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.
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.
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.
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.
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.
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.
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
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
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.