Research Report
Balance and Functional Outcomes for Older
Community-Dwelling Adults Who Practice
Tai Chi and Those Who Do Not: A Comparative
Study
Deborah Bubela, PT, PhD1; Laddie Sacharko, MA2; Judy Chan, PT, DPT1;
Maegen Brady, PT, DPT1
ABSTRACT
Background and Purpose: A growing body of literature sub-
stantiates that Tai Chi is a form of exercise that may help older
adults increase strength, improve balance, lower fall rates,
and experience less fear of falling. Few studies, however, offer
controlled experimental design and simultaneously investigate
multiple factors known to contribute to fall risk. The purpose
of this study was to compare performance on measures relat-
ing to fall risk (strength, balance, functional mobility, and fear
of falling) in older community-dwelling adults who participated
in a community-based Tai Chi program with a control group
of their peers who had no Tai Chi training over the same time
period.
Methods: A quasi-experimental comparative pre- and post-
test design was used to compare an experimental group
of 16 community-dwelling older adults, mean (SD) age =
80.4 (6.8) years, participating in a 16-week Tai Chi training
program with a group of 13 adults, mean (SD) age = 71.2
(6.1) years, who had no Tai Chi experience in the areas of
knee extension strength (measured by handheld dynamom-
etry), functional strength (by five-time sit to stand), mobility
(by Timed Up and Go [TUG] test and Fifty-Foot Walk Test),
balance (by Functional Reach and Berg Balance Scale), and
fear of falling (by Activity-specific Balance Confidence scale).
Within-group and between-groups comparisons were made
using 2×2 mixed analysis of variance.
Results: Tai Chi participants improved in nearly all measures,
whereas controls did not. Tai Chi participants experienced
significant improvement in the TUG test during the training
period (P = .003), with significant difference when com-
pared with controls (P = .049) and moderate effect size and
1Physical Therapy Program, Kinesiology Department,
University of Connecticut, Storrs.
2Starfarm Tai Chi Qigong Search Center, Chaplin,
Connecticut.
The authors declare no conflicts of interest.
Address correspondence to: Deborah Bubela, PT, PhD,
Physical Therapy Program, Department of Kinesiology,
University of Connecticut, 3107 Horsebarn Hill Rd, Unit
4137, Storrs, CT 06269 (deborah.bubela@uconn.edu).
Kerstin Palombaro was the Decision Editor.
Copyright © 2017 Academy of Geriatric Physical Therapy,
APTA
DOI: 10.1519/JPT.0000000000000153
Journal of GERIATRIC Physical Therapy
Copyright © 2017 Academy of Geriatric Physical Therapy, APTA. Unauthorized reproduction of this article is prohibited.
observed power (ηp2 = 0.165; observed power = 0.512).
Significant knee extension strength improvement occurred
(P = .042) with moderate effect size and observed power
(ηp2 = 0.183; observed power = 0.543). While the total
balance confidence scale score did not change significantly,
responses on many individual items did reach a level of signif-
icant change for persons participating in the Tai Chi training.
Conclusion: Older adults’ participation in a community-based
Tai Chi program may lead to improvement in strength, mobil-
ity, and confidence in performing functional tasks. Incorpora-
tion of elements of Tai Chi into therapy programs for older
adults at risk for fall and referral to community-based Tai Chi
programs may be viable options in the continuum of health-
related care for older adults.
Key Words: fall risk reduction, older adults, Tai Chi
(J Geriatr Phys Ther 2017;00:1-7.)
INTRODUCTION
Tai Chi is a form of exercise that has evolved from its origin
in martial arts to the current practice of meditative move-
ments focusing on mind-body and body-environment inter-
actions. Tai Chi, as a form of traditional Chinese medicine,
offers 3 regulatory components: body focus that addresses
posture and movement control, breath focus to coordinate
respiration with movement, and mind focus that provides
a meditative element.1 Tai Chi is typically performed as a
series of choreographed movements designed to promote a
smooth balanced flow of energy through the body, increase
awareness of space through which movement occurs, and
enhance movement control.2-4 While there are several
forms of Tai Chi, basic principles serve as the foundation
in all. The practice of Tai Chi is grounded in the mind-body
connection such that the mind must be alert, but calm, as
the person increases awareness of the presence of the body
and its movement within space. The person practicing Tai
Chi maintains an erect, but relaxed, posture. Controlled
weight shift and axial rotation are integral components of
the various Tai Chi elements.2 The series of movements
within the Tai Chi form requires the coordination of body
segments originating from the waist and upper hips and
progressing to the distal extremities while maintaining
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 Research Report
a semisquat position. The practice of Tai Chi involves
repeated motions, with the degree of movement being self-
regulated by each individual such that the person is func-
tioning within his or her safe movement range.
