Tai Chi Can Reduce Risk for Falls for Elderly

tai chi to avoid emergencies

Story at-a-glance -

  • Balance is important to athletic performance, work and in reducing the number of seniors who fall each year, which drives direct medical health care costs to $31 billion
  • Tai chi has demonstrated improvements in balance, strength and flexibility in the elderly, which may potentially have an impact on the 800,000 people hospitalized each year after a fall
  • Benefits of tai chi also include improved cognitive performance, increased brain volume and reduced stress; integrating other balance training may add variety to your routine

By Dr. Mercola

Balance is extraordinarily important in your life. Whether you're older than 65 years or younger, both your body and mind require balance to achieve optimal health. Unfortunately, many spend hours behind a desk each day, increasing their risk of impairing muscle development and losing strength and balance.

Many exercise programs engage the use of machines for cardiovascular work without improving balance and coordination. The elderly experience more risk from poor balance, as it increases the potential for falling and a subsequent bone break.

It can be easy to take your ability to walk, move and balance for granted. But, like all things in life, without practice your skill level diminishes. Going up and down stairs, getting up from a chair and picking up something off the floor are all everyday activities that require balance.

To successfully train your balance requires performing movements that closely approximate these activities, or activities that commonly result in falls. In new research, participants who engaged in the practice of tai chi had a significantly reduced risk of falling and demonstrated improved balance.1

How Do You Balance?

What may seem like a simple task is actually a complex coordination of several different bodily systems. Your sensory systems give your brain accurate feedback about your relative position in space; your brain processes the information, and your muscles and joints coordinate the movement necessary to stay upright.

Inner ear infections, inability to sense the ground or loss of eyesight are just a few of the conditions which may significantly impact your body's ability to sense the environment and react appropriately. For the most part, balance is on "auto-pilot," or done subconsciously without significant effort.

If you experience a balance problem, focusing on staying balanced may increase fatigue and shorten your attention span. With age, some people find they get dizzy or unsteady when in motion. This can be a combination of environmental sensory integration and muscle strength.

The list of disorders that trigger balance problems includes positional vertigo, Meniere's disease and vestibular neuronitis,2 to name a few. Balance problems are among the more common reasons the elderly seek a physician's advice. While a disturbance in the inner ear is one common cause, so are loss of neuromuscular integration, muscle tone and strength.

Tai Chi May Reduce Your Risk of Falls

In a meta-analysis of 18 different studies involving over 3,800 participants who were 65 years and older, researchers determined those who practiced tai chi at least once weekly had a 20 percent lower chance of falling than those who did not practice tai chi.'3

The researchers compared senior students against how much time they spent practicing tai chi, the style and the falling risk for the individuals. They found any amount of tai chi exercise was associated with a lower risk of falling as compared to control groups. As the frequency of the sessions increased from once weekly to three times weekly, the risk reduction jumped from 5 to 64 percent.

The researchers felt performing tai chi improved the participant's knee extension strength, flexibility and balance, and reduced the risk of falls. As this was a meta-analysis, the researchers were only able to measure the variables previous studies had included. Dr. Chenchen Wang, director of the Center for Complimentary and Integrative Medicine at Tufts Medical Center in Boston, commented on the results:4

"Many important components include: exercise, breathing techniques, awareness of the body, focused attention, mindfulness, balance and function, visualization and relaxation. These components also positively impact health by improving self-efficacy, psychosocial functioning, and depression and can help patients bolster self-confidence, which also helps balance and coordination to avoid falls."

Preserving Independence and Cost

Nearly 40 percent of people over 65, and half of those over 80, will fall in any given year. Falling is the leading cause of injury death in people over age 65 and 1 in 3 Americans over 65 will fall each year.5 Over 800,000 older adults are hospitalized each year after a fall, many because of a broken hip or head injury.6

According to the Centers for Disease Control and Prevention (CDC), falls in older adults cost nearly $31 billion in direct medical healthcare costs. As the number of aging people in the U.S. is rising, the CDC estimates both the number of falls and the total health care cost to treat individuals will only continue to rise.7

These cost estimates do not account for out-of-pocket family expenses to care for the individual after hospital release, time away from work, or homecare expenses not covered by Medicare or insurance. The total cost of a fall and subsequent injury in the elderly is significant, but not inevitable with practical lifestyle adjustments and balance training.

