Effects of a 12-Week Tai Chi Chuan Program Versus a Balance Training Program on Postural Control and Walking Ability in Older People

Lelard T, Doutrellot P-L, David P, Ahmaidi S. Effects of a 12-week Tai Chi Chuan program versus a balance training program on postural control and walking ability in older people.

Objective

To compare the respective effects of 2 balance training programs: a Tai Chi (TC) program and a balance training program on static postural control and walking ability.

Design

Randomized controlled trial.

Setting

General community.

Participants

Older subjects (N=28) participated in the study.

Interventions

The TC group (n=14; mean age ± SD, 76.8±5.1y) and the balance training group (n=14; 77.0±4.5y) were both trained for 12 weeks.

Main Outcome Measures

Static postural control was assessed via measurement of center of pressure sway under eyes open (EO) and eyes closed (EC) conditions. Walking speed over a 10-meter course was also assessed.

Results

After the 12-week training period, there were no significant differences in walking speed or postural parameters in either the EO or EC conditions for the TC and balance training groups. Performance in the EC condition was lower than in the EO condition in pretest and posttest for the balance training and TC groups. The Romberg quotient (EO/EC ratio) was significantly higher after the balance training program than the TC program (P<.05).

Conclusions

We cannot conclude that the balance training program has better effects than the TC program on postural control or walking ability. None of the outcome measures showed significant change posttraining in either the TC or the balance training groups. However, the differences described in the Romberg quotient after the training period between the TC and the balance training groups suggest that TC should be helpful to limit the deleterious effects of eye closure on postural balance.     

Effect of a 12-Week Yoga Intervention on Fear of Falling and Balance in Older Adults: A Pilot Study

Schmid AA, Van Puymbroeck M, Koceja DM. Effect of a 12-week yoga intervention on fear of falling and balance in older adults: a pilot study.

Objective

To determine whether fear of falling (FoF) and balance improved after a 12-week yoga intervention among older adults.

Design

A 12-week yoga intervention single-armed pilot study.

Setting

A retirement community in a medium-sized university town in the Midwest.

Participants

A convenience sample of adults (N=14) over the age of 65 years who all endorsed an FoF.

Intervention

Each participant took part in a biweekly 12-week yoga intervention. The yoga sessions included both physical postures and breathing exercises. Postures were completed in sitting and standing positions.

Main Outcome Measures

We measured FoF with the Illinois FoF Measure and balance with the Berg Balance Scale. Upper- and lower-body flexibility were measured with the back scratch test and chair sit and reach test, respectively.

Results

FoF decreased by 6%, static balance increased by 4% (P=.045), and lower-body flexibility increased by 34%.

Conclusions

The results indicate that yoga may be a promising intervention to manage FoF and improve balance, thereby reducing fall risk for older adults. Rehabilitation therapists may wish to explore yoga as a modality for balance and falls programming; however, future research is needed to confirm the use of yoga in such programming.     

Feasibility and Outcomes of a Home-Based Exercise Program on Improving Balance and Gait Stability in Women With Lower-Limb Osteoarthritis or Rheumatoid Arthritis: A Pilot Study

Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study.

Objective

To evaluate the feasibility and gait stability and balance outcomes of a 4-month individualized home exercise program for women with arthritis.

Design

Pre-post interventional study.

Setting

General community.

Participants

Women (N=49) (volunteers) with lower-limb osteoarthritis or lower-limb rheumatoid arthritis were enrolled. Only 39 subjects were eligible and completed the study.

Intervention

After completion of the initial assessment, all participants received home balance exercises from an experienced physiotherapist based on assessment findings and exercises available from commercially available kits. All measures were repeated 4 months later.

Main Outcome Measures

Falls risk (Falls Risk of Older People—Community Setting) and balance measures.

Results

Thirty-nine women (mean age, 69.3y; 95% confidence interval, 65.7-72.9) completed the 4-month program. At baseline, 64% of participants reported falling in the preceding 12 months, and the average falls risk (Falls Risk of Older People—Community Setting) score was 14.5, with 42% rated as moderate risk (16-23). Participants achieved improved performance on most balance and related measures after the exercise program, including falls risk (P=.01), activity levels (P=.015), fear of falling (P=.022), functional reach test (P=.001), rising index for sit to stand (P=.001), step width in walking (P=.001), and body mass index (P=.006).

