were validated by 10 experts using an evaluation survey. SETTING: Long-term care facilities. RESULTS: The newly developed simplified Tai Chi exercise program (STEP) included three stages-(1) warm-up: comprised nine exercises specifically designed to loosen up the body from head to toe; (2) Tai Chi movements: encompassed 12 easy-to-learn and easy-to-perform movements; (3) cool-down: included three activities to cease the chi and rest the body. CONCLUSIONS: The STEP should be further evaluated for its effectiveness in enhancing the relative well being and quality of life of frail older adults and its applicability as a floor activity in long-term care facilities.     

太极拳（剑）锻炼与中老年人心理健康的关系

目的研究太极拳（剑）锻炼与中老年人心理健康的关系。方法 120名受试者被分为锻炼组和对照组各60例。锻炼组即太极拳（剑）组,对照组为不参加任何形式的身体锻炼活动者,或虽参加锻炼活动但平均每周不足1次者。结果①积极锻炼者的心理健康指标明显优于不积极锻炼者。②太极拳（剑）锻炼对于中老年人数字广度的保持具有更积极的意义,表现为见效快,负荷小,非常适合老年人。③身体锻炼对延缓心理衰老的积极作用,可能在于其对参与者注意和意识状态的有效调整。结论身体锻炼对延缓心理衰老有积极作用。     

Well-being of institutionalized elders after Yang-style Tai Chi practice

Aims and objectives. The purpose of this study was to examine the effects of Tai Chi on the physical and psychological well‐being of elders who resided in long‐term care facilities. Background. The beneficial effects of Tai Chi on elders’ well‐being have been well‐documented; however, most of the studies focused on community‐dwelling or healthier elders. Design and methods. In this longitudinal, time‐series, quasi‐experimental study, a convenience sample of 28 institutionalized elders was recruited. A six‐month Yang‐style Tai Chi intervention was administered twice a week for 60 minutes per practice. The well‐being outcome variables, including physical and mental health status, blood pressure, quality of sleep, occurrence of falls and fear of falling, were measured before the intervention and then at one‐month, two‐month, three‐month and six‐month intervals. Results. Results indicated that the physical health status and social functioning of frail elders were significantly improved after Tai Chi practice [F(4,24) = 3·42, p = 0·038; F(4,24) = 9·66, p = 0·001 respectively]. Conclusions. Tai Chi practice is beneficial for frail older people. Relevance to clinical practice. The findings provide a basis for using Yang‐style Tai Chi as a floor activity in long‐term care facilities to promote the well‐being of the older residents.     

Seated Tai Chi versus usual activities in older people using wheelchairs: A randomized controlled trial

ObjectiveCompare the effect of seated Tai Chi exercise (intervention) to usual activities on quality of life and depression symptoms in older people using wheelchairs.DesignRandomized controlled trial.SettingOne long-term care facility in Taiwan.Participants86 long-term care residents were screened; 60 were eligible and randomized to Tai Chi group (n = 30), or usual activity (n = 30).InterventionOne certified trainer provided the intervention group with 40 min of seated Tai Chi exercise, three times a week for 26 weeks. Trial registration ACTRN12613000029796.Main outcome measuresQuality of Life (WHOQOL (BREF)); depression symptoms (GDS-SF)ResultsParticipants in the Tai Chi group (M = 3.76, SD = 3.65) recorded significantly lower GDS-SF scores than participants in the control (M = 7.76, SD = 5.15) and the Tai Chi group registered significantly higher scores across overall QOL [p = 0.03], general health [p = 0.04], and the associated domains: physical health [p = 0.00], psychological health [p = 0.02], social relations [p = 0.00], and environment [p = 0.00].ConclusionsThe findings highlight the importance of Tai Chi in improving QOL and depression in this population.     

