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VA RESEARCH ON BALANCE AND MOBILITY IN OLDER
ADULTS --
Balance training better than tai chi at
improving
mobility among older adults.
Story here...
http://www.eurekalert.org/pub_releases/2006-12/uomh-btb121106.php
Story below:
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Balance training better than tai chi at
improving mobility among older adults
Both programs have been proven to reduce falls,
but new study shows more improvement from balance program with balance,
stepping and mobility
ANN ARBOR, Mich. -- Physicians and physical therapists in recent years
have explored whether tai chi, balance programs and fitness routines can
help decrease the likelihood that older adults will fall and injure
themselves. Many of these programs have shown promise, but their
relative value is still open to debate.
Now, a study from researchers at the University of Michigan Health
System and the Veterans Affairs Ann Arbor Healthcare System suggests
that a program focusing on increasing step length and speed is more
effective at improving mobility and balance than tai chi. While tai chi
– a Chinese martial art form consisting of slow, rotational movements
and weight-shifting – offers many benefits, the researchers say, they’re
not as great as those produced by a balance-training program.
"Our results indicate that in older adults with at least mild balance
impairment, Combined Balance and Stepping Training (CBST) results in
modestly greater improvement in balance, stepping and functional
mobility compared to tai chi training," says senior author Neil B.
Alexander, M.D., professor in the Division of Geriatric Medicine,
Department of Internal Medicine, at the U-M Health System, and acting
director of the Geriatric Research, Education, and Clinical Center, VA
Ann Arbor Healthcare System.
"What this tells us is that if you want to improve your ability to
balance and walk, try a program that focuses on improving balance while
moving and the ability to step quickly and further," he says of the
study, which appears in the new edition of the Journal of the American
Geriatrics Society. "Data from this study can help determine which
balance training program may be most optimal to improve balance and
eventually reduce falls. Among older adults, falls are becoming an
increasing problem, so it is important that we find ways to help prevent
them in the first place."
This is the first comparison of two balance training programs in which
each type of program has been proven to reduce falls, notes lead author
Joseph O. Nnodim, M.D., Ph.D., clinical instructor in the Division of
Geriatric Medicine at the U-M Health System and a research scientist at
the VA Ann Arbor GRECC.
The researchers add that the CBST program requires no specialized
equipment or advanced training for the instructor. "It’s a very easy
program to implement," says Alexander, director of the Mobility Research
Center at the U-M Geriatrics Center.
The study lasted 10 weeks, and participants did three one-hour sessions
a week with an instructor. Of the 162 people in the study, 81 were in
the CBST group and 81 were in the Tai Chi classes. All were ages 65 and
older.
Participants performed several tests at the beginning and end of the
study, including balance measures in which they were timed while they
stood with one foot forward and while they stood on one leg – tests
called tandem stance and unipedal stance. They also were measured while
stepping as far as they could in three directions: forward, to the side
and backward (the maximal step length test). Another measure had them
take a series of steps and return quickly to the starting position
(rapid step test), and a final test measured how quickly they rose from
sitting in a chair, walked three meters, turned and returned to the seat
(timed up and go).
After initial testing, the participants were assigned to one of the two
fall-prevention training options. The CBST classes included activities
in which participants moved their upper bodies while bouncing and
catching a ball; increasing the complexity of ambulatory tasks, such as
changing direction to walk forward or laterally; walking on a plank;
turning, bending and stepping on and off curbs; stepping over obstacles;
and more. The tai chi classes focused on body alignment; weight shifts,
including standing on one leg; hip and ankle rotations; stepping motions
backward, forward and laterally; and more. Emphasis was on awareness of
one’s body alignment, relaxation and distribution of weight, and 12
sequences from the tai chi Yang Short Form were practiced.
At the end of the 10 weeks, improvements in unipedal stance were roughly
the same between the two groups. But compared to tai chi, CBST had
greater improvements in the timed up and go measure (9.4 percent faster
than the tai chi group); and in the two step measurements, (9.8 percent
higher in the CBST group for the maximal step length test, and 5.4
percent higher in the rapid step test).
"This research is very promising in our efforts toward reducing falls
among older adults," Nnodim says. "We would like future research to
include a comparison of fall rates in response to these two programs so
we can develop an even better sense of what works best in the prevention
of falls."
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In addition to Alexander and Nnodim, authors were Debra Strasburg, M.S.,
and Martina Nabozny, B.A., both of the Mobility Research Center,
Division of Geriatric Medicine, at the U-M Health System; and Lynda
Nyquist, Ph.D., Andrzej Galecki, Ph.D., M.D., and Shu Chen, M.S., all of
the Institute of Gerontology at the U-M Health System.
Primary financial support came from the National Institute on Aging
Michigan Claude Pepper Older Americans Independence Center and the K24
Mid-Career Investigator Award in Patient-Oriented Research. The authors
also acknowledge support from the Department of Veterans Affairs
Research and Development. Nnodim was a fellow in the VA Special
Fellowship Program in Academic Geriatrics. The authors have no conflict
of interest to disclose.
Citation: Journal of the American Geriatrics Society, Dec. 2006,
54:1825–1831.
For more about the Mobility Research Center at the U-M Health System,
visit
www.med.umich.edu/geriatrics%20/moblab/index.htm. The MRC
focuses on studies of mobility and physical activity assessment and
enhancement in older adults and is part of the U-M Geriatrics Center.
For information about the Geriatrics Center's Mobility Enhancement
Clinic, call 734-764-6831 to make an appointment with Dr. Alexander. For
more information about the VA Ann Arbor GRECC, visit
www.med.umich.edu/geriatrics_center/grecc/.
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Larry Scott