The repetitive controlled movements of Tai Chi may
theoretically allow for motor learning and address many of
the foundational building blocks of gross motor functional
mobility. Even more specifically, Tai Chi may be beneficial
in addressing many of the observable changes that occur
in association with advancing age including documented
reduction in trunk and limb mobility,5 diminished mus-
cle strength,6 and the tendency toward flexed posture
and impaired upright balance.7 We hypothesize that the
repetitive motions that gently expand range of movement,
increase body awareness, and promote motor control may
also enhance an individual’s confidence and diminish fear
of falling, which contributes to fall risk in older adults.8
Indeed, some of these theoretical assumptions of Tai
Chi’s benefits have been validated by empirical study. For
example, healthy community-dwelling persons older than
50 years experienced a significant increase in the knee
extensor endurance ratio after practicing Tai Chi daily for
a 6-month period.3 In a cross-sectional study comparing
older adults who participated in Tai Chi for longer than
1 year with older nonparticipants and with healthy young
subjects, the older Tai Chi practitioners demonstrated sig-
nificantly better balance control under visual and vestibular
challenging conditions than did nonparticipating older
adults to the point that the older Tai Chi practitioners actu-
ally obtained the same balance control as young healthy
subjects.9 Frail older adults participating in supervised Tai
Chi exercises as part of their rehabilitation program expe-
rienced greater benefits than those receiving only conven-
tional physical therapy exercises.10 On the basis of evidence
review, the Centers for Disease Control and Prevention
(CDC) recommends that older persons reduce their risks
of falls by exercising regularly with activities that focus
on increasing leg strength and improving balance11,12 and
suggest that Tai Chi may be one such form of exercise.13
Tai Chi was also added as an exercise option to reduce fall
risk in The American Geriatrics Society Clinical Practice
Guidelines: Prevention of Falls in Older Persons.14
The growing body of literature investigating Tai Chi’s
efficacy supports its use to improve health. Early systematic
reviews of Tai Chi’s use as a rehabilitation intervention
were inconclusive, with positive effects being influenced
by factors such as age, level of frailty, attendance, and
study duration, with Tai Chi being most effective for the
relatively young who are not frail.15,16 A meta-analysis of
9 controlled studies found that older adults participating in
Tai Chi demonstrated improved balance, lower fall rates,
and less fear of falling than exercising controls.17 Another
comprehensive review by Jahnke et al4 identified 77 articles
that investigated Tai Chi’s efficacy in a variety of popula-
tions: healthy adults, older adults, and persons with medi-
cal diagnoses including arthritis, cardiac abnormalities,
and high blood pressure. Despite the diversity of studies
2 Volume 00 • Number 0 • Month-Month 2017
Copyright © 2017 Academy of Geriatric Physical Therapy, APTA. Unauthorized reproduction of this article is prohibited.
represented in the review, most studies demonstrated
significantly positive effects of Tai Chi on various medically
oriented outcomes and functionally based health-related
outcome measures, especially when comparing those who
practiced Tai Chi with those who were minimally active or
inactive. Tai Chi seemed to have less effect when partici-
pants had compromising medical conditions with multiple
comorbidities or when practice occurred with relatively
low intensity or frequency of less than 8 weeks. The find-
ings of this comprehensive review of literature unequivo-
cally concluded that Tai Chi had no adverse effects for
those practicing this form of exercise.4 An even more recent
review of Tai Chi–related literature spanning 2 decades
supported Tai Chi as having substantial impact on health
and health behaviors in older adults.18 This review by
Hackney and Wolf18 supports the implementation of Tai
Chi groups as an economical means of providing balance
training for older adults and recommends specifically con-
sidering the mechanisms of Tai Chi that lead to functional
improvement including lowering fall risk.