The National Council on Aging developed a Falls Free initiative to address public health issues, injuries and death from falls in the elderly.8 The initiative includes a coalition of over 70 organizations working toward educating older adults on fall prevention. A fall is one of the greatest risk factors for the elderly to lose their independence,9 which in turn is associated with the development of depression.10

Moreover, depression often complicates other health conditions the elderly may suffer, such as diabetes, heart disease and stroke, and is associated with an increase in healthcare costs.11 Even living at home, but being unable to drive, doubles the risk the elderly may suffer depression.12

The longer individuals are able to stay independent, both physically and cognitively, the lower the risk of depression, which in turn has an impact on healthcare costs and the burden on the family. Implementing effective preventive strategies may reduce falls and improve quality of life.

Benefits of Tai Chi

This short excerpt from MSNBC's "The Mind-Body Connection" describes some of the benefits you may experience from tai chi. Tai chi originated in China and is often thought of as an alternative to yoga. It is a form of fluid exercise designed to relax the body and refresh the mind through muscle toning, balance, coordination and flexibility. As you watch someone perform tai chi, it appears they are making fluid dance-like movements and poses.

One of the benefits of tai chi is that it is non-competitive, non-aggressive and a self-paced program that doesn't require physical strength, agility or flexibility to begin. Participants gain strength and flexibility through practice. Some of the essential principles are fluidity of movement, breath control and mental concentration.13 The practice of tai chi encompasses cardiovascular fitness, flexibility and strength.

The combination of these three factors may also help improve your posture, as good posture is part of good tai chi form. Sitting and standing with good posture relieves stress on your lower and upper back, reducing back pain,14 and may reduce your potential for tension and neck-related headaches.15 Good posture opens your chest and improves your ability to breathe and builds a stronger core.

Research has associated the practice of tai chi in adults between 60 and 80 years with an increase in upper and lower body muscle strength, balance, endurance and flexibility after both six weeks and 12 weeks of a 60-minute class, three times a week.16 The researchers recommended including tai chi in public health initiatives to reduce disability and enhance physical function in the elderly.

Peter Wayne, Ph.D., assistant professor of medicine at Harvard, has studied the clinical effects of tai chi on patients with Parkinson's disease and other balance disorders. He comments:17

"The focus of our work is to take advantage of traditional exercises in which it's implicit that the mind and body are connected more efficiently. Tai chi is one such exercise that we focus on because of its benefits for both balance and mental function. Practicing mindful movement may help compensate for some of the motor deficits that are common in Parkinson's and aging."

One study published in the New England Journal of Medicine found tai chi improved balance and prevented falls in individuals who had mild Parkinson's disease.18 The researchers found those who practiced tai chi fell less and had a much slower rate of physical decline related to their disease than those who did not practice tai chi.

Mental Improvements in Elderly Who Practice Tai Chi

Research also demonstrates the practice of tai chi may improve mental attention and executive control in the elderly when the participants were motivated to pursue the practice.19

Age associated cognitive decline is a growing public health issue. In the U.S. alone, researchers estimate over 5.4 million elderly are cognitively impaired without dementia and another 3.4 million suffer from dementia.20 Cost of care continues to increase as the number of individuals suffering from these conditions also rises.

However, findings from several studies suggest the practice of tai chi may enhance executive functioning in the elderly, especially those without current significant deficits.21,22,23 Further study also links tai chi with improved verbal working memory.24 Cognitive impairment is a major risk factor for reduced independent living, and therefore increases the risk of depression and rising healthcare costs.

