Effectiveness of Tai Ji Quan vs Multimodal and Stretching Exercise Interventions for Reducing Injurious Falls in Older Adults at High Risk of Falling: Follow-up Analysis of a Randomized Clinical Trial | Complementary and Alternative Medicine | JAMA Network Open | JAMA Network
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    Original Investigation
    Geriatrics
    February 15, 2019

    Effectiveness of Tai Ji Quan vs Multimodal and Stretching Exercise Interventions for Reducing Injurious Falls in Older Adults at High Risk of Falling: Follow-up Analysis of a Randomized Clinical Trial

    Author Affiliations
    • 1Oregon Research Institute, Eugene, Oregon
    • 2Department of Exercise and Health Science, Willamette University, Salem, Oregon
    • 3Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health and Science University, Portland
    • 4Oregon Medical Group Neurology, Eugene
    • 5Department of Human Physiology, University of Oregon, Eugene
    • 6School of Kinesiology, Shanghai University of Sport, Shanghai, China
    JAMA Netw Open. 2019;2(2):e188280. doi:10.1001/jamanetworkopen.2018.8280
    Key Points español 中文 (chinese)

    Question  Is a therapeutically tailored tai ji quan intervention more effective than stretching exercise or a proven multimodal exercise intervention in decreasing injurious falls among community-dwelling older adults at high risk of falling?

    Findings  In this follow-up analysis of a randomized clinical trial that included 670 older adults with a history of falls or impaired mobility, a therapeutic tai ji quan intervention, Tai Ji Quan: Moving for Better Balance, was significantly more effective for lowering the incidence of both moderate injurious falls compared with stretching exercise and serious injurious falls compared with stretching exercise and multimodal exercise.

    Meaning  The therapeutically tailored tai ji quan training intervention proved to be more safe and effective than stretching or multimodal exercises in reducing the incidence of injurious falls in older adults at high risk of falling.

    Abstract

    Importance  Exercise has been shown to reduce injurious falls in older adults. Evidence, however, is lacking regarding the types of intervention that are most effective in preventing injurious falls among older adults at high risk of falling.

    Objective  To determine the longer-term effectiveness of therapeutic tai ji quan intervention vs multimodal exercise and stretching exercise in decreasing injurious falls among older adults at high risk of falling.

    Design, Setting, and Participants  This trial involves a prespecified analysis with the data analyzed by intent-to-treat. Follow-up analysis of a single-blind randomized trial conducted in community settings of 7 urban and suburban cities in Oregon from February 20, 2015, to September 15, 2018, compared a therapeutic tai ji quan intervention with multimodal exercise and stretching exercise. Eligible participants were community-dwelling adults aged at least 70 years who were considered by a clinician to be at high risk of falling because they had fallen during the preceding year or who had impaired mobility with scores higher than 13.5 seconds on the Timed Up & Go test. Participants were randomized to 1 of the 3 interventions and were assessed monthly after randomization for 12 months, encompassing a 6-month active intervention phase and a 6-month after intervention follow-up phase.

    Interventions  The 3 group-based interventions were therapeutic tai ji quan (Tai Ji Quan: Moving for Better Balance [TJQMBB]), multimodal exercise, and stretching exercise, each implemented twice weekly in 60-minute sessions for 24 weeks.

    Main Outcomes and Measures  Primary outcomes were the incidence of moderate and serious injurious falls at 12 months, measured as incidence rate ratios (IRRs).

    Results  Of the 1147 persons screened, 670 (mean [SD] age, 77.7 [5.6] years; 436 women [65.1%]) were randomly assigned to 1 of 3 intervention groups: 224 persons in TJQMBB, 223 in multimodal exercise, and 223 in stretching exercise. At 12 months, the unadjusted IRR for moderate injurious falls was lower in the TJQMBB (IRR, 0.51; 95% CI, 0.35-0.74; P < .001) and multimodal exercise (IRR, 0.62; 95% CI, 0.42-0.89; P = .01) groups compared with the stretching exercise group. There was no difference between TJQMBB and multimodal exercise groups (IRR, 0.85; 95% CI, 0.58-1.25; P = .42). Both TJQMBB and multimodal exercise significantly reduced serious injurious falls (TJQMBB: IRR, 0.25 [95% CI, 0.13-0.48; P < .001]; multimodal: IRR, 0.56 [95% CI, 0.33-0.94; P = .03]) compared with stretching exercise. Use of TJQMBB was more effective than multimodal exercise (IRR, 0.47; 95% CI, 0.24-0.92; P = .03) in reducing serious injurious falls.

    Conclusions and Relevance  For preventing injurious falls, including those that resulted in medical treatment, TJQMBB intervention was found to be superior to multimodal and stretching exercises for older adults at high risk of falling. The findings appear to strengthen the clinical use of TJQMBB as a single exercise intervention to prevent injurious falls in this population.

    Trial Registration  ClinicalTrials.gov Identifier: NCT02287740

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