IMPORTANCE: Falls in older adults are a serious public health problem associated with irreversible health consequences and responsible for a substantial economic burden on health care systems. However, identifying optimal choices from among evidence-based fall prevention interventions is challenging as few comparative data for effectiveness are available. OBJECTIVE: To determine the effectiveness of a therapeutically tailored Tai Ji Quan intervention, Tai Ji Quan: moving for better balance (TJQMBB), developed on the classic concept of Tai Ji (also known as Tai Chi), and a multimodal exercise (MME) program relative to stretching exercise in reducing falls among older adults at high risk of falling. DESIGN, SETTING, AND PARTICIPANTS: A single-blind, 3-arm, parallel design, randomized clinical trial (February 20, 2015, to January 30, 2018), in 7 urban and suburban cities in Oregon. From 1147 community-dwelling adults 70 years or older screened for eligibility, 670 who had fallen in the preceding year or had impaired mobility consented and were enrolled. All analyses used intention-to-treat assignment. INTERVENTIONS: One of 3 exercise interventions: two 60-minute classes weekly for 24 weeks of TJQMBB, entailing modified forms and therapeutic movement exercises; MME, integrating balance, aerobics, strength, and flexibility activities; or stretching exercises. MAIN OUTCOMES AND MEASURES: The primary measure at 6 months was incidence of falls. RESULTS: Among 670 participants randomized, mean (SD) age was 77.7 (5.6) years, 436 (65%) were women, 617 (92.1%) were white, 31 (4.6%) were African American. During the trial, there were 152 falls (85 individuals) in the TJQMBB group, 218 (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. At 6 months, the incidence rate ratio (IRR) was significantly lower in the TJQMBB (IRR 0.42; 95% CI 0.31 to 0.56; p < 0.001) and MME groups (IRR 0.60; 95% CI 0.45 to 0.80; p = 0.001) compared with the stretching group. Falls were reduced by 31% for the TJQMBB group compared with the MME group (IRR 0.69; 95% CI 0.52 to 0.94; p = 0.01). CONCLUSIONS AND RELEVANCE: Among community-dwelling older adults at high risk for falls, a therapeutically tailored Tai Ji Quan balance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02287740.

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