Conclusions

An individualized balance training home exercise program is feasible for older women with osteoarthritis or rheumatoid arthritis and may improve stability during walking and other functional activities.     

Computer-Adaptive Balance Testing Improves Discrimination Between Community-Dwelling Elderly Fallers and Nonfallers

Objectives

To build an item response theory–based computer adaptive test (CAT) for balance from 3 traditional, fixed-form balance measures: Berg Balance Scale (BBS), Performance-Oriented Mobility Assessment (POMA), and dynamic gait index (DGI); and to examine whether the CAT's psychometric performance exceeded that of individual measures.

Design

Secondary analysis combining 2 existing datasets.

Setting

Community based.

Participants

Community-dwelling older adults (N=187) who were aged ≥65 years (mean age, 75.2±6.8y, 69% women).

Interventions

Not applicable.

Main Outcome Measures

The BBS, POMA, and DGI items were compiled into an initial 38-item bank. The Rasch partial credit model was used for final item bank calibration. CAT simulations were conducted to identify the ideal CAT. CAT score accuracy, reliability, floor and ceiling effects, and validity were examined. Floor and ceiling effects and validity of the CAT and individual measures were compared.

Results

A 23-item bank met model expectations. A 10-item CAT was selected, showing a very strong association with full item bank scores (r=.97) and good overall reliability (.78). Reliability was better in low- to midbalance ranges as a result of better item targeting to balance ability when compared with the highest balance ranges. No floor effect was noted. The CAT ceiling effect (11.2%) was significantly lower than the POMA (40.1%) and DGI (40.3%) ceiling effects (P<.001 per comparison). The CAT outperformed individual measures, being the only test to discriminate between fallers and nonfallers (P=.007), and being the strongest predictor of self-reported function.

Conclusions

The balance CAT showed excellent accuracy, good overall reliability, and excellent validity compared with individual measures, being the only measure to discriminate between fallers and nonfallers. Prospective examination, particularly in low-functioning older adults and clinical populations with balance deficits, is recommended. Development of an improved CAT based on an expanded item bank containing higher difficulty items is also recommended.     

Effects of a Community-Based Tai Chi Program on Balance,Functional Outcomes,and Sensorimotor Function in Older Adults

Abstract

Aims: Examine effects of a community Tai Chi program on measures of balance and sensorimotor function.

Methods: In a pretest and post-test design, balance was measured in older adults (N?=?344; 73.4?±?7.4?years) with 30-s chair stand, timed-up-and-go, and 4-stage balance test following a 12-week community-based Tai Chi intervention. Balance and sensorimotor measures, including hip abductor electromechanical delay and hip proprioception, were measured in a smaller sample of older adults (n?=?11; 67.3?±?3.7?years).

Results: Balance improved (p?<?0.0001) following intervention compared to pretest. Similarly, participants in the smaller sample showed improvements at post-test (p?<?0.05) in electromechanical delay and lower extremity proprioception, but no bone density or muscle mass changes.

Conclusions: These preliminary results suggest that a community-based Tai Chi program improves balance in older adults. In a smaller sample, Tai Chi resulted in additional sensorimotor changes, specifically faster hip abductor muscle contraction speed and improved hip proprioception.     

Stability Limits, Single-Leg Jump, and Body Awareness in Older Tai Chi Practitioners

Gyllensten AL, Hui-Chan CWY, Tsang WWN. Stability limits, single-leg jump, and body awareness in older Tai Chi practitioners.

Objective

To compare stability limits, single-leg jumping, and body awareness in older Tai Chi practitioners and healthy older controls and to determine possible interrelationships among these variables.

Design

Cross-sectional study.

Setting

University-based rehabilitation center.

Participants

Tai Chi practitioners (n=24; age±SD, 68.5±6.6y) and control subjects (n=20; age, 71.3±6.7y) were recruited.

