Virtual Tai Ji Quan for Fall Prevention

Overseen By Fuzhong Li, Ph.D.

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: Oregon Research Institute

Disqualifiers: Dementia, Cognitive impairment, Mobility issues, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 6 months

620 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two virtual exercise programs to determine their effectiveness in preventing falls among older adults. One program, Virtual Tai Ji Quan: Moving for Better Balance Intervention (V-TJQMBB), uses tai ji quan to enhance balance and strength through gentle movements. The other program, Virtual Multimodal Exercise Intervention (V-Multimodal), combines walking, strength, and flexibility exercises. The trial seeks participants aged 65 to 90 who have fallen at least once in the past year. Those needing balance assistance or experiencing frequent falls may find this trial suitable. As an unphased trial, it offers a unique opportunity to contribute to research that could enhance fall prevention strategies for older adults.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that these exercise programs are safe for older adults?

Research has shown that the tai ji quan program, which aims to improve balance and prevent falls, is safe for older adults. It proves more effective and safer than only stretching exercises. This program enhances strength, balance, and mobility, making it an excellent option for those at risk of falling.

For the virtual multimodal exercise program, studies have found that this online approach to preventing falls is well-received by older adults. It includes light walking, strength, and flexibility exercises. Participants generally manage these exercises well, with no major safety issues reported.

Both exercise programs are designed to be safe for seniors and aim to help reduce the risk of falls. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Virtual Tai Ji Quan for Fall Prevention trial because it explores innovative ways to enhance balance and prevent falls, especially in older adults. Unlike traditional fall prevention methods, which often involve in-person physical therapy or exercise classes, this trial examines virtual interventions, making it more accessible to people who may have difficulty attending in-person sessions. The Virtual Tai Ji Quan intervention focuses on improving lower-extremity strength and postural control through tai ji quan forms, while the Virtual Multimodal Exercise incorporates a variety of exercises like walking, strength training, and flexibility routines. This approach not only aims to improve physical stability but also integrates daily functional movements, potentially making it a more holistic and practical solution for fall prevention.

What evidence suggests that this trial's exercise programs could be effective for fall prevention?

Research shows that tai ji quan, particularly the "Moving for Better Balance" program, helps reduce falls in older adults. Studies have found that this specific tai ji quan program is more effective than stretching or other exercises in preventing falls. It enhances balance by focusing on strength, posture, and movement. In this trial, participants in one arm will receive the Virtual tai ji quan: Moving for Better Balance intervention (V-TJQMBB).

Another exercise program, the Virtual multimodal exercise intervention (V-Multimodal), includes balance, strength, walking, and stretching exercises and also shows promise. Research indicates that these programs improve balance and strength, reducing the risk of falling. Participants in another arm of this trial will receive this multimodal exercise program. Both exercise programs are easy to follow and have proven effective in preventing falls. ^{3 5 6 7 8}

Are You a Good Fit for This Trial?

This trial is for older adults aged 65-90 who have experienced at least one fall in the past year and take longer than normal to stand up from a seated position. They should not have dementia, be able to walk on their own, and must not have done tai ji quan or similar exercises regularly in the last six months.

Inclusion Criteria

I am between 65 and 90 years old.

I have fallen at least once in the last year.

It takes me 12 seconds or longer to stand up, walk a short distance, and sit down again.

Exclusion Criteria

Having no medical clearance

I cannot walk on my own for short distances inside my house.

Showing a diagnosis of dementia or significant cognitive impairment (indicated by a score of <24 on the Mini Mental State Evaluation)

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in either a virtual tai ji quan intervention or a virtual multimodal exercise intervention to reduce falls

6 months

Monthly phone calls for fall reporting

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Virtual multimodal exercise intervention (V-Multimodal)
• Virtual tai ji quan: moving for better balance intervention (V-TJQMBB)

Trial Overview

The study tests two virtual exercise programs designed to prevent falls: one focuses on various types of exercises (V-Multimodal), while the other is centered around tai ji quan movements (V-TJQMBB). Participants will be randomly assigned to either program.