Change in perceived psychosocial status following a 12-week Tai Chi exercise programme

AIM: This paper reports a study to examine change in psychosocial status following a 12-week Tai Chi exercise intervention among ethnic Chinese people with cardiovascular disease risk factors living in the United States of America. BACKGROUND: Regular participation in physical activity is associated with protection against cardioavascular disease, and improvements in physical and psychological health. Increasing amounts of scientific evidence suggests that mind-body exercise, such as Tai Chi, are related to improvements in mental health, emotional well-being, and stress reduction. No prior study has examined the effect of a Tai Chi exercise intervention on psychosocial status among people with cardiovascular disease risk factors. METHODS: This was a quasi-experimental study. Participants attended a 60-minute Tai Chi exercise class three times per week for 12 weeks. Data were collected at baseline, 6 and 12 weeks following the intervention. Psychosocial status was assessed using Chinese versions of Cohen's Perceived Stress Scale, Profile of Mood States, Multidimensional Scale of Perceived Social Support, and Tai Chi exercise self-efficacy. RESULTS: A total of 39 participants, on average 66-year-old (+/-8.3), married (85%), Cantonese-speaking (97%), immigrants participated. The majority were women (69%), with < or =12 years education (87%). Statistically significant improvements in all measures of psychosocial status were found (P < or = 0.05) following the intervention. Improvement in mood state (eta2 = 0.12), and reduction in perceived stress (eta2 = 0.13) were found. In addition, Tai Chi exercise statistically significantly increased self-efficacy to overcome barriers to Tai Chi (eta2 = 0.19), confidence to perform Tai Chi (eta2 = 0.27), and perceived social support (eta2 = 0.12). CONCLUSIONS: Tai Chi was a culturally appropriate mind-body exercise for these older adults, with statistically significant psychosocial benefits observed over 12-weeks. Further research examining Tai Chi exercise using a randomized clinical trial design with an attention-control group may reduce potential confounding effects, while exploring potential mechanisms underlying the relaxation response associated with mind-body exercise. In addition, future studies with people with other chronic illnesses in all ethnic groups are recommended to determine if similar benefits can be achieved.     

A randomized controlled trial of tai chi for tension headaches

This study examined whether a traditional low-impact mind–bodyexercise, Tai Chi, affects health-related quality-of-life (HRQOL)and headache impact in an adult population suffering from tension-typeheadaches. Forty-seven participants were randomly assigned toeither a 15 week intervention program of Tai Chi instructionor a wait-list control group. HRQOL (SF-36v2) and headache status(HIT-6^TM) were obtained at baseline and at 5, 10 and 15 weekspost-baseline during the intervention period. Statisticallysignificant (P < 0.05) improvements in favor of the interventionwere present for the HIT score and the SF-36 pain, energy/fatigue,social functioning, emotional well-being and mental health summaryscores. A 15 week intervention of Tai Chi practice was effectivein reducing headache impact and also effective in improvingperceptions of some aspects of physical and mental health.     

长期护理保险制度下构建失能老人多平台综合延续护理模式

目的在长期护理保险制度下构建失能老人多平台综合延续护理模式,并探究该模式对失能老人自理能力和心理健康水平的影响。方法选取该院出院的失能老人168例,建立延续性护理技术服务档案数据库。根据信封法随机分为对照组(87例)和干预组(81例)。对照组仅接受常规出院健康知识宣教,干预组在此基础上增加基于多平台协作的综合延续护理。比较失能老人的自理能力和心理水平。结果干预组干预后各时间点的自理能力得分和心理评分均有明显提高,且得分均高于同期对照组,差异有统计学意义(均P<0.05)。结论长期护理保险制度下构建的失能老人多平台综合延续护理模式能够改善失能老人的自理能力和心理健康水平。     

Examining Peplau's pattern integrations in long-term care.

Contrary to the societal view that only the frail elderly reside in long-term care facilities, many young adults who require residential care to maintain optimal health, or who are in a rehabilitation program, also live in these facilities. The relationships between residents and caregivers in long-term care facilities may develop into relationships that are more typically familial than professional. With these emerging family-like relationships, the interpersonal pattern interactions may be healthy or unhealthy and may create opportunities for growth or pathology-producing patterns. This article illustrates how applying Peplau's concept of need-pattern integrations in the long-term care setting has the potential to enhance understanding, and subsequently guide interactions, between younger residents and caregivers. The potential is greatest when interactions are guided.     

