Author: Lee, Yin Tak Ken
Title: Will sitting Tai Chi improve eye-hand coordination, sitting balance or the subjective well-being of institutionalized older adults?
Degree: Ph.D.
Year: 2013
Subject: Tai Chi.
Eye-hand coordination.
Equilibrium (Physiology)
Older people -- Health and hygiene.
Hong Kong Polytechnic University -- Dissertations
Department: Department of Rehabilitation Sciences
Pages: xviii, 187 leaves : ill. (some col.) ; 30 cm.
Language: English
Abstract: Several studies of Tai Chi have been conducted over the last two decades and its therapeutic value for older adults has been well demonstrated. However, the traditional Tai Chi forms pose difficulty for frail older adults who have difficulty in standing. There is therefore a need to design Tai Chi forms that can be practiced in a stable sitting position by frail older adults. Such routines have been developed, but to date their effects have not been documented. The objectives of this study were to design a Tai Chi routine which can be performed while seated and to investigate its therapeutic effects among frail older adults with different mobility levels. Prior to the clinical intervention studies, a novel 12-form sitting Tai Chi was designed by the investigators and an experienced Tai Chi master. The seated routine retained the representative components of conventional Tai Chi styles using the trunk, upper limbs and limited lower limb movements, but it was specific to the needs of frail older adults. The kinematics and energy expenditure of this new sitting Tai Chi routine was analyzed in study 1. The results showed that the maximum COM displacements in anteroposterior (AP), mediolateral (ML) and vertical directions were 10.3%, 5.7% and 7.5% with respect to subject's standing height during sitting Tai Chi and the trajectory of centre of mass displacement was smooth and sinusoidal, confirming the coordinated movement patterns underlying the routine. The routine's exercise intensity was 1.9 metabolic equivalents (METs) on average, which satisfies the minimum effective training intensity for older adults. The routine was demonstrated to be simple and safe for frail older participants. In study 2, a new sequential weight shifting test of sitting balance which is functional in nature was developed and its psychometric properties were established. This test was used as one of the primary outcome measures in the later experiments, since techniques for quantitative measurement of sitting balance specifically for frail older adults are lacking in the literature. In the reliability study (n=10), result showed that the sequential weight shifting test has acceptable test-retest reliability (intraclass correlation coefficient (ICC) (3,1) = 0.67). In the correlation study (n=23), sequential weight shifting test showed the strongest correlations with the forward reach test (r = -0.74, p ≤ 0.01) followed by hand grip strength tests (right: r = -0.666, p ≤ 0.05; left: r = -0.615, p ≤ 0.05) and forced vital capacity (r = -0.594, p ≤ 0.01).
Study 3 was a randomized clinical trial examining the effects of 3 months of sitting Tai Chi training on the sitting balance control and eye-hand coordination of frail older subjects. Fifty-nine older adults were randomly assigned to either a sitting Tai Chi group or a mobilizing exercises control group. Only those with functional ambulation category (FAC) scores of 3 or 4 were included, which means that they could walk only under supervision. The sitting Tai Chi group received 36 Tai Chi training sessions over 3 months (1hour/session, 3 sessions/week). Equivalent limb mobilizing exercise sessions were conducted for the control group subjects. After the intervention the sitting Tai Chi practitioners showed significant improvement in their sequential weight shifting while sitting (improved by 29.0%, p ≤ 0.05) and in their maximum reaching distance from a sitting position (improved 21.2%, p ≤ 0.05). No such improvements were found in the control group. In the eye-hand coordination test, the sitting Tai Chi practitioners had significant improvements in their average reaction time (improved by 16.5%, p ≤ 0.01) and accuracy (improved by 17.3%, p ≤ 0.05). No improvement was found in the control group in either outcome. Based on these promising results with a relatively mobile group, the investigation was extended to more frail older adults in study 4. The subjects had FAC scores of 0 to 2, which means that they could not walk at all or required physical assistance in walking. The outcome measures in this study involved not only physical characteristicsrange of motion, strength, eye-hand coordination, sitting balance and functional scoresbut also subjective impressions of well-being, a psychosocial outcome. The therapeutic effects of practicing sitting Tai Chi were compared with those of conventional exercises in this randomized clinical trial. The results showed that both sitting Tai Chi and conventional exercise can improve eye-hand coordination and sitting balance, but the effects of the two treatments were not significantly different. The conventional exercise group showed a statistically significant improvement in left deltoid strength (p ≤ 0.001) and also a significant group x time interaction effect (p ≤ 0.05). Post hoc analysis showed that left deltoid strength in the conventional exercise group increased significantly after the intervention (53.5% increase; p ≤ 0.001). Sitting Tai Chi shows an improving trend in life satisfaction and different domains of subjective well-being (standard of living, personal health, future security) but not in exercise group. The results showed that sitting Tai Chi has beneficial effects for older adults with FAC scores of 3 or 4. Sitting Tai Chi and conventional exercise benefit those unable to walk unaided about equally well. A longer training period may be required to gain the full therapeutic effects of either sitting Tai Chi or conventional exercise with such subjects. Further study with larger samples is required to confirm this.
Rights: All rights reserved
Access: open access

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