While the causes for falls among older individuals are multifactorial, their consequences extend well beyond physical trauma and its associated costs. Falls augment the fear of falling, which, in turn, encroaches upon the freedom to voluntarily engage in activities of daily living and the enjoyment of life. As a result of health-related changes in quality of life, older people in transition toward frailty may lose their enthusiasm to participate in previously enjoyable activities while also compromising important socialization behaviors. During the FICSIT trials (1990-1994), the investigators provided a 15 week program of mild Tai Chi (TC), an exercise form practiced by Chinese elders for centuries. All subjects came to one site to participate. TC reduced the rate of falls by 47.5% compared to a control group or a group undergoing computerized balance training after adjusting for significant risk factors, such as fear of falling, falls within the past year, and trouble falling asleep (Wolf, Barnhart, Kutner et al., 1996). Concomitant improvements were also noted among TC practitioners in cardiovascular status after a 12 minute walk and in select quality of life measures. Many study participants were relatively active. However, in view of these findings and the far-reaching effects that falls may have upon costs for medical care, independent functioning, and health-related quality of life, justification can now be made for pursuing a more intense TC intervention (three times a week for 48 weeks in one year) within the congregate living facilities of people 70 years of age or older. The purpose of this clinical trial, for at-risk volunteer subjects who have fallen at least once in the previous year and are in transitional phase toward frailty, is to examine the effect of intense TC training (N=150) on time to onset of falls or multiple falls compared to a group receiving an education intervention (N=150) once a week for 48 weeks in one year. Subjects will be recruited from 20 congregate living facilities in the greater Atlanta area with 15 participants per site. Facilities will be randomized in pairs by similarity in socioeconomic factors, functional capabilities of residents and minority representation. The investigators also plan to determine if TC improves function as measured by single limb stance, reach, body turning, and bending as well as health-related quality of life as measured by falls efficacy and sickness impact profile. In an effort to examine how TC may cause improvements in movement capabilities, a subset from each group (N=25 per group) will be examined for changes in biomechanical aspects of movement and strength. Evaluators will be blinded to the interventions, and all subjects will receive evaluations every four months over two years to ascertain the persistence of improvements.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG014767-04
Application #
6168975
Study Section
Special Emphasis Panel (ZRG4-GRM (01))
Program Officer
Dutta, Chhanda
Project Start
1997-09-15
Project End
2001-08-31
Budget Start
2000-09-01
Budget End
2001-08-31
Support Year
4
Fiscal Year
2000
Total Cost
$513,238
Indirect Cost
Name
Emory University
Department
Physical Medicine & Rehab
Type
Schools of Medicine
DUNS #
066469933
City
Atlanta
State
GA
Country
United States
Zip Code
30322
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Greenspan, Arlene I; Wolf, Steven L; Kelley, Mary E et al. (2007) Tai chi and perceived health status in older adults who are transitionally frail: a randomized controlled trial. Phys Ther 87:525-35
Wolf, Steven L; O'Grady, Michael; Easley, Kirk A et al. (2006) The influence of intense Tai Chi training on physical performance and hemodynamic outcomes in transitionally frail, older adults. J Gerontol A Biol Sci Med Sci 61:184-9
Sattin, Richard W; Easley, Kirk A; Wolf, Steven L et al. (2005) Reduction in fear of falling through intense tai chi exercise training in older, transitionally frail adults. J Am Geriatr Soc 53:1168-78
Hass, Chris J; Gregor, Robert J; Waddell, Dwight E et al. (2004) The influence of Tai Chi training on the center of pressure trajectory during gait initiation in older adults. Arch Phys Med Rehabil 85:1593-8
Kressig, Reto W; Gregor, Robert J; Oliver, Alanna et al. (2004) Temporal and spatial features of gait in older adults transitioning to frailty. Gait Posture 20:30-5
Wolf, Steven L; Sattin, Richard W; Kutner, Michael et al. (2003) Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial. J Am Geriatr Soc 51:1693-701
Freret, Nana; Ricci, Lois; Murphy, Susan (2003) Recruiting and screening older, transitional to frail adults in congregate living facilities. Appl Nurs Res 16:118-25
Kressig, R W; Wolf, S L; Sattin, R W et al. (2001) Associations of demographic, functional, and behavioral characteristics with activity-related fear of falling among older adults transitioning to frailty. J Am Geriatr Soc 49:1456-62
Wolf, S L; Sattin, R W; O'Grady, M et al. (2001) A study design to investigate the effect of intense Tai Chi in reducing falls among older adults transitioning to frailty. Control Clin Trials 22:689-704

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