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Study: Tai chi improves balance in Parkinson's patients
February 8th, 2012
05:01 PM ET

Study: Tai chi improves balance in Parkinson's patients

Researchers and aficionados of the ancient Chinese art of tai chi are already aware of how this moving meditation can help reduce stress and improve balance.  Now a new study finds that the gentle flowing motions of this so-called "soft martial art" can help improve balance problems commonly suffered by Parkinson's patients.  The study finds that bi-weekly tai chi training improved balance and reduced falls among a group of patients with mild to moderate Parkinson’s disease.

“While medication can relieve some, but not all Parkinson's symptoms such as tremors, rigidity and slowness,” explained lead author Fuzhong Li of the Oregon Research Institute, “Tai chi helped patients improve their posture and balance.”  The study was published in the New England Journal of Medicine Wednesday.

Every day, up to a million Americans are coping with Parkinson’s disease, one of the most common nervous system disorders among the elderly. Parkinson's patients lose muscle function because nerve cells in a certain part of the brain that produce dopamine are slowly destroyed and the brain can no longer properly send messages.  As a results, patients develop characteristic tremors of the hands, arms, legs, jaw and face, as well as poor posture and difficulty maintaining balance, among many other possible symptoms.

Li explained that exercise is an important part of treatment for Parkinson’s patients, helping them to increase and retain their mobility.  The authors conducted a clinical trial that included 195 patients with mild to moderate Parkinson’s. They were randomly assigned to one of three exercise groups that performed one hour of exercise, twice a week for 24 weeks.  The exercises were tai chi, resistance training, or stretching.

The patients in the tai chi group learned six movements that were combined into a routine.  Tai chi requires participants to use conscientious controlled use of muscles, combined with balance shifts and trunk movements. “Imagine standing on a moving bus,” Li explained, “And when the bus turns a corner and changes speed, you need to shift your balance and move your feet to remain stable.  That’s similar to how the tai chi training works.”

Participants were evaluated when the study began, at three months, six months and again three months after the trial ended.  Patients in the tai chi group improved posture stability and balance, compared to people in the resistance training and stretching groups. Tai chi also reduced falls, and the study notes: “Falls are a common and sometimes life-threatening event in patients with Parkinson’s disease.  However, to our knowledge, no clinical trial has shown the efficacy of exercise in reducing falls in this population.”

The tai chi movements involved controlled swaying using ankles and hips, which helped patients to increase their stability, Li explained, adding “Exercise can be an integral part of the treatment for Parkinson’s disease, and tai chi can be used as a self-care activity that patients can do at home, requiring no special equipment.”

The Parkinson’s Disease Foundation also echoes the importance of using exercise as part of a multifaceted treatment program, which may also include prescription drug therapy, and deep brain stimulation therapy to control Parkinson’s symptoms. “Regular exercise or physical therapy is crucial for maintaining and improving mobility, flexibility, balance, and range of motion,” their website notes, adding that researchers believe exercise may play a part in preventing the progression of the disease.


soundoff (26 Responses)
  1. Neil

    Tai Chi is great for balance and flow.....

    Neil
    Tinnitus Magazine

    February 9, 2012 at 01:55 | Report abuse | Reply
  2. rick

    it looks like it would be

    February 9, 2012 at 08:43 | Report abuse | Reply
  3. Maelius

    Can anyone say, duh?

    February 9, 2012 at 09:40 | Report abuse | Reply
    • dan-o

      All of us who regularly practice tai chi know instinctively the amazing health benefits we receive. Yes, to us these findings are a big "DUH!" But to the general medical community (particularly the neurophysiological community), legislators, the public health policy makers, and the bureaucrats who control the $$$, our warm, fuzzy feelings about the benefits tai chi are worthless. They hold to a much higher standard when awarding grants to states for the purpose of implementing alternative interventions such as tai chi (the buzzword is "evidence based"; you may want to get familiar with this term).