This study considers the effects of community-based
Tai Chi programs on participants’ gross motor ability in
areas known to contribute collectively to fall risk, namely,
strength, balance, functional mobility, and fear of falling.
The purpose of this study was to compare performance on
measures relating to fall risk (strength, balance, functional
mobility, and fear of falling) in older community-dwelling
adults who participated in a 16-week community-based Tai
Chi program with a control group of their peers who had
no Tai Chi training over the same time period.
METHODS
Study Design
This study utilized a quasi-experimental pre- and posttest
design allowing comparison of an experimental group with
a control group. This study was approved by the institu-
tional review board at the University of Connecticut, and
written informed consent was obtained from all partici-
pants prior to their participation.
Subjects and Recruitment
A convenience sample of persons enrolled in the local senior
citizen center Tai Chi class comprised the experimental
group. The group consisted of 16 participants (8 males, 8
females); of those, 85.7% had previous Tai Chi experience
in the recent past. The average (SD) age of the experimental
group was 80.4 (6.8) years. The control group comprised
volunteers who learned of the study primarily by word of
mouth. Fourteen community-dwelling older adult volun-
teers (6 males, 8 females) were recruited for the study with
an average (SD) age of 71.2 (6.1) years. To be included in
the study, subjects in either group had to be community-
dwelling and English-speaking, aged 55 years or older,
who ambulated independently with or without an assistive
device. There were no specifications with respect to gen-
der, income, or educational level. Individuals with recent

cardiac or neurological changes in medical status or surgi-
cal procedures within the last 6 months were not included
in the study. In both groups, subjects reported various long-
standing cardiac, hypertension, and arthritic issues.
Testing Procedure and Outcome Measures
Members of the Tai Chi experimental group were tested
1 week prior to the start of training and within 1 week of
completion of the Tai Chi program. Testing for the control
group was performed 16 weeks apart. The testing was
conducted by a trained physical therapist and 2 physical
therapy graduate students, with pre- and posttest measures
done by the same tester to ensure consistency. Intrarater
reliability was established with interclass correlation (ICC)
> 0.85. Outcome measures were utilized to assess 4 factors
known to contribute to fall risk: strength, balance, func-
tional mobility, and fear of falling.
Two measures of strength were conducted, one to assess
maximal force generated by the knee extensors and the other
to measure functional strength. Knee extensor strength was
quantified using a handheld dynamometer (HHD). Subjects
were seated in a standard chair with both feet planted on the
ground before starting. The instrument was positioned at
the bottom third of the tibial shaft, and the tester instructed
subjects to take 2 to 3 seconds to come to their maximum
strength and then push with maximum force against the
instrument for another 5 seconds. Functional strength was
measured by the five-time sit to stand (FTSTS). Subjects
were instructed to come to a full stand from a seated posi-
tion when “Go” was announced, to return to a seated posi-
tion, and to repeat 4 additional times with someone count-
ing out loud as each repetition was performed. They were
instructed to perform this task as quickly as possible without
use of upper extremity support while being safe. The timer
was started at the same time as “Go” was announced and
stopped when they came to a full sit after the fifth stand.
The FTSTS is a reliable measure (ICC = 0.89), with a 66%
sensitivity rate and a 67% specificity rate for community
dwellers and persons older than 60 years.19
Balance was measured using Functional Reach (FR) and
the Berg Balance Scale (BBS), both of which were adminis-
tered using standard protocol. The FR test has high test-retest
reliability and has been found to be associated with risk for
falls. The BBS is a highly reliable measure (>0.95) that can
be used as an assessment or a screening tool and is one of the
most commonly used tools for assessing balance.20
Functional mobility was assessed using both the Timed
Up and Go (TUG) test in the standard manner and a Fifty-
Foot Walk Test (FFWT). The TUG is a highly sensitive and
specific (87% for both) outcome measure that is used to
assess functional mobility and predict falls in community-
dwelling older adults.20 The FFWT, a component of the
Modified Physical Performance test, is an easily and quickly
administered measure of short-distance ambulation that has
been shown to have a high ICC for older adults with a vari-
ety of conditions.21,22 Because of area constraints, subjects
were instructed to perform the FFWT by walking as quickly
as possible 25 feet toward a target, turn, and walk back.