Interventions

Not applicable.

Main Outcome Measures

Measures included the following: (1) subjects' intentional weight shifting to 8 different spatial positions within their base of support using the limits of stability test, (2) the ability to leave the floor in single-leg jumping and to maintain balance on landing using force platform measurements, and (3) body awareness and movement behaviors using the Body Awareness Scale-Health (BAS-H).

Results

The findings showed that Tai Chi practitioners had a significantly better ability to lean further without losing stability and better directional control (P<0.01). They had a better ability to jump off the floor (P<0.05) and to maintain a longer single-leg stance after landing (P<.05) and better overall body awareness (P<.001). The single-leg jumps also correlated significantly with limits of stability measures of movement velocity, endpoint excursions, and maximum excursions but not with directional control. The BAS-H scores correlated significantly with the limits of stability measures except directional control. They also correlated significantly with the ability to jump off the floor and maintain stability after landing.

Conclusions

When compared with healthy controls, Tai Chi practitioners had better stability limits, increased ability to perform a single-leg jump, and more stability in landing on 1 leg as well as better body awareness. Significant correlations among limits of stability measures, single-leg jumping tests, and the BAS-H scores indicate the importance of body awareness in limits of stability, single-leg jumping, and landing.     

Comparison of Telecommunication, Community, and Home-Based Tai Chi Exercise Programs on Compliance and Effectiveness in Elders at Risk for Falls

Wu G, Keyes L, Callas P, Ren X, Bookchin B. Comparison of telecommunication, community, and home-based Tai Chi exercise programs on compliance and effectiveness in elders at risk for falls.

Objective

To compare the adherence to and effectiveness of Tai Chi exercise program through a live, interactive, telecommunication-based exercise (Tele-ex) with that of a similar program through a community center-based exercise (Comm-ex) and a home video-based exercise (Home-ex) among community-dwelling elders who are at risk for falls.

Design

Three groups randomized controlled trial with pretests and posttests.

Setting

Exercise programs were community-based, and the outcome measures were laboratory-based.

Participants

Adults (N=64) age 65+ years with positive fall history in the previous year and/or significant fear of falling.

Intervention

A 24-form, Yang-style Tai Chi for 15 weeks, 3 hours a week.

Main Outcome Measures

Exercise compliance, number of falls, fear of falling (Activities-specific Balance Confidence [ABC] score), self-perceived health (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]), Timed Up & Go (TUG), single leg stance (SLS), and body sway during quiet stance (medial-lateral foot center of pressure [ML-COP]).

Results

Tele-ex and Comm-ex groups demonstrated significantly higher exercise attendance and in-class practice time than the Home-ex group (P<.01) and significant reductions in the mean number of falls and injurious falls (P<.01). There were significant improvements posttraining in SLS, ABC, ML-COP, and Physical Health subscore of the SF-36 (P<.05). Both Tele-ex and Comm-ex groups demonstrated larger improvements than the Home-ex group in TUG, ML-COP, and the Social Function, Mental Health, and Physical Health subscores of the MOS SF-36.

Conclusion

Compared with the Home-ex, the Tele-ex and Comm-ex groups are better in exercise compliance, fall reduction and balance and health improvements. Tele-ex is an effective, affordable, and acceptable choice of exercise for elders.     

Effects of Aging and Tai Chi on Finger-Pointing Toward Stationary and Moving Visual Targets

Kwok JC, Hui-Chan CW, Tsang WW. Effects of aging and Tai Chi on finger-pointing toward stationary and moving visual targets.

Objective

To examine the aging effect on speed and accuracy in finger pointing toward stationary and moving visual targets between young and older healthy subjects and whether or not Tai Chi practitioners perform better than healthy older controls in these tasks.

Design

Cross-sectional study.

Setting

University-based rehabilitation center.

Participants

University students (n=30) (aged 24.2±3.1y), were compared with healthy older control subjects (n=30) (aged 72.3±7.2y) and experienced (n=31) (mean years of practice, 7.1±6.5y) Tai Chi practitioners (aged 70.3±5.9y).

Interventions

Not applicable.

