Preventing falls with Tai Ji Quan: A public health perspective

This research from Stevens et al, bridges the gap between the world of research and implementation and provides some important recommendations for delivering Tai Ji Quan programmes in the community.

Background
Tai Ji Quan is a moderate intensity aerobic exercise that consists of continuous, rhythmic, and low impact movements. It addresses a number of important fall risk factors by improving leg strength, balance, coordination, postural control, mobility, and reducing fear of falling. Trials of have shown that Tai Ji Quan can reduce the risk of falls by as much as 28%; however, programmes appear to be most beneficial for healthy, and possibly transitionally frail, older adults, as opposed to older frail individuals.

The research outlines the following differences between those interventions carried out as part of an RCT, and those that are delivered within community settings:

Selection criteria: older adults participating in trials have been recruited according to strict selection criteria (age, functional ability, etc.), whereas Tai Ji Quan programmes implemented within the community are typically offered to everyone over the age of 60 years.

Frequency: older adults participating in trials attended classes two to three times a week for 15–26 weeks. Community classes are generally held once a week and programmes last, on average, between 8 and 12 weeks. Participants may attend as many or as few classes as they wish.

Instructors: programmes within trials of Tai Ji Quan programmes to date have used highly experienced instructors that taught one specific style. Programmes in the community are led by instructors with varying degrees of experience and who teach different styles of Tai Ji Quan.

Barriers and challenges to implementation:

It also recognises that capacity and infrastructure (e.g. training staff as instructors and running classes within existing venues), and the modification of programmes to suit different needs and abilities, which reduces its effectiveness in preventing falls, are common challenges and barriers to implementing evidence-based programmes. In addition, the research highlights the scale of training that will be needed if Tai Ji Quan programmes are to be implemented widely.

Challenges to adopting Tai Ji Quan are similar to those for other types of exercise programs for older adults: health and mobility issues, low interest in increasing physical activity, and concerns about injury. In addition, Tai Ji Quan faces some unique barriers. It may be seen as strange or foreign, which could make Tai Ji Quan less appealing to many people.

Recommendations for wide-spread implementation:

• A range of classes for different levels of ability (beginning, intermediate, and advanced) offered on an ongoing basis, and provided at times of the day which are likely to improve adherence, (e.g. older adults are more likely to attend classes offered between 9:00 am and noon rather than later in the day).
• Standardised training in Tai Ji Quan for falls prevention for existing instructors who are currently delivering general adult exercise, health and wellness programmes, (e.g. along the lines of practical short-term workshop programmes which have been developed to train Tai Ji Quan instructors with previous experience working with older adults, and who have an allied health or medical background, or are qualified exercise instructors).
• Participants encouraged to practice Tai Ji Quan at home, thereby increasing the effective “dose”, and offered supporting materials for use at home.
• Classes must be made accessible, both in terms of public transport and venues themselves (e.g. nearby parking, not having to climb a lot of stairs). Classes should be reasonably priced.
• Marketing of Tai Ji Quan should be given due consideration. Where possible, mechanisms for support and encouragement from friends, relatives and health professionals should be embedded with the programmes, as they can correct mistaken ideas about Tai Ji Quan, and support an older adult's confidence in his or her ability to carry out the programme.
• In order to ensure sustainability, organisations implementing Tai Ji Quan programmes should conduct evaluations to demonstrate uptake and effectiveness (e.g. showing no. of instructors trained; no. of classes conducted by each instructor; extent to which the programme reached the intended audience, including no. of people enrolled; no. that completed the program; and participant feedback about the perceived benefits of the programme). Maintaining reliable program resources, including ongoing funding support, is also essential for long-term sustainability.

For more information and to download a copy of the research, click here.