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Research Report
All participants were asked to complete the Activity-
specific Balance Confidence (ABC) scale to rate their fear of
falling. The scale asks respondents to rate their confidence
in performing 16 functional tasks, with responses rang-
ing from 0% confidence, representing an activity that the
subject will not perform, to 100% confidence such that the
person has full confidence in performing the task without
threat to safety. Each item was read to the subject by a
tester, and the answer was recorded by the tester. The scale
has good test-retest reliability (r = 0.92) and high internal
consistency (Cronbach α = 0.96).20
Intervention
The Tai Chi class was offered at a local senior citizen center
as part of a fall prevention training program. The class was
offered 5 days per week, and participants could choose to
attend 1, 2, or 3 days weekly. Attendance was taken, and
those subjects regularly participating 2 to 3 times a week
were included in the study.
The Tai Chi instruction protocol was implemented as
specified in Tai Chi: Moving for Better Balance, A Guide
for Program Implementation, one of the first evidence-
based fall intervention guides introduced by the CDC.
Initially developed as a tool kit for community use, it is
currently offered as an exemplar of evidence-based preven-
tion programs by the CDC.23 The one exception to the
protocol was the duration of the program; while the guide
specifies a 12-week duration, this program was offered for
16 weeks as recommended by Dr Li (oral communication,
May 2011), with the training instructor, an experienced Tai
Chi master certified by Dr Li, to teach the program.
Each session was 60 minutes long, with a 10-minute
warm-up utilizing traditional Tai Chi exercises and activities
recommended in the original version of the training. The
Tai Chi program concentrated on the proper execution of
each of the 8 Tai Chi exercises or “movements” specified by
the protocol. Concentrated practice of 1 or 2 of the move-
ments occurred during each class session along with review
of previously learned activities. The practice emphasized
overall posture, upper and lower limb positioning, trunk
rotation, unilateral and bilateral stance, and stepping in
forward, backward, sideways, and diagonal directions. Tai
Chi exercises were performed with slow, balanced move-
ments with emphasis on weight shifting from a double-leg
stance to a single-leg stance, controlling center of gravity
and base of support, coordinating upper and lower extremi-
ties, and rotating the trunk. Participants were encouraged to
perform movements throughout the entire range in which
they felt safe. Some time was spent developing a sequence
of the movements to challenge faster learners. Practicing
the sequence was used for cooldown at the end of the
training period. Time was allotted during each class for
questions and demonstrations as requested by participants.
Participants were encouraged to practice daily at home.
For the control group, researchers requested that the
group members continue with their typical daily rou-
tines following initial testing. Some control group mem-
bers reported doing little to no exercise, whereas others
3
 Research Report

participated in a variety of exercise such as walking and
light resistance activities. Control group members returned
for testing 16 weeks after their initial session.
Statistical Analysis
All statistical analyses were conducted using SPSS version
15 with an α level of .05. Between-groups and within-group
characteristics and performance on each outcome measure
were compared before beginning training and after the
16-week period. The main effects of group and time for
all measures were explored using a 2 (group) × 2 (time)
mixed analysis of variance with those factors identified as
being initially different between the groups, that is, age and
knee strength being accounted for as covariates. In addition
to the cumulative score of the ABC scale, individual items
on that scale were also analyzed. Given the relatively small
sample size, Cohen’s d values were calculated to determine
the effect sizes of changes.24
RESULTS
Initial comparison of the intervention and control groups
identified 3 significant differences in group characteristics
and member performance. First, the average (SD) age
of persons participating in the Tai Chi group was 80.4
(6.8) years, which was significantly different (P = .00) by
being nearly a decade older than that of the control group,
mean (SD) = 71.2 (6.1) years. The second difference was in
strength such that the control group demonstrated greater
lower extremity strength than the Tai Chi group as mea-
sured by force production of knee extensors bilaterally (left
knee: P = .02; right knee: P = .00). The third difference
was in the participants’ reported confidence for one of the
questions on the ABC scale, namely, members of the con-
trol group initially indicated greater confidence than mem-
bers of the Tai Chi group when asked how they felt about
standing on a chair and reaching for an object (P = .00).