Main Outcome Measures

Subjects pointed with the index finger of their dominant hand from a fixed starting position on a desk to a visual signal (1.2cm diameter dot) appearing on a display unit, as quickly and as accurately as possible. Outcome measures included (1) reaction time—the time from the appearance of the dot to the onset of the anterior deltoid electromyographic response; (2) movement time—the time from onset of the electromyographic response to touching of the dot; and (3) accuracy—the absolute deviation of the subject's finger-pointing location from center of the dot.

Results

Young subjects achieved significantly faster reaction and movement times with significantly better accuracy than older control subjects in all finger-pointing tasks. Tai Chi practitioners attained significantly better accuracy than older controls in pointing to stationary visual signals appearing contralaterally and centrally to their pointing hand. They also demonstrated significantly better accuracy when the target was moving. Accuracy in Tai Chi practitioners was similar to young controls.

Conclusions

Eye-hand coordination in finger-pointing declines with age in time and accuracy domains. However, Tai Chi practitioners attained significantly better accuracy than control subjects similar in age, sex, and physical activity level.     

Exergaming With Additional Postural Demands Improves Balance and Gait in Patients With Multiple Sclerosis as Much as Conventional Balance Training and Leads to High Adherence to Home-Based Balance Training

Objective

To assess the effectiveness of and adherence to an exergame balance training program with additional postural demands in patients with multiple sclerosis (MS).

Design

Matched controlled trial, assessment of balance before and after different balance training programs, and adherence to home-based balance exercise in the 6 months after the training.

Setting

A neurorehabilitation facility and center for MS.

Participants

Patients with balance problems (N=70) matched into 1 of the training groups according to age as well as balance and gait performance in 4 tests. Nine patients dropped out of the study because of scheduling problems. The mean age of the 61 remaining participants was 47±9 years, and their Expanded Disability Status Scale score was 3±1.

Interventions

Three weeks of (1) conventional balance training (control), (2) exergame training (playing exergames on an unstable platform), or (3) single-task (ST) exercises on the unstable platform.

Main Outcome Measures

Test scores in balance tests and gait analyses under ST and dual-task (DT) situations. Furthermore, in the 6 months after the rehabilitation training, the frequency and type of balance training were assessed by using questionnaires.

Results

All 3 groups showed significantly improved balance and gait scores. Only the exergame training group showed significantly higher improvements in the DT condition of the gait test than in the ST condition. Adherence to home-based balance training differed significantly between groups (highest adherence in the exergame training group).

Conclusions

Playing exergames on an unstable surface seems to be an effective way to improve balance and gait in patients with MS, especially in DT situations. The integration of exergames seems to have a positive effect on adherence and is thus potentially beneficial for the long-term effectiveness of rehabilitation programs.     

The effects on sensorimotor performance and balance with Tai Chi training

OBJECTIVES: To compare the effects of short-term and long-term Tai Chi training on the sensorimotor and balance performance of able-bodied subjects. DESIGN: A nonrandomized cross-sectional controlled trial. SETTING: Sport laboratory. PARTICIPANTS: Forty-eight healthy subjects, 16 with 3 months of experience in Tai Chi training, 16 with 1 to 3 years of experience in Tai Chi training, and 16 with no experience in Tai Chi training. INTERVENTION: Experimental. MAIN OUTCOME MEASURES: The reflex contraction latencies (reaction time) of medial hamstrings and gastrocnemius after perturbation, the active knee joint angle-repositioning error, and the balance time on a tilt board were measured and analyzed with 1-way analysis of covariance. Significant results were further analyzed with post hoc linear contrasts. RESULTS: Long-term Tai Chi practitioners had a significantly faster reflex reaction time in hamstrings (P<.000) and gastrocnemius (P=.043) muscles and a longer balance time on a tilt board (P<.000) than short-term Tai Chi practitioners and nonpractitioners. Both long- and short-term Tai Chi practitioners had significantly less knee joint angle-repositioning error than nonpractitioners (P=.001 and P=.027, respectively). CONCLUSIONS: Tai Chi training of more than 1 year might have the benefits of faster hamstrings and gastrocnemius reflex reaction and improved knee joint position sense (JPS). These changes might be associated with an improved dynamic standing balance. Better knee JPS was shown in subjects with 3 months of Tai Chi practice, but this had not led to a significant improvement in balance.     

