Oregon Research Institute, Eugene, OR.
Department of Exercise and Health Science, Willamette University, Salem, OR.
Med Sci Sports Exerc. 2019 Nov;51(11):2318-2324. doi: 10.1249/MSS.0000000000002051.
Emerging evidence indicates exercise training improves mobility and cognition and reduces falls in older adults, but underlying mechanisms are not well understood. This study tested the hypothesis that change in dual-task walking capacity mediates the positive effect of Tai Ji Quan and multimodal exercise on physical performance, activity confidence, global cognition, and falls among community-dwelling older adults at high risk of falling.
We conducted a secondary analysis of a 6-month randomized clinical trial comparing Tai Ji Quan: Moving for Better Balance (TJQMBB) and multimodal exercise to stretching exercise in a sample of 670 adults older than 70 yr who had a history of falls or impaired mobility. Distal outcome measures, ascertained at a 12-month follow-up, were the Short Physical Performance Battery, Activities-Specific Balance Confidence, Montreal Cognitive Assessment, and falls. The mediator hypothesized to account for the intervention effects was dual-task cost estimated by calculating changes in gait speed from single-task to dual-task walking from baseline to the end of intervention.
At 12 months, compared with stretching exercise, multimodal exercise significantly improved Short Physical Performance Battery and Activities-Specific Balance Confidence outcomes and reduced the number of falls (P < 0.05). However, it did not lower dual-task cost or mediate the intervention effects on distal outcomes. In contrast, TJQMBB significantly reduced dual-task cost relative to multimodal and stretching exercises (P < 0.05) which in turn resulted in improvements in lower-extremity physical performance, activity confidence, global cognitive function, and reductions in falls (P < 0.05) during follow-up.
Enhanced dual-task walking capacity as a result of Tai Ji Quan training mediated improvements in physical and cognitive outcomes in older adults at high risk of falling.
新出现的证据表明，锻炼训练可以提高老年人的活动能力和认知能力，并减少跌倒，但潜在的机制尚不清楚。本研究检验了以下假设：双重任务行走能力的变化介导了太极拳和多模式运动对身体表现、活动信心、整体认知和跌倒的积极影响，这些影响在有跌倒史或行动不便的社区老年人中更高。
我们对一项为期 6 个月的随机临床试验进行了二次分析，该试验比较了太极拳：移动以获得更好的平衡（TJQMBB）和多模式运动与拉伸运动在 670 名年龄在 70 岁以上、有跌倒或行动不便史的成年人中的效果。在 12 个月的随访中，采用短体物理性能电池、活动特异性平衡信心、蒙特利尔认知评估和跌倒来评估远端结果。假设干预效果的中介物是通过从基线到干预结束时计算从单任务到双重任务行走的步态速度变化来估计双重任务成本。
与拉伸运动相比，多模式运动在 12 个月时显著改善了短体物理性能电池和活动特异性平衡信心结果，并减少了跌倒次数（P < 0.05）。然而，它并没有降低双重任务成本或介导对远端结果的干预效果。相比之下，TJQMBB 与多模式和拉伸运动相比，显著降低了双重任务成本（P < 0.05），这反过来又导致了下肢身体表现、活动信心、整体认知功能的改善，并减少了跌倒（P < 0.05）在随访期间。
由于太极拳训练增强了双重任务行走能力，从而改善了有跌倒风险的老年人的身体和认知结果。