Besides these 3 factors of age, strength, and confidence, no
other significant differences were found upon the initial
comparison of the 2 groups.
All 16 participants in the Tai Chi training group were
able to complete the 16-week program and were available
for follow-up reassessment. One of the 14 members of the
control group was unable to return for posttest assessment
because of relocation; therefore, pre- and posttest compari-
sons were done for the 13 participants who were available.
In general, individuals within the Tai Chi group exhibited
improvements in performance on several measures follow-
ing training whereas the control group did not exhibit any
statistically significant changes in any of the test scores over
the 16-week period. See the Table for pre- and posttest data
for the training group and the control group.
Participants of the Tai Chi group improved their func-
tional mobility as demonstrated by a significant change
in their TUG scores, whereas a slight insignificant change

Table. Pre- and Posttest Outcome Measure Performance for Older Adults Participating in the Tai Chi Training Group and Those in the
Control Group (in Italic)
Pretest Score, Posttest Score, Significance Effect Size
Measure Mean (SD) Mean (SD) (P Value) (Cohen’s d)
Five-time sit to stand, s 16.1 (6.5) 15.3 (7.4) .06 0.45
13.5 (3.6) 13.4 (5.0)
Functional Reach, cm 30.8 (8.5) 28.8 (7.3) .23 −0.25
29.9 (9.7) 27.5 (4.9)
Timed Up and Go, s 10.9 (5.9) 9.6 (4.8) .00a 0.24
8.4 (2.7) 8.2 (2.9)
Left knee extension strength, kg 11.4 (2.3) 15.9 (5.2) .02a 1.07
17.4 (5.9) 17.0 (4.9)
Right knee extension strength, kg 11.7 (2.1) 15.9 (4.3) .02a 1.17
19.5 (5.2) 18.3 (5.6)
Activity-specific Balance Confidence scale #3, 80.6 (23.6) 92.6 (11.1) .04a 0.65
percent confidence
93.9 (13.6) 92.7 (20.6)
Activity-specific Balance Confidence scale #6, 37.5 (27.1) 60.6 (31.0) .02a 0.79
percent confidence
68.4 (35.5) 75.6 (34.8)
Activity-specific Balance Confidence scale #11, 85.3 (17.0) 95.6 (6.0) .05a 0.81
percent confidence
92.3 (17.1) 95.2 (8.7)
Activity-specific Balance Confidence scale #16, 44.1 (29.5) 59.1 (22.5) .02a 0.57
percent confidence
56.8 (30.0) 61.1 (33.5)
aStatistical significance was set at α level = .05.

4 Volume 00 • Number 0 • Month-Month 2017

Copyright © 2017 Academy of Geriatric Physical Therapy, APTA. Unauthorized reproduction of this article is prohibited.

occurred in the control group’s TUG scores. Comparison
of the 2 groups over the training period through analysis
of variance (ANOVA), with age and initial knee strength
accounted for as covariates, indicated significant differ-
ences (P = .049) and moderate effect size and observed
power (ηp2 = 0.165; observed power = 0.512).
The second significant difference found in the Tai Chi
group after intervention was in knee extension strength.
The Tai Chi group showed a mean increase of 10 pounds
of force production, with HHD measurements improving
significantly on both the left and right sides with a very
high effect size The change in knee extension strength in
the control group was not statistically significant, with the
trend being toward a decrease in force production on both
the left and right sides. Comparison of the 2 groups over
the training period through mixed ANOVA, with age and
initial knee strength accounted for as covariates, indicated
significant differences in the right knee extension strength
(P = .042) and moderate effect size and observed power
(ηp2 = 0.183; observed power = 0.543).
While changes in functional strength as measured by
the FTSTS did not reach a level of statistical significance in
either group, improvements in performance occurred more
so in those participating in Tai Chi than in the control group.