Comparison of the Test-Retest Reliability of the Balance Computerized Adaptive Test and a Computerized Posturography Instrument in Patients With Stroke

Objective

To compare the test-retest reliabilities of the scores of the Balance Computerized Adaptive Test (CAT) and the Biodex Balance System in patients with stroke.

Design

A repeated-measures design (at a 1-wk interval) was used to examine the test-retest reliabilities of the scores of the Balance CAT and the Biodex Balance System.

Setting

One rehabilitation unit in a local hospital.

Participants

Patients (N=50) with stroke for more than 6 months and undergoing outpatient rehabilitation completed the Balance CAT and the eyes open (EO)/closed (EC) tests, but only 17 patients finished the Limit of Stability (LOS) test because they were unable to reach all the targets.

Interventions

Not applicable.

Main Outcome Measures

The Balance CAT and 2 computerized tests of the Biodex Balance System, namely the EO/EC test and the LOS, were used to evaluate balance function.

Results

The test-retest reliabilities of the scores of the Balance CAT (Pearson r=.92, minimal detectable change [MDC] percent=12.8%) was excellent. Those of the EO/EC and LOS tests were poor to good (Pearson r=.56–.85, MDC%=50.8%–126.9%).

Conclusions

The test-retest reliabilities of the scores of the Balance CAT were sufficient for assessing balance function in patients with stroke. Moreover, the test-retest reliabilities of the scores of the Balance CAT, one of the functional balance measures, were superior to those of the Biodex Balance System, 1 type of computerized posturography instrument. Therefore, the Balance CAT may be a more reliable measure for clinicians and researchers to use in assessing the balance function of patients with stroke for more than 6 months.     

Randomized Comparison Trial of Balance Training by Using Exergaming and Conventional Weight-Shift Therapy in Patients With Chronic Stroke

Objective

To compare the effects of exergaming with conventional weight-shift training on balance function in patients with chronic stroke.

Design

Single-blind randomized controlled trial.

Setting

Medical center.

Participants

Patients (N=30) with chronic stroke and balance deficits.

Interventions

Twelve weeks of Wii Fit training or conventional weight-shift training.

Main Outcome Measures

Static balance was assessed using posturography. We recorded the stability index and percentage of weight bearing on the affected leg in 8 positions. We also used the timed Up and Go and forward reach tests for dynamic balance evaluation, Falls Efficacy Scale-International for fear of falling assessment, and Physical Activity Enjoyment Scale for estimating the enjoyment of training.

Results

The exergaming group showed more improvement in stability index than the control group in head straight with eyes open while standing on a foam surface, eyes closed while standing on a solid surface with head turned 30° to the left, and eyes closed while standing on a solid surface with head turned up positions (time-group interaction P=.02, .04, and .03, respectively); however, the effects were not maintained. At 3-month follow-up, the control group showed more improvement in weight-bearing symmetry in the head straight with eyes open while standing on a solid surface position than the exergaming group (time-group interaction P=.03). Both groups showed improvement in the timed Up and Go test, forward reach test, and fear of falling. The improvement in fear of falling was not maintained. The exergaming group enjoyed training more than the control group (P=.03).

Conclusions

Exergaming is enjoyable and effective for patients with chronic stroke.     