      Essentially, the test protocol was a set of therapeutic exercises for improving static and dynamic postural stability all wrapped up in a tight little "tai chi" wrapper. The Yang style movements were selected, slightly modified, and sequenced into a bilaterally symmetric form by exercise physiologists, neurologists, certified physical/occupational therapists, geriatricians, and certified T'ai Chi instructors. True, the resulting form is not absolutely faithful to classic T'ai Chi Ch'uan principals due to the therapeutic movement "enhancements", but these modifications, to the untrained eye, are practically unnoticeable. And to the target community (i.e. Parkinson's patients) they are virtually indistinguishable from classic T'ai Chi.

      February 11, 2012 at 02:29 | Report abuse |
    • Grant

      Community based tai chi programs vary seocidnrably; they emphasize different elements of the Tai Chi practice and they utilize varying models of instructional delivery. It is very important to find the right match for persons seeking to join a movement- based activity program in the community. Laddie Sacharko is a master Tai Chi instructor who delivers exceptional programming to multiple age groups. Laddie has a keen ability to analyze movement that is on par with trained physical therapists. He conveys knowledge holistically throough cognitive, visual and kinesthetic activities that enhance the learner's awareness and execution of movements. Everyone leaves his training session having experienced a new appreciation for movement.

      March 3, 2012 at 21:10 | Report abuse |
  4. Leprakawn

    @Marlius:

    I came over here to say pretty much the same thing. I mean come on, "news." Really? And it is not just Parkinson's patients... They could have/should have done the same study on people with CP and HSP.

    February 9, 2012 at 10:30 | Report abuse | Reply
    • Leprakawn

      *Maelius (Obviusly did not ctrl+c/+v that time. 'Doh!)

      February 9, 2012 at 10:32 | Report abuse |
    • dan-o

      Uh, yeah...! This is definitely news. It is the first peer-reviewed, randomized controlled trial of the efficacy of Tai Chi in reducing balance impairments in patients with mild to moderate PD. This is science. Nearly every other claim you read or hear about the health benefits of Tai Chi (and I am a believer in most of these) are unsupported by clinical evidence.

      Cerebral palsy (CP) involves abnormal musculoskeletal development, usually from birth; secondary conditions include seizures, epilepsy, apraxia, dysarthria or other communication disorders, sensory impairments, mental retardation, and learning disabilities. A relatively very small percentage of this population, compared to Parkinson's patients, is capable of the coordinated, controlled movements near the limits of postural stability that are the foundation of this Tai Chi program.
      Parkinson's Disease, on the other hand, is a progressive, degenerative disorder of the CNS (not muscular or skeletal) and most cases develop after the age of 50. PD sufferers typically have normal development and are generally mobile and functional even after initial onset of symptoms. Because the study was limited to patients in stages 1 through 3 on the UPDRS, they have the capability to learn and practice all 3 exercise interventions (Tai Chi, resistance, stretching) involved in Dr. Li's program.

      Hereditary spastic paraplegia (HSP) is a genetic disorder and is classified as a "rare disease" by the NIH. Currently there are about 200,000 cases in the U.S. Parkinson's, on the other hand, is the second most common neurodegenerative disorder after Alzheimer's disease, with approx 950,000 cases in the U.S. (2010). Do the math. It's just putting the money where it will do the most good.

      February 11, 2012 at 02:21 | Report abuse |
    • Leprakawn

      @dan-o:

      Well, not like it is a bad idea to see what condition has the best bang for the buck, right? And those two came to mind for obvious reasons, but I am sure there are plenty of other disabilities that could/should be tested as well.

      March 31, 2012 at 22:59 | Report abuse |
  5. Leprakawn

    ...Criminy. Obviously I need to read it a little better [i]before[/i] hitting the post button.

    February 9, 2012 at 10:34 | Report abuse | Reply
  6. Paul

    Why did these researchers compare Tai Chi with resistant training and stretching? Why did they not compare Tai Chi with slow line dancing? Because that comparison would have shown Tachi is less effective than slow line-dancing in improving balance in Parkinson's patients! What a faulty, self-serving research design!