The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study: Design and rationale of a cluster randomized controlled trial of Tai Chi in senior housing

Supporting the health of growing numbers of frail older adults living in subsidized housing requires interventions that can combat frailty, improve residents' functional abilities, and reduce their health care costs. Tai Chi is an increasingly popular multimodal mind–body exercise that incorporates physical, cognitive, social, and meditative components in the same activity and offers a promising intervention for ameliorating many of the conditions that lead to poor health and excessive health care utilization. The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study is an ongoing two-arm cluster randomized, attention-controlled trial designed to examine the impact of Tai Chi on functional indicators of health and health care utilization. We are enrolling participants from 16 urban subsidized housing facilities (n = 320 participants), conducting the Tai Chi intervention or education classes and social calls (attention control) in consenting subjects within the facilities for one year, and assessing these subjects at baseline, 6 months, and 1 year. Physical function (quantified by the Short Physical Performance Battery), and health care utilization (emergency visits, hospitalizations, skilled nursing and nursing home admissions), assessed at 12 months are co-primary outcomes. Our discussion highlights our strategy to balance pragmatic and explanatory features into the study design, describes efforts to enhance site recruitment and participant adherence, and summarizes our broader goal of post study dissemination if effectiveness and cost-effectiveness are demonstrated, by preparing training and protocol manuals for use in housing facilities across the U.S.     

Family involvement with communication-impaired residents in long-term care settings.

This article describes the outcomes of a study involving family members of communication-impaired long-term care residents in a collaborative nursing/speech language pathology intervention designed to increase the residents' communication ability. Family members provided memorabilia and artifacts or produced audio or video tapes, for use in conjunction with a speech therapy enhancement program (STEP). Findings revealed that, despite a minimal improvement in speech ability, there was a dramatic increase in family members' satisfaction.     

Effects of Sun-style Tai Chi exercise on physical fitness and fall prevention in fall-prone older adults

AIM: This paper reports a study to determine changes in the physical fitness (knee and ankle muscle strength, balance, flexibility, and mobility), fall avoidance efficacy, and fall episodes of institutionalized older adults after participating in a 12-week Sun-style Tai Chi exercise programme. BACKGROUND: Fall prevention has a high priority in health promotion for older people because a fall is associated with serious morbidity in this population. Regular exercise is effective in fall prevention for older adults because of improvements in strength and balance. Tai Chi exercise is considered to offer great potential for health promotion and rehabilitation, particularly in the maintenance of good mental and physical condition in older people. METHODS: A quasi-experimental design with a non-equivalent control group was used. Data were collected from September 2001 to January 2002. A total of 68 fall-prone older adults with a mean age of 77.8 years participated in the study, and 29 people in the Tai Chi group and 30 controls completed the post-test measures. The Tai Chi exercise programme was provided three times a week for 12 weeks in the experimental group. Data were analysed for group differences using t-tests. RESULTS: At post-test, the experimental group showed significantly improved muscle strength in knee and ankle flexors (P < 0.001) and extensors (P < 0.01), and improved flexibility (P < 0.01) and mobility (P < 0.001) compared with the control group. There was no significant group difference in fall episodes, but the relative risk ratio for the Tai Chi exercise group compared with the control group was 0.62. The experimental group reported significantly more confidence in fall avoidance than did the control group. CONCLUSION: The findings reveal that Tai Chi exercise programmes can safely improve physical strength and reduce fall risk for fall-prone older adults in residential care facilities.     

Tai Chi improves standing balance control under reduced or conflicting sensory conditions

OBJECTIVE: To investigate the effects of long-term Tai Chi practice on balance control when healthy elderly Tai Chi practitioners stood under reduced or conflicting somatosensory, visual, and vestibular conditions, as compared with healthy elderly non-Tai Chi practitioners and young subjects. DESIGN: Cross-sectional study. SETTING: University-based rehabilitation center in Hong Kong. PARTICIPANTS: Twenty elderly Tai Chi practitioners (mean experience +/- standard deviation, 7.2+/-7.2 y) were compared with 20 elderly non-Tai Chi practitioners and 20 young, healthy university students. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The amplitude of anteroposterior body sway under different somatosensory, visual, and vestibular conditions was measured using computerized dynamic posturography, whereby subjects underwent 6 combinations of visual and support surface conditions. RESULTS: The Tai Chi practitioners had significantly better balance control than the non-Tai Chi subjects in the visual and vestibular ratios, but not in the somatosensory ratio. Furthermore, there were no significant differences in any of these 3 sensory ratios when the Tai Chi practitioners were compared with those of the young, healthy subjects. CONCLUSIONS: Long-term Tai Chi practice improved balance control in the elderly population when there was an increased reliance on the visual and vestibular systems during stance. Of particular interest is that our elderly Tai Chi practitioners attained the same level of balance control performance as did young, healthy subjects when standing under reduced or conflicting somatosensory, visual, and vestibular conditions.     