How Is the Trial Designed?

Group I: Virtual tai ji quan Active Control 1 Intervention

Participants participating are intervened with practice and drills of tai ji quan forms and associated movements. Training focuses on lower-extremity strength, postural control, and mobility, with an emphasis on weight bearing and weight shifting, extending and controlling the body's center of mass over its base of support; self-induced movement perturbation; gait preparation, initiation, locomotion, and termination; and sensory integration. The exercise training also emphasizes connecting tai ji quan forms to transitional movements that are associated with performing daily activities. Each session includes brief movement-based warm-ups and light breathing cool-down exercises.

Group II: Virtual multimodal exercise Active Control 1 Intervention

Participants participating are intervened with a multicomponent exercise program that involves light walking, strength, postural control, and flexibility exercises. Walking exercises include amble forward and backward walk, long strides, heel-toe walking, narrow- and wide-base walking, and sidestepping. Strength training includes single- and multi-joint exercises such as semi-squats, lunging forward and sideways, and toe stands that involve exercising ankle dorsiflexors, knee extensors, and hip abductors. Balance training involves semi-tandem foot-standing, heel-toe and line walking, single-leg standing, alternation of the base of support, weight transfers, toe and heel movements, and various reaching and stretching movements away from the center of the base of support. Flexibility exercises include a static stretching routine of major upper and lower body muscle groups. Each session includes brief movement-based warm-ups and light breathing cool-down exercises.

Who Is Running the Clinical Trial?

Oregon Research Institute

Lead Sponsor

Trials

87

Recruited

62,600+

Published Research Related to This Trial

A study involving 145 older adults (average age 75) showed that participating in Tai Ji Quan: Moving for Better Balance (TJQMBB) classes twice a week for 48 weeks significantly improved their limits of stability, which is crucial for daily activities.

Improvements in limits of stability were also linked to better physical performance, as participants showed reduced times in mobility tests like the Timed Up and Go and the 50-foot walk, indicating that TJQMBB can enhance both balance and functional movement in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of Tai Ji Quan training on limits of stability in older adults. Li, F.[2021]

Tai chi is a safe and effective exercise intervention that significantly reduces falls and fall injuries among older adults, improving their postural control and sensory integration.

Recent studies indicate that tai chi is more effective than conventional exercise programs in preventing falls, suggesting it could be a valuable addition to health practices for older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Tai chi reduces the number of falls]. van Vugt, VA., Maarsingh, OR.[2020]

The study aims to disseminate the evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program to community-dwelling older adults through senior centers in Oregon over a 48-week period, addressing the significant public health issue of falls among older adults.

If successful, the TJQMBB program could provide a practical, low-cost intervention for fall prevention that is easy to implement in community settings, potentially benefiting low-income and underserved older adults at risk of falling.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Protocol for disseminating an evidence-based fall prevention program in community senior centers: evaluation of translatability and public health impact via a single group pre-post study. Li, F., Harmer, P.[2021]

There are currently over 13.7 million cancer survivors in the U.S., a number expected to rise by 31% in the next decade, highlighting the need for effective health strategies for this aging population.

Tai Ji Quan is suggested as a beneficial exercise for older cancer survivors to help reduce risks of disability, falls, and cardiovascular disease, but more controlled trials are needed to confirm its efficacy in this specific group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tai Ji Quan for the aging cancer survivor: Mitigating the accelerated development of disability, falls, and cardiovascular disease from cancer treatment. Winters-Stone, K.[2021]

Vestibular rehabilitation therapy (VRT) significantly improves balance in stroke patients, with a standardized mean difference (SMD) of 0.59, particularly effective for those who had a stroke within the last 6 months (SMD of 0.56).