    February 9, 2012 at 13:42 | Report abuse | Reply
    • dan-o

      The resistance training (RT) used by one of the three random groups focused on strengthening the muscles that are important for posture, balance, and gait. RT is representative of several exercise programs that emphasize strength, conditioning and/or agility training, and it is suitable for stage 1 thru 3 PD patients in that it is generally familiar, scalable, progressive, and can be modified individually for students with physical limitations. What these types of strength programs generally ignore are the sensory systems (visual, vestibular, somatosensory) that are critical for balance and effective movement. Furthermore, these types of exercise programs do practically nothing to stimulate cognitive processes in the participant. (Cognitive impairment (CI) commonly occurs during advance stages of PD, and slight symptoms of CI were noted in several of the participants. CI is a risk factor for falls.)

      Dr. Li's version of tai chi, on the other hand, focuses not only on strengthening those posture & balance muscles, but also stimulates the three essential sensory systems in special ways so that, with training, they provide improved posture/balance/movement information and feedback to the brain. The slow, controlled, "mindful" movements were expected to better integrate all of these elements than exercising & stimulating them separately; in other words, the mind-body connection of tai chi was put to the test. The integration of all of these musculoskeletal and sensory systems were clinically assessed (pre, post, and 3-mo follow-up) using state-of-the-art, computerized tools for the assessment and rehabilitation of balance and mobility disorders. (Check out http://www.onbalance.com.) The data don't lie... The tai chi group performed consistently better than the RT and stretching groups.

      This study was designed, in part, to compare this more "complete" balance therapy specifically to RT (for the reasons stated above). The stretching group was essentially a control, since there were no appreciable strength, sensory, or sensory integration aspects to those types of training.

      Andrew Feigin, a neurologist specializing in Parkinson’s disease at the North Shore-LIJ Medical Group in Great Neck, New York, said the findings give scientific backing to doctor recommendations that patients try exercises like tai chi to improve balance. “Balance and gait are problems that people with Parkinson’s disease have,” said Feigin (not one of the study's authors). “Things like stretching and resistance aren’t really working on balance. Tai chi really focuses on improvements in balance. It’s nice to get some actual data that shows doing those things can be helpful.”

      Almost any form of exercise, even line-dancing, will have some measurable positive effect on Parkinson's patients. Since (as far as I know) there have, as yet, been no randomized controlled trials, conducted by any competent organization using scientific (WESTERN!) methods, on the efficacy of line-dancing in reducing falls and improving balance in PD patients, I am going to assume you are joking. I am willing to be convinced, but you had better be willing to show me the data.

      February 11, 2012 at 02:23 | Report abuse |
  7. PRINCE

    I am 76 and I study Tai Chi Chuan. I have never studied slow line dancing because I am of the generation that thinks that line dacing is ridiculous. I do find that Tai Chi Chuan improves my balance, flexibility, etc.

    February 9, 2012 at 14:58 | Report abuse | Reply
    • Paul

      I agree. So you knew (we all knew) Tai Chi improves balance before reading this expensive "research" which compares Tai Chi with resistance training or weight lifting. The research money could have been much better spent.
      By the way, If a person is suffering from Parkinson's disease and wants to improve his balance, he is advised to use the most beneficial method which has been tested by a well designed, solid research, not by this one which made ridiculous comparisons.