The use of touch to enhance nursing care of older person in long-term mental health care facilities

The self-care deficits experienced by older clients in long-term mental health settings, because of cognitive impairment, are likely to impact upon the clients' higher-order needs. The practice of nursing the elderly involves a lot of personal contact, during the delivery of fundamental physical care. While physiological and safety needs are crucial to clients in long-term settings, higher-order needs need also to be addressed. From the clients' perspective nurse's use of touch provides comfort, warmth and security, although there is a dearth of empirical evidence of these benefits. This paper explores the nurse's use of touch, the impact of touch and the experiences of touch on the older person in long-term settings. Because of the dearth of research in the use of touch with elderly clients in long-term care mental health facilities, a review of the literature was performed on the topic. This revealed that touch by nurses is frequently associated with routine tasks within nursing, and is less likely to be a caring touch intervention. Recommendations include further research on the topic and caution with widespread adoption of caring touch as an intervention.     

Outcomes of wheelchair systems intervention with residents of long-term care facilities

This pilot study was designed to measure the effects of individually prescribed wheelchair systems on posture and reach, mobility, quality of life, and satisfaction with technology for residents of long-term care facilities. Thirty persons 60 years of age or older who resided permanently in a long-term care facility and who used seating and mobility systems for 6 hours or more each day were recruited for this project. Outcomes included timed independent mobility, forward and lateral reach, quality of life, and satisfaction with assistive technology. The study used semicrossover design with participants measured three times. Measurements were first made in the existing seating and mobility system and a second time immediately after participants were provided with individually prescribed seating and mobility systems. The final measurement was 3 months after the delivery of the individually prescribed system. Results indicated that individually fitted wheelchair systems for elderly residents of long-term care facilities are beneficial. Participants had less difficulty independently propelling their systems and increased forward reach, quality of life for social function and physical role, and satisfaction with the new wheelchair technology. Persons residing in extended care facilities benefit from receiving individually prescribed wheelchair systems. The individual systems enhance elderly persons' independent mobility, functional reach, feeling of well-being, and satisfaction with their assistive technology.     

Tai chi improves cognitive and physical function in the elderly: a randomized controlled trial

[Purpose] To investigate the effect of Tai Chi on cognitive and physical function in the elderly. [Subjects and Methods] A randomized trial design was used. A total 150 subjects were enrolled and were divided into Tai Chi and control groups. Subjects in the Tai Chi group participated Tai Chi for 6 months, and subjects in the control group participated in other non-athletic activities. [Results] There were no differences between the groups in the one leg standing time with eyes open, left grip strength, or the Frontal Assessment Battery at bedside after 3 and 6 months of intervention. The Mini-Mental State Examination scores after 3 and 6 months were higher in the Tai Chi group than in the control group. The right grip strength after 3 months increased more in the Tai Chi group than in the control group. Both the 5-m high walking speed and 10-m normal walking speed were significantly lower after 3 and 6 months of Tai Chi practice. [Conclusion] These results suggest that regular Tai Chi practice may improve cognitive and physical function in the elderly.Key words: Tai Chi, Mobility, Cognition     

太极拳在冠心病心脏康复中的研究进展

太极拳秉承了中国古代哲学阴阳辨证及道教“太极”理念,又暗合中医阴阳五行及经络学说思想,长期锻炼有益于人的身心健康。近年来关于太极拳在冠心病心脏康复中的一系列研究表明,太极拳运动不仅减轻冠心病患者临床症状,提高生活质量,并且有效干预冠心病危险因素如高血压、高血脂、高血糖,改善不良情绪,延缓动脉粥样硬化,修复血管内皮功能,调控心脏自主神经,降低心血管事件的再发率,改善冠心病患者的远期预后。     

Quality of life and successful aging in long-term care: perceptions of residents

This study explores factors related to quality of life and successful aging in long-term care from the perspective of residents. Thirty-two residents from a long-term care facility rated factors related to quality of life and responded to open-ended items on quality of life and successful aging. Although experiencing health problems and disability, residents were optimistic about their health and quality of life. Factors identified as important to their quality of life included: interaction with family and friends, personal qualities, "room and board" items, and aspects of well-being. Notably, two factors--enjoying nature and being helpful to others--have not been widely reported in the literature but were identified here. Future research might explore other factors not traditionally associated with quality of life in long-term care.