The total ABC scale scores did not change significantly
in either the intervention group or the control group after
the 16-week period. Those individuals participating in the
Tai Chi training, however, reported significant increase
in self-reported confidence on several items on the ABC
scale, with moderate to high effect sizes. These particular
questions were as follows: “How confident are you that
you will not lose your balance or become unsteady when
you…: ABC #3 ‘bend over and pick up a slipper off the
floor?’ ABC #6 ‘stand on a chair and reach for something?’
ABC #11 ‘walk up or down a ramp?’ and ABC #16 ‘walk
outside on icy sidewalks?’” The control group’s confidence
ratings on the ABC items showed no statistically significant
changes over the 16-week period.
No significant changes were identified in either group’s
performance in any of the other outcome measures used to
assess balance or functional mobility. Comparison of the
2 groups through mixed ANOVA, with age and initial knee
strength accounted for as covariates, indicated significant
differences in question ABC #1 “How confident are you
that you will not lose your balance or become unsteady
when you are walking around the house?” (P = .022) and
moderate effect size and observed power (ηp2 = 0.217;
observed power = 0.656). Comparison of the 2 groups after
the 16 week period indicated that the group participating in
Tai Chi improved to the point that no significant differences
were found in the strength or confidence between the two
groups as had been present on initial assessment despite the
fact that the control group was nearly a decade younger.
DISCUSSION
The findings of this study support the viability of com-
munity-based Tai Chi training as a means of improving
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Research Report
older adults’ performance of indicators associated with
fall risk, that is, functional mobility, strength, and fear
of falling. Older adults participating in a Tai Chi train-
ing group experienced improvements in several outcome
measures, whereas nonparticipants demonstrated no such
improvements over a 16-week period. The changes in these
measures indicate improvement in functional ambulation,
strength, and confidence for older adults participating in
structured Tai Chi activities. While previous studies of Tai
Chi have examined the training effects on strength or bal-
ance of program participants, this study uniquely provided
a comparison of a group of older adults participating in
community-based Tai Chi with a control group of their
peers who have never participated in that form of exercise.
The study also included the examination of older individu-
als’ personal perception of confidence in performing func-
tional movement-related tasks.
The significant improvement in the TUG score of those
participating in the training program may indicate Tai Chi’s
potential usefulness for improving functional mobility in
older adults. The Tai Chi group’s initial mean TUG score
of 10.87 seconds was typical of the normative reference
value of a group aged 80 to 99 years (mean 11.3, 95% CI
10.0-12.7)25 and was therefore consistent with the value
expected of the group with an average age of 80.4 years.
After Tai Chi intervention, the average score of 9.59 sec-
onds was more within the range expected of the 70 to 79
years age group (mean 9.2, 95% CI 8.2-10.2)25 than the
score expected of persons in their 80s. The control group
did not experience these same improvements and in some
measures actually demonstrated a trend toward decline
expected with advancing age.
Adequate knee extension strength is necessary for the
performance of everyday activities including transfers and
ambulation. Findings from this study support previous
publications that found that those participating in the
Tai Chi training exhibited a significant increase in lower
extremity knee extension strength as measured by an HHD
bilaterally.3 Unlike the Tai Chi participants, the control
group’s performance declined but not with statistical sig-
nificance. With consideration of functional strength, the
Tai Chi group’s performance on the FTSTS improved to
a level that approached significance whereas the control
group’s performance did not. These positive results sup-
port the value of Tai Chi training as a practical means for
significantly increasing force production and improving
functional lower extremity strength in older adults.
While improvement was found in older adults’ perfor-
mance on most outcome measures after participating in
Tai Chi training, statistically significant change was not
reached in some measures, namely, the BBS, FR, and the
FFWT. The subtle changes in balance occurring over the
16-week period may not be captured in the BBS scoring
mechanism, which requires the evaluator to rate the per-
son’s performance based on specific descriptions given in
the instrument. Perhaps, timed components of the BBS, such
as tandem stance and one-leg stance, would have provided
5
 Research Report
information that was better indicative of change in balance
than consideration of the BBS total score. The small sample
size and the tendency for persons to stay in their comfort
zone of reach and self-selected walking pace may explain
the lack of change in the FR and FFWT measures.