      February 9, 2012 at 15:24 | Report abuse |
  8. PRINCE

    Most research is flawed

    February 9, 2012 at 15:35 | Report abuse | Reply
    • Paul

      But this one must have been designed by an undergraduate student for this fourth year thesis in psychology or kinesiology

      February 9, 2012 at 15:55 | Report abuse |
    • Senthilkumar

      like to support our cause of kmiang healthcare better for all with a free market model then please go vote for us by clicking the badge

      March 5, 2012 at 21:37 | Report abuse |
  9. Chris

    It has always amazed me how adaptive the human body can be even in a complex motor disease state such as Parkinson's disease. Currently Tai chi has an Evidence Grade C rating from Natural Standard (That Authority on Integrative Medicine). This evidence rating is derived from a professional’s review of the existing literature followed by a rigorous peer review and standardization processes. The resultant evidence rating of Grade C means that the pertinent evidence from the literature that has been reviewed is inconclusive as to the efficacy of the intervention. However this new study looks rather powerful (given the indication concerned, population size and quality of life driven endpoints) and as such the evidence for Tai chi in Parkinson's patients may be mounting. With the science aside however I theoretically agree with the sentiment expressed in this article and by the authors of the study in that exercise induced stimulation of motor related dopaminergic pathways should be an essential part of a multi-faceted treatment approach in Parkinson's patients.

    February 9, 2012 at 18:11 | Report abuse | Reply
  10. seeya

    very helpful for the people .and thanks for posting this.Canada Medical Supplies

    February 10, 2012 at 07:27 | Report abuse | Reply
  11. Shannon

    As Chris said above, Natural Standard (www.naturalstandard.com), which is a leading database on integrative medicine, gives Tai Chi an evidence grade of C for Parkinson’s meaning that scientific evidence is unclear or conflicting. Therefore, more studies are needed to support its use in aiding Parkinson’s patients. Medicine is practiced based on evidence from scientific trials. Therefore, if some treatment has evidence that is unclear or conflicting more studies need to be completed in order to recommend that treatment to a patient. Also, risks and benefits are weighed for a specific patient when choosing treatment, especially when evidence is conflicting. I am interested in actually reading this study. Based on this article, the study seems promising. Parkinson’s is such a debilitating disease in which patients might greatly benefit from integrative medicine!

    February 10, 2012 at 10:56 | Report abuse | Reply
  12. R Berg

    Impressive! I accidently cured my PD by taking High Stress B-Complex vitamin tablets (1 tablet morning daily) and Calcium-magnesium tablets (1,500 mg evening daily) until the shaking is gone, then normal or regular multi-supplement vitamins daily or as desired ONLY from health food stores. Get top quality brands that are ALL NATURAL and not chemical based vitamins usually found in Rx or grocery stores.

    March 14, 2012 at 14:53 | Report abuse | Reply
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    December 1, 2012 at 03:30 | Report abuse | Reply
  14. Practice tai chi

    Learn authentic Tai chi and kung fu in Florida. http://www.practicekungfu.com

    May 14, 2013 at 02:56 | Report abuse | Reply
  15. Claudia Tofanelli

    The main motor symptoms are collectively called parkinsonism, or a "parkinsonian syndrome". Parkinson's disease is often defined as a parkinsonian syndrome that is idiopathic (having no known cause), although some atypical cases have a genetic origin. Many risk and protective factors have been investigated: the clearest evidence is for an increased risk of PD in people exposed to certain pesticides and a reduced risk in tobacco smokers.*:-'

    My own blog site
    <http://www.wellnessdigest.co/

    July 1, 2013 at 02:26 | Report abuse | Reply
  16. Dean Arollo

    Tai chi is an ancient Chinese tradition that, today, is practiced as a graceful form of exercise. It involves a series of movements performed in a slow, focused manner and accompanied by deep breathing. :""'

    Newly released piece of writing straight from our personal web-site
    <http://healthmedicine.co/index.php/

    July 6, 2013 at 01:34 | Report abuse | Reply
  17. Jerry Wild

    Tai Chi is very effective in helping People With Parkinson's. I have used Tai Chi to fight this disease for 30 years.
    I taught the first published clinical trial in 2007 at Washington University School of Medicine.published 2008 " Gait & Posture.H Hackney PhD G. Earhart PhD.
    Jerry Wild ,Tai Chi Expert -40 years experience.

    August 14, 2014 at 22:56 | Report abuse | Reply

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