Tai Chi for Health & Falls Injury Prevention Program
By Professor Fred Ehrlich, Ph.D, FRCS, FACRM, MRCPsych, FRCSEdin, MRCPsych,
FAFRM(RACP), MACLM
Henry Zheng, Alice L. Yuan
Falls Injury Prevention – A National Health Priority
Injury prevention is identified as a national health priority in Australia.
Throughout the 1990s, injury was annually responsible for more than 7,000
deaths, 400,000 hospitalisations (NHMRC, 1999), direct medical costs of AU$2.6
billion and total lifetime costs of AU$13.3 billion (CSIRO 2000). Falls are
by far the most common cause of injury among elderly Australians (Pointer
et al., 2003). Approximately 1 in every 3 of Australians aged 65 or older
suffers one or more falls each year (Dolinis, 1997; Lord, 1993). The cost
from falls to the health system is simply astronomical. In 1995-96 alone,
the lifetime cost from falls stood at AU$3.1 billion. The annual lifetime
cost of injuries from falls exceeds that of motor vehicle crashes and all
other causes (CSIRO, 2000). In New South Wales alone, the direct cost from
falls injury to the health system in 1998-99 was estimated at AU$333 million.
The total lifetime cost was AU$644 million, which includes mortality and
morbidity costs of AU $311 million (Potter-Forbes & Aisbett, 2003).
One of the most serious injuries from falls is hip fracture. Based on current
trends, it is projected that the number of hip fractures from falls each year
will double by 2026 and increase four-fold by 2051 (Sanders, 1999). It is also
estimated that if the falls rates continue at the 2001 rate, an additional
886,000 hospital bed days will be required in Australia per year, specifically
allocated to manage fall-related injuries (Moller, 2003).
As the population becomes increasingly sedentary and ages rapidly, the situation
for falls and fall-related injury is expected to worsen and calls for comprehensive
and effective intervention strategies.
Exercise Intervention Strategy
One of the key objectives in falls prevention is to identify, develop and implement safe, effective, cost-efficient and evidence-based intervention strategies to manage falls risk factors and prevent falls. Falls risk factors are multifactorial, ranging from physical, psychological, social to environmental. Reduced muscle strength, poor balance, mobility and flexibility, limited motion range or low Body Mass Index due to physical inactivity and aging are among the most significant physical risk factors for falls and fall-related injury (Nevitt et, al, 1989; Lord et al 1993, 2001; Campbell, et al, 1989; Tinetti, et al, 1995, etc). These risk factors are not only identifiable, but also modifiable. Research shows that physical exercises incorporating strength, balance, endurance, flexibility and mobility training can improve the performance of these falls risk indicators (Hill et al., 1999; Johansson & Jarnlo, 1991; Judge et al., 1994; Skelton et al., 1995). Multi-component group exercises targeting balance and strength training can reduce falls risk among older people (Lord et al., 1995 & 2003; Means et al., 1996; Barnett et. al., 2003; Rubenstein et al., 2000; Day et al., 2002).
One type of exercise identified by a number of studies as particularly
effective in reducing falls risk and preventing falls is Tai Chi (Wolf
et al, 1996; Jacobson et al., 1997; Sun et al., 1996; Hong et al 2000;
Tse and Bailey, 1992; Li et al, 2004, etc). Tai Chi is a system of low
impact, cognitive and aerobic exercise for health and fitness. It contains
weight-bearing and weight-transferring movements. It is characterised
by circular and fluid movements flowing in a natural, smooth and ceaseless
sequence. Tai Chi emphasizes the importance of dynamic balance, postural
control, movement coordination and mental focus. This low-tech and moderate
exercise regimen is demonstrated to be effective in counteracting the
major
amendable physical risk factors and preventing falls.
Tai Chi for Health & Falls Injury Prevention Program
One major barrier to the public access to Tai Chi as a safe and effective
exercise intervention strategy for falls prevention is, however, the significant
variability in the content of Tai Chi. Tai Chi is a general term. There
exists a great variety of Tai Chi – traditional Tai Chi versus modern
Tai Chi and spiritual Tai Chi versus martial art Tai Chi, etc. Within traditional
Tai Chi, there are many different styles such as Chen style Tai Chi, Sun
style Tai Chi, Yang style Tai Chi, Wu style Tai Chi, Tai Chi Chih, etc.
