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Tele-Tai Chi Brings Vital Balance to Elders
by Jennifer Nachbur, University of Vermont

Nov 22, 2010 - Imagine swaying to and fro, dancing to the rhythm of a slow love song. Then switch that image to maintaining balance while standing on one foot. How about standing straight with two feet on the ground and not moving? It's not as easy as one would think.

Posture experts refer to the ability to control body sway as functional balance. "People don't really stand still like a block, because we breathe, have a heartbeat, and have blood flowing in our bodies," explains Ge Wu, professor of rehabilitation and movement sciences at University of Vermont. "All those kinds of dynamic movements disturb our balance, so we move, but we also constantly control our body sway," she adds. Keeping the body's center of gravity in a very small range comes easily to the young, but gets progressively more difficult to accomplish as we age. Consequently, with a larger range comes an increased risk of falls.
Unintentional falls are the leading cause of injurious death and nonfatal injury among the elderly, according to the National Safety Council. More than 30 percent of people over the age of 65 experience a fall each year, and as a result, suffer fractures, fear of falling, depression, and loss of independence. The risk is higher among the country's more than six million homebound elders, who are four to five times more likely to suffer serious injury as a result of a fall.
Wu, a UVM faculty member since 1996, had studied a variety of strengthening and balancing exercise approaches, including Tai Chi, for her work on falls prevention and understanding falls in the elderly.
Addressing compliance among her elderly Tai Chi research participants, who were often reluctant to drive anywhere, was challenging. "That's how I started thinking about using tele-communication technology to deliver exercise," says Wu, who in 2005 began researching available technologies that could distribute Tai Chi classes from a supervisor/instructor to multiple participants' homes. Telemedicine was available through Fletcher Allen, but was expensive and only offered one-to-one communications between hospitals, so she searched for collaborators. While time-consuming, the efforts paid off. She connected with Microdesign Consulting, Inc. in Colchester and Larry Keyes, who had previously worked at UVM.
"He was very interested in the idea, but told me he had done the telecommunications thing before, and it wasn't very easy," says Wu. But Keyes, driven by new ideas and challenges, agreed to work with her.
Together, they secured funding from the National Institute on Aging and with that support, Keyes developed an Internet-based, senior-friendly system -- affordable and easy to operate -- that worked with a home television.
Wu led two trials -- a Phase 1 to determine whether the interactive tele-communications technology was effective and acceptable by the elder population and a Phase 2 to determine if doing the tele-Tai Chi exercises had the same benefit as the traditional in-person class format.
A single group of 17 individuals -- many of whom were homebound and did not drive --participated in the first trial, performing 15 weeks of Tai Chi three times per week. "At the end, everybody loved it, and they all wanted to continue," recalls Wu, who adds that everyone in the group improved their balance.
Her second study, a randomized controlled trial, compared three types of delivery mechanisms -- an improved (from the Phase 1) interactive home television system, a traditional class at a community gym/health club, and a non-interactive Tai Chi exercise DVD.
Not surprisingly, the DVD group was the least effective, both in terms of compliance and balance improvement. The tele-interactive group and community exercise class group achieved remarkably similar results. According to Wu, the attendance and compliance was much higher in these groups and balance improved, while fear of falling and falls decreased. And there was another benefit -- improved social functioning.
Tai Chi's complicated set of movements are often difficult to learn, even face-to-face; you have to look at the instructor from the front, the back and the side. The tele-technology system -- available to seniors with a simple press of a power button -- provides effective instruction and allows not only real-time patient and instructor interaction, but also communication among the participants, who can all see each other at the same time. The program posts the name of each person on the screen, so participants recognize fellow/sister Tai Chi classmates by name, by face and by voice.
The Phase 2 trial wrapped up earlier this year, and in June, the results were published in the Archives of Physical Medicine and Rehabilitation.
The 65 and over crowd hasn't heard the last from Wu. Her future research targets have a neuroscience link -- brain changes associated with Tai Chi practice and the effect of meditation. "Part of Tai Chi has this energy flow concept, but what is energy, how do you measure it and what does it do?" asks Wu, who looks forward to tackling this new set of mysteries in the years ahead.




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