Oregon Research Institute, Eugene.
School of Kinesiology, Shanghai University of Sport, Shanghai, China.
JAMA Intern Med. 2018 Oct 1;178(10):1301-1310. doi: 10.1001/jamainternmed.2018.3915.
Falls in older adults are a serious public health problem associated with irreversible health consequences and responsible for a substantial economic burden on health care systems. However, identifying optimal choices from among evidence-based fall prevention interventions is challenging as few comparative data for effectiveness are available.
To determine the effectiveness of a therapeutically tailored tai ji quan intervention, Tai Ji Quan: Moving for Better Balance (TJQMBB), developed on the classic concept of tai ji (also known as tai chi), and a multimodal exercise (MME) program relative to stretching exercise in reducing falls among older adults at high risk of falling.
DESIGN, SETTING, AND PARTICIPANTS: A single-blind, 3-arm, parallel design, randomized clinical trial (February 20, 2015, to January 30, 2018), in 7 urban and suburban cities in Oregon. From 1147 community-dwelling adults 70 years or older screened for eligibility, 670 who had fallen in the preceding year or had impaired mobility consented and were enrolled. All analyses used intention-to-treat assignment.
One of 3 exercise interventions: two 60-minute classes weekly for 24 weeks of TJQMBB, entailing modified forms and therapeutic movement exercises; MME, integrating balance, aerobics, strength, and flexibility activities; or stretching exercises.
The primary measure at 6 months was incidence of falls.
Among 670 participants randomized, mean (SD) age was 77.7 (5.6) years, 436 (65%) were women, 617 (92.1%) were white, 31 (4.6%) were African American. During the trial, there were 152 falls (85 individuals) in the TJQMBB group, 218 (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. At 6 months, the incidence rate ratio (IRR) was significantly lower in the TJQMBB (IRR, 0.42; 95% CI, 0.31-0.56; P < .001) and MME groups (IRR, 0.60; 95% CI, 0.45-0.80; P = .001) compared with the stretching group. Falls were reduced by 31% for the TJQMBB group compared with the MME group (IRR, 0.69; 95% CI, 0.52-0.94; P = .01).
Among community-dwelling older adults at high risk for falls, a therapeutically tailored tai ji quan balance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls.
ClinicalTrials.gov identifier: NCT02287740.
老年人跌倒问题严重，会对健康造成不可逆转的后果，并给医疗系统带来巨大的经济负担。然而，由于缺乏有效的比较数据，确定最佳的基于循证的预防跌倒干预措施具有挑战性。
确定基于经典太极理念开发的治疗性量身定制太极拳干预措施——太极平衡运动（TJQMBB），以及多模式运动（MME）方案与伸展运动相比，在减少高跌倒风险的老年人跌倒方面的有效性。
设计、地点和参与者：这是一项单盲、3 臂、平行设计、随机临床试验，于 2015 年 2 月 20 日至 2018 年 1 月 30 日在俄勒冈州的 7 个城市和郊区进行。从筛选出的 1147 名 70 岁或以上的社区居住成年人中，有 670 名在过去一年中跌倒或行动不便的人同意并参与了研究。所有分析均采用意向治疗分配。
3 种运动干预措施之一：每周 2 次，每次 60 分钟，共 24 周的 TJQMBB，包括改良形式和治疗性运动练习；MME，整合平衡、有氧运动、力量和灵活性活动；或伸展运动。
6 个月时的主要测量指标是跌倒发生率。
在随机分组的 670 名参与者中，平均（SD）年龄为 77.7（5.6）岁，436 名（65%）为女性，617 名（92.1%）为白人，31 名（4.6%）为非裔美国人。在试验期间，TJQMBB 组有 152 人（85 人）跌倒，MME 组有 218 人（112 人）跌倒，伸展运动组有 363 人（127 人）跌倒。6 个月时，TJQMBB 组（IRR，0.42；95%CI，0.31-0.56；P<0.001）和 MME 组（IRR，0.60；95%CI，0.45-0.80；P=0.001）的发病率比率（IRR）明显低于伸展运动组。与 MME 组相比，TJQMBB 组的跌倒率降低了 31%（IRR，0.69；95%CI，0.52-0.94；P=0.01）。
在高跌倒风险的社区居住老年人中，治疗性量身定制的太极拳平衡训练干预措施比传统运动方法更能有效降低跌倒发生率。
ClinicalTrials.gov 标识符：NCT02287740。