Within modern Tai Chi, there are 8-Form Tai Chi, 16-Form Tai Chi, 24-Form
Tai Chi, 42-Form Tai Chi and other competition forms. Spiritual Tai Chi
such as Taoist Tai Chi emphasizes spiritual dimension whereas martial art
Tai Chi stresses self-defense tactics. Tai Chi varies significantly from
style to style and from form to form in terms of exercise principles, techniques,
intensity and duration, etc. Studies relied on grossly different content
of Tai Chi. In most cases, only a few movements extracted from different
styles or forms were used in Tai Chi trials and the results were scattered.
Therefore, it is imperative and important to develop a modified and targeted
Tai Chi intervention model that incorporates essential Tai Chi exercise
techniques effective for counteracting falls risk factors and eliminates
dangerous, ineffective or irrelevant movements in existing Tai Chi forms.
Tai Chi for Health & Falls Injury Prevention Program, jointly developed
by Exercise Medicine Australia and Professor Ehrlich from the School of
Public Health & Community Medicine, the University of New South Wales,
offers precisely such a modified Tai Chi model. It is a targeted and comprehensive
Tai Chi intervention program newly developed in Australia. The key exercise
techniques developed in the special Tai Chi intervention program include
weight bearing & weight transfer; isometric and isotonic contractions;
low body gravity centre; directional change; symmetrical movements; dynamic
balance and postural control; toe clearance and visualisation, which are
designed to effectively tackle the major physical, psychological and social
risk factors of falls and fall-related injury. Based on exercise science
and falls risk management principles with incorporation of essential Tai
Chi techniques, Tai Chi for Health & alls Injury Prevention Program
aims at achieving the following objectives:
• To overcome lower body weakness by building strength of the legs,
waist and back.
•
To improve the body’s mobility, flexibility, coordination and balance
by increasing strength and flexibility of working muscles and joints and
expanding motion range.
•
To prevent bone demineralisation and build bone mass, thus minimising risks
of bone fractures.
•
To improve the body’s balance control mechanism by increasing its
ability to sense, adjust and orient to changes of motion direction and
floor conditions.
•
To improve the blood-pumping capacity of the muscle, thereby reducing high
blood pressure and minimising falls risk.
•
To improve the body’s ability to stabilise and balance itself through
half-squat movement techniques with lowered gravity centre.
•
To improve toe clearance during walking.
•
To manage stress, increase self-confidence and overcome anxiety and fear
of falling.
Tai Chi for Health & Falls Injury Prevention Program is developed for
wide public access for the purpose of improving public health and preventing
falls. It is easy to learn and safe to deliver in community, residential
care and rehabilitation settings. It contains compete warm-up and cool-down
exercises as an integral part of the program. There is a complete and detailed
manual and instructional DVD available for this program, which provides
comprehensive information on falls risk factors and management, key exercise
techniques, teaching and practice guidelines, detailed description and
analysis of the physiological functions of each movement. There is a step-by-step
teaching and demonstration of the program on the DVD.
‘From research to practice’ characterized the central theme
of 2004 National Falls Prevention Conference held in Sydney. The success
of the campaign in falls prevention lies in a coordinated and sustained
approach towards implementing safe, effective, evidence-based and cost-efficient
intervention practices. In order to facilitate effective implementation
of Tai Chi for Health & Falls Injury Prevention Program, Exercise Medicine
Australia conducts special training workshops in collaboration with falls
injury prevention bodies, research institutions, health promotion units,
hospitals and community service centers to train exercise instructors,
nurses and physiotherapists for safe and effective delivery of the program.
It also conducts classes for people at risk of falls at various community
centers.
For further information, please contact:
Henry Zheng, Researcher of Exercise Medicine Australia on (02) 9262 1662
Email: service@exercisemedicine.com.au
Professor Ehrlich, Faculty of Medicine, the University of New South Wales
f.ehrlich@unsw.edu.au
More information about Tai Chi for Health & Falls Injury Prevention Program is also available on the website of Exercise Medicine Australia: www.exercisemedicine.com.au