The effects of Tai Chi on bone mineral density in postmenopausal women: a systematic review

OBJECTIVE: To evaluate the evidence for Tai Chi as an intervention to reduce rate of bone loss in postmenopausal women. DATA SOURCES: Literature search using Medline, Science Citation Index, Cochrane databases, China Biological Medicine Database, and additional manual reference searches of retrieved articles and personal libraries. STUDY SELECTION: Randomized controlled trials (RCTs), prospective cohort studies, and cross-sectional studies that included Tai Chi as an intervention, and had at least 1 outcome related to measurement of bone mineral density (BMD). DATA EXTRACTION: Authors critically reviewed studies, evaluated methodologic quality, and synthesized study results in a summary table. DATA SYNTHESIS: Six controlled studies were identified by our search. There were 2 RCTs, 2 nonrandomized prospective parallel cohort studies, and 2 cross-sectional studies. The 2 RCTs and 1 of the prospective cohort studies suggested that Tai Chi-naive women who participated in Tai Chi training exhibited reduced rates of postmenopausal declines in BMD. Cross-sectional studies suggested that long-term Tai Chi practitioners had higher BMD than age-matched sedentary controls, and had slower rates of postmenopausal BMD decline. No adverse effects related to Tai Chi were reported in any trial. CONCLUSIONS: Conclusions on the impact of Tai Chi on BMD are limited by the quantity and quality of research to date. This limited evidence suggests Tai Chi may be an effective, safe, and practical intervention for maintaining BMD in postmenopausal women. In combination with research that indicates Tai Chi can positively impact other risk factors associated with low BMD (eg, reduced fall frequency, increased musculoskeletal strength), further methodologically sound research is warranted to better evaluate the impact of Tai Chi practice on BMD and fracture risk in postmenopausal women.     

Effects of Tai Chi Intervention on Dual-Task Ability in Older Adults: A Pilot Study

Hall CD, Miszko T, Wolf SL. Effects of Tai Chi intervention on dual-task ability in older adults: a pilot study.

Objective

To determine if a 12-week program of Tai Chi that has been shown to reduce falls incidence in older adults would improve the ability to allocate attention to balance under dual-task conditions.

Design

Pre-/posttest experimental research design.

Setting

Movement studies research laboratory.

Participants

Community dwelling older adults (N=15; range, 62-85y) participated in either Tai Chi training or health education classes (controls) for 12 weeks.

Interventions

Participants in the Tai Chi group attended a twice-weekly, 1.5-hour class taught by an experienced instructor. The control group attended a biweekly, 1-hour class for lectures on health-related topics.

Main Outcome Measures

Two cognitive tasks (responding to auditory or visual stimulus as quickly as possible) were performed concurrently while maintaining static balance during the Sensory Organization Test (SOT) and while avoiding obstacles while walking. The percent change in performance relative to the single-task condition was calculated and defined as the dual-task cost. The dual-task cost was calculated for both the postural and cognitive measures.

Results

There was no improvement in the performance of postural stability or cognitive task under dual-task conditions for the SOT for Tai Chi versus controls. There was no improvement in avoiding obstacles under dual-task conditions for Tai Chi versus controls.

Conclusions

Contrary to our hypothesis, the findings of this study did not support a benefit of Tai Chi on the ability to allocate attention to balance under dual-task conditions.     

Effect of 12 weeks of Tai Chi training on soleus Hoffmann reflex and control of static posture in older adults

Chen Y-S, Zhou S, Cartwright C. Effect of 12 weeks of Tai Chi training on soleus Hoffmann reflex and control of static posture in older adults.

Objective

To investigate the effect of 12 weeks of Tai Chi training on soleus (SOL) Hoffmann reflex (H-reflex) modulation and postural control in standing under 4 sensory conditions in older adults.

Design

Experimental research design with pre- and posttraining tests in a training group and a control group.

Setting

University biomechanics laboratory.

Participants

Community-dwelling older adults (N=34) were assigned to a training (n=20; mean ± SD age, 72.9±4.4y) and a control (n=14; mean ± SD age, 72.9±6.5y) group.

Intervention

Tai Chi participants attended a 1-hour session of Yang style Tai Chi, 3 sessions a week, for 12 weeks, while control participants maintained their regular daily activities during the same period.

Main Outcome Measures

SOL H-reflex (maximal amplitudes of H-reflex [H_max] and M-wave [M_max] waves) and mean displacement of the center of pressure (COP) in the anterior-posterior (COP_A-P) and medial-lateral (COP_M-L) directions were measured during bipedal standing, with the feet placed on a forceplate and the heels 6cm apart, under 4 sensory conditions: stable surface with eyes open, stable surface with eyes closed, unstable surface with eyes open, and unstable surface with eyes closed.

