Social and Administrative Sciences Division, School of Pharmacy.
Doctor of Physical Therapy Program, Department of Family Medicine and Community Health.
Gerontologist. 2020 May 15;60(4):765-775. doi: 10.1093/geront/gnz006.
Falls among older adults is a pressing public health challenge. Considerable research documents that longer tai chi courses can reduce falls and improve balance. However, longer courses can be challenging to implement. Our goal was to evaluate whether a short 6-week modified tai chi course could be effective at reducing falls risk if older adults designed a personal home practice plan to receive a greater tai chi "dose" during the 6 weeks.
A 3-city wait-listed randomized trial was conducted. Habituation Intention and Social Cognitive Theories framed the "coaching" strategy by which participants designed practice plans. RE-AIM and Treatment Fidelity Frameworks were used to evaluate implementation and dissemination issues. Three advisory groups advised the study on intervention planning, implementation, and evaluation. To measure effectiveness, we used Centers for Disease Control and Prevention recommended measures for falls risk including leg strength, balance, and mobility and gait. In addition, we measured balance confidence and executive function.
Program Implementation resulted in large class sizes, strong participant retention, high program fidelity and effectiveness. Participants reported practicing an average of 6 days a week and more than 25 min/day. Leg strength, tandem balance, mobility and gait, balance confidence, and executive function were significantly better for the experimental group than control group.
The tai chi short course resulted in substantial tai chi practice by older adults outside of class as well as better physical and executive function. The course reach, retention, fidelity, and implementation across 3 cities suggest strong potential for implementation and dissemination of the 6-week course.
老年人跌倒问题是一个紧迫的公共卫生挑战。大量研究表明，较长时间的太极拳课程可以减少跌倒并改善平衡。然而，较长时间的课程可能难以实施。我们的目标是评估如果老年人设计个人家庭练习计划，在 6 周内接受更大的太极拳“剂量”，那么较短的 6 周改良太极拳课程是否能有效降低跌倒风险。
进行了一项三城市候补随机试验。习惯意向和社会认知理论为参与者设计练习计划的“辅导”策略提供了框架。重新评估和治疗保真度框架用于评估实施和传播问题。三个咨询小组就干预计划、实施和评估为研究提供建议。为了衡量效果，我们使用疾病控制和预防中心推荐的跌倒风险测量方法，包括腿部力量、平衡和移动性以及步态。此外，我们还测量了平衡信心和执行功能。
计划实施导致班级规模大、参与者保留率高、计划保真度和效果高。参与者报告平均每周练习 6 天，每天练习超过 25 分钟。实验组的腿部力量、并足平衡、移动性和步态、平衡信心和执行功能明显优于对照组。
短期太极拳课程导致老年人在课堂外进行大量的太极拳练习，身体和执行功能也得到改善。该课程在三个城市的参与率、保留率、保真度和实施情况表明，该 6 周课程具有很强的实施和传播潜力。