VRT also enhances gait function, showing a significant improvement in the Timed Up-and-Go test with a mean difference of -4.32 seconds, especially for patients who experienced a stroke within 6 months, indicating moderate certainty of its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vestibular rehabilitation therapy on balance and gait in patients after stroke: a systematic review and meta-analysis. Meng, L., Liang, Q., Yuan, J., et al.[2023]

Tai Ji Quan, a traditional martial art, is being scientifically validated for its health benefits, particularly in preventing and managing diseases while improving quality of life for middle-aged and older adults.

The program 'Tai Ji Quan: Moving for Better Balance' adapts traditional Tai Ji Quan movements into a contemporary therapeutic approach aimed at enhancing balance, gait, and mobility, which is crucial for reducing falls in older adults and those with neurodegenerative conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transforming traditional Tai Ji Quan techniques into integrative movement therapy-Tai Ji Quan: Moving for Better Balance. Li, F.[2022]

Tai Chi training for nine months in a group of 86 post-menopausal osteopenic women showed a significant positive effect on bone mineral density (BMD) at the femoral neck compared to usual care, indicating its potential to help prevent bone loss.

Participants in the Tai Chi group also demonstrated improved balance and sway parameters, which are important for reducing fall risk, suggesting that Tai Chi is a safe and effective intervention for enhancing stability in older women.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial. Wayne, PM., Kiel, DP., Buring, JE., et al.[2022]

The study successfully developed a falls prevention program called Tai Chi: Moving for Better Balance, which included comprehensive materials for implementation and evaluation, tailored for older adults and local senior service organizations.

Pilot testing indicated that the program was feasible, with high participant satisfaction and interest in continuing classes, suggesting it could effectively help prevent falls in community-living older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tai Chi: moving for better balance -- development of a community-based falls prevention program. Li, F., Harmer, P., Mack, KA., et al.[2019]

The Tai Chi: Moving for Better Balance (TCMBB) program, involving 421 participants aged around 75 years, significantly improved functional mobility as evidenced by a decrease in Timed Up and Go (TUG) test scores, particularly among high-risk individuals.

Participants reported a fivefold increase in confidence regarding their ability to prevent falls after completing the 3-month TCMBB program, highlighting its effectiveness in enhancing balance and reducing fall risk in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fall prevention in community settings: results from implementing tai chi: moving for better balance in three States. Ory, MG., Smith, ML., Parker, EM., et al.[2020]

A 14-week Tai Ji Quan: Moving for Better Balance (TJQMBB) program significantly improved global cognitive function in older adults with cognitive impairment, as indicated by a notable increase in Mini-Mental State Examination (MMSE) scores (mean increase of 2.26, p<0.001).

Participants in the TJQMBB program also showed significant improvements in physical performance and balance, suggesting that cognitive benefits may be linked to enhanced physical abilities and balance efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tai Ji Quan and global cognitive function in older adults with cognitive impairment: a pilot study. Li, F., Harmer, P., Liu, Y., et al.[2021]

Tai Chi is supported by high and moderate quality evidence from 27 meta-analyses, showing significant improvements in balance, cardiorespiratory fitness, cognition, mobility, sleep, and strength in older adults.

Practicing Tai Chi can also reduce the incidence of falls and nonfatal strokes, making it a valuable exercise for promoting overall health and well-being in older populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Tai Chi for Health Promotion of Older Adults: A Scoping Review of Meta-Analyses. Yang, FC., Desai, AB., Esfahani, P., et al.[2022]

A community-based Tai Chi program, 'Moving for Better Balance,' was successfully implemented with 131 older adults, leading to significant improvements in balance and mobility as measured by the Timed Up and Go test, Functional Reach test, and Activities-Specific Balance Scale.

After 12 weeks of participation, the program effectively reduced fall risk among older adults, demonstrating that such evidence-based interventions can be feasibly taught by novice instructors and are well-received by the target population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using Tai Chi to Reduce Fall Risk Factors Among Older Adults: An Evaluation of a Community-Based Implementation. Gallant, MP., Tartaglia, M., Hardman, S., et al.[2020]

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