Tai chi participants have also demonstrated an increase in brain volume, which is significant as this indicator often declines with age.25 In this study participants practiced tai chi for 40 weeks, being tested at 20 weeks and 40 weeks, demonstrating improvements at both testing periods. Another study from Harvard Medical School demonstrated similar results in an even shorter time span.26

Tai chi may also improve mental balance and reduce stress. Chronic physical health problems, often found in the elderly population, are associated with stress, anxiety, poor mood and depression.27 Tai chi has been found to reduce blood pressure and anxiety.28 Some authors were unsure if the benefits from stress reduction were due specifically to tai chi or related to participating in an enjoyable activity.29

However, the authors did note that all studies involving tai chi in their meta-analysis demonstrated positive results for the participants. The meditative movements of tai chi are associated with improvements in neuroplasticity, or an improvement in your ability to learn through reorganization of neural pathways. Research demonstrates these connections help to reduce your stress levels.30

Other Types of Balance Training

While tai chi is very effective in improving your balance, strength and flexibility, having additional choices helps to add variety to your balance training. In this short video, personal trainer Jill Rodriguez works with my mother on balance exercises, starting in a chair and moving to a standing position.

You can never start improving your balance skills too early in life and it's never too late either. Balance is necessary in most competitive sports and will help improve performance.31 Below are several other exercises you may want to include in your balance training routine.

Avoid quick movements. Instead, concentrate on posture and keeping your weight over your ankles while moving slowly and deliberately. Don't close your eyes while balancing and be sure you use a chair or the wall to stabilize yourself as you begin. Wear smooth bottom shoes that won't catch on the carpet or floor.32

Remember, you are not racing or competing with anyone but your own last performance. Take it slowly, learn the moves and stay safe. If you lose your balance and fall during balance training you may set your progress back weeks or even months.

The Flamingo

Ever notice how the flamingo bird can stand for long lengths of time on one foot? In this exercise you'll use the wall or a sturdy chair to balance while standing on one foot, concentrating on keeping your weight over your ankle.  Work up to standing on one leg and then the other for 10 seconds, and then up to a minute.

This may take weeks to achieve. What's important is to continue to practice; not being perfect the first time. Once you can stand on one foot for one minute, start to remove some of the stability by holding on with one hand, then your fingertips, then one finger and finally letting go. Remember this takes time and practice.

Clocking It

This exercise strengthens your ankle and hip muscles and improves balance. Begin by standing on the right side of a chair. Hold it with your left hand and raise your right leg off the floor. Imagine you are the center of a clock and reach your right hand straight above your head, to the 12 o'clock position.

Move it to your shoulder level or 3 o'clock and then down to your side or 6 o'clock position. Next, move to the other side of the chair and repeat holding with your right hand and lifting your left leg. As you become stronger you may consider adding a 1-pound weight to your wrists.

Staggered Foot

This helps build balance and helps you to recognize how to keep your weight over your ankles. Stand with both feet together and your hands at your side. Keep a chair nearby if you need it to balance. Move your right foot forward one foot length in a straight line, keeping your weight centered and balanced. Hold for 15 seconds and return to the start position. Repeat with your left foot.

Marching Band

This helps to improve your moving balance. In the starting position your feet are shoulder width apart and arms at your side. Raise one knee up as high as you are comfortable and return to the starting position. Repeat with the opposite leg. March in place without moving forward.

Narrow Stance Walk

Begin standing straight and tall with your feet shoulder width apart. Move your right foot in front of your left with the heel of the right touching the toe of the left. Step forward with your left foot in a straight line, placing the heel of the front foot directly in front of the toe of the back foot.

Step Up and Over

This is a series of exercises using several soft objects on the floor. Before attempting these be sure there is someone home if you fall and you are easily able to perform the first five exercises without a problem.

Put three soft objects on the floor, 12 to 16 inches apart and in a straight line. Start with your feet shoulder width apart at the head of one object. Step over and bring both feet to the ground together. Leading with the opposite foot, step over the next object and bring both feet together on the ground. Repeat until you get to the end of the objects.

Once you are able to do this without trouble you may increase the challenge by continuing to walk over the objects without putting your feet together on the ground and starting from a standing position between each object. Using the same three objects on the floor, walk in a figure 8 around the objects 10 times.

Seated Posture Training

This helps develop core muscles to support your body in the proper posture, reducing your risk of falling. Sit on a properly sized Swiss ball and, while holding a neutral curve in your lower back, gently draw in your belly button while sitting in good posture.

As you become more confident with this exercise, one foot can be lifted off the ground, shifting your center of gravity and increasing the amount of balance you need. With this one exercise, your posture, balance and confidence should improve. Eventually, you should be able to sit on the ball with good upright posture for one minute without allowing your feet to touch the ground.

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