This study uniquely investigated the psychosocial aspect
of Tai Chi’s effects on older individuals by quantifying
confidence in movement and thus giving insight into an
individual’s fear of falling. Lack of confidence in mov-
ing can lead to a negative cascade of events including
development of fear avoidance behaviors, diminished
independence, increased risk of falls, and consequently
compromised quality of life.8 This study showed significant
changes in individual’s perceived confidence in perform-
ing specific functional tasks following participation in Tai
Chi as measured by the ABC scale. Score improvements
indicate increased confidence in both static and dynamic
balance associated with such important daily activities as
walking around their homes, cleaning, dressing, bathing,
and reaching for items. Participants in the Tai Chi group
also indicated increased confidence to navigate a ramp
and manage challenging outdoor mobility as experienced
functionally in driveways, walkways, and entrances to resi-
dences or businesses. Such confidence in navigating these
inclines and challenging weather conditions may translate
into improved community participation for older adults.
Findings from this study supported the Tousignant et al10
claim that Tai Chi may promote older adults’ self-efficacy
with respect to fall prevention.
The results of this study support community-based Tai
Chi training as a means of positively affecting older adults’
lower extremity strength and functional mobility, as well
as their confidence in performing movement-related tasks.
Regular engagement in a Tai Chi regimen may help delay
some of the loss of mobility and strength associated with the
aging process and implies the possibility of improving these
facets of motor performance once decline has occurred.
Limitations
This study has limitations in both sample and design. First,
the sample size of both groups was relatively small (Tai
Chi: n = 16; control: n = 13), making it difficult to gener-
alize conclusions, identify training effects, or analyze based
on subgroups. The lack of randomization and use of con-
venience sampling led to the creation of groups with char-
acteristics that could affect the outcome, specifically results
associated with ceiling effects. For example, there was no
control for variables such as level of previous Tai Chi expe-
rience, which ranged from weeks to years. Given that the
most pronounced improvements may occur early in train-
ing, this sample of experienced Tai Chi practitioners may
have shown change scores that were comparatively low rel-
ative to novices. With positive effects having been measured
up to 6 months following intervention, Li et al26 cautioned
that limited changes may occur with persons with previ-
ous Tai Chi experience. Thus, it can be hypothesized that
individuals without any previous Tai Chi experience would
6 Volume 00 • Number 0 • Month-Month 2017
Copyright © 2017 Academy of Geriatric Physical Therapy, APTA. Unauthorized reproduction of this article is prohibited.
demonstrate even greater change scores than experienced
persons. Future research involving participants with no Tai
Chi experience may be beneficial in ascertaining the true
effect of the Tai Chi exercise. On the contrary, participants
in the control group were all relatively healthy and younger
than participants in the training group, with limited room
for improvement from their initial baseline. While both the
intervention and control groups were potentially limited
by a ceiling effect, the Tai Chi group’s performance did
continue to improve.
While the significant age difference between the inter-
vention and control groups could be viewed as a threat
to group equality, the positive changes experienced by the
older Tai Chi participants are only reinforced by such a dis-
parity. Given the positive trends in individuals participat-
ing in Tai Chi on virtually all performance measures, it is
anticipated that statistically significant changes may occur
if sample size increased and previous Tai Chi experience
was controlled.
CONCLUSION
Tai Chi may lead to improvement in strength, mobility, and
confidence in older adults that collectively may contribute
to reducing fall risk in this population. Tai Chi’s focus on
body awareness and relaxed postural control serves as a
foundation on which to build dynamic control. An indi-
vidual’s movement repertoire can be enhanced through the
repeated subtle weight shifts and transfers, trunk rotation,
and controlled extremity movement within increasing self-
regulated ranges. The repetition of the series of Tai Chi
activities affords the optimal motor learning experience.
Principles and specific elements of Tai Chi can be incor-
porated into traditional physical therapy practice as part
of neuromuscular reeducation. Community-based Tai Chi
programming can also be considered as an adjunct to direct
therapy in appropriate cases or as a viable option within
the continuum of physical activity programs designed to
promote wellness and fall prevention for groups of persons
who are at risk for falls. The results of this study support
the CDC’s endorsement of Tai Chi as a means of fall pre-
vention in older community-dwelling adults.
ACKNOWLEDGMENT
Recruitment for this investigation was done with the assis-
tance of the Mansfield Senior Center.
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