Results

SOL H_max/M_max ratio in the Tai Chi group was upregulated significantly in all 4 sensory tasks after the 12-week Tai Chi training (P<.05). No significant change in COP measurements (mean displacement of COP_A-P and COP_M-L) was found in either the Tai Chi or control group after the 12-week period.

Conclusions

An increase in SOL H_max/M_max ratio during static postural tasks is observed after 12 weeks of Tai Chi training in older adults under all 4 sensory conditions. However, training-induced changes in H-reflex were not accompanied by improvement of performance in the static postural control tasks.     

Age-Related Hip Proprioception Declines: Effects on Postural Sway and Dynamic Balance

Objective

To evaluate the effects of age on hip proprioception, and determine whether age-related hip proprioception declines disrupt balance.

Design

Survey of proprioception and balance differences between 3 age groups.

Setting

University balance laboratory.

Participants

Volunteer sample of independent community-dwelling adults (N=102) without sensory or other neurologic impairments in 3 age groups: younger (mean age, 24.6y; range, 19–37y), mid-aged (mean age, 53.3y; range, 40–64y), and older adults (mean age, 76.3y; range, 65–94y).

Interventions

Not applicable.

Main Outcome Measures

Hip joint position sense (JPS) and kinesthesia were measured using a custom-built device. JPS error was determined by the magnitude of matching errors during vision and no-vision conditions. Kinesthesia was evaluated by the ability to detect passive limb rotation without vision. Postural sway was assessed during static stance and measured using root mean square of center of pressure (COP) displacement and velocity of COP displacement. Clinical balance and fear of falling were assessed with the mini-Balance Evaluation Systems Test (mini-BESTest) and Activities-specific Balance Confidence Scale, respectively.

Results

Both older and mid-aged adults had significantly increased JPS error compared with younger adults (P<.05). Kinesthesia accuracy was significantly decreased in older adults compared with mid-aged and younger adults (P≤.01). Both measures of proprioception error correlated with age (P≤.001). There were no relationships between hip proprioception error and postural sway during static stance. However, older adults with lower proprioceptive error had significantly higher mini-BESTest scores of dynamic balance abilities (P=.005).

Conclusions

These results provide evidence of significant hip proprioception declines with age. Although these declines are not related to increases in postural sway, participants with hip proprioception declines demonstrated disrupted dynamic balance, as indicated by decreased mini-BESTest scores.     

The influence of Tai Chi training on the center of pressure trajectory during gait initiation in older adults

OBJECTIVE: To determine if a program of intense Tai Chi exercise that has been shown to reduce the risk of falling in older adults improves postural control by altering the center of pressure (COP) trajectory during gait initiation. DESIGN: Before-after trial. SETTING: Biomechanics research laboratory. PARTICIPANTS: Twenty-eight older adults transitioning to frailty who participated in either a 48-week intervention of intense Tai Chi training or a wellness education (WE) program. INTERVENTIONS: Eight Tai Chi forms emphasizing trunk rotation, weight shifting, coordination, and narrowing of lower-extremity stance were taught twice weekly. WE program participants met once a week and received lectures focused on health.Main outcome measures The COP was recorded during gait initiation both before and after the 48-week intervention by using a forceplate sampling at 300 Hz. The COP trajectory was divided into 3 periods (S1, S2, S3) by identifying 2 landmark events. Displacement and average velocity of the COP trace in the anteroposterior (x) and mediolateral (y) directions, as well as smoothness, were calculated. RESULTS: Tai Chi training increased the posterior displacement of the COP during S1 and improved the smoothness of the COP during S2. CONCLUSIONS: Tai Chi improved the mechanism by which forward momentum is generated and improved coordination during gait initiation, suggesting improvements in postural control.     

Effects of a Resistance and Stretching Training Program on Forward Head and Protracted Shoulder Posture in Adolescents

Objective

The purpose of this study was to evaluate the effects of a 16-week resistance and stretching training program applied in physical education (PE) classes on forward head posture and protracted shoulder posture in Portuguese adolescents.