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Tai Chi training may reduce dual task gait variability, a potential mediator of fall risk, in healthy older adults: cross-sectional and randomized trial studies
Wayne PM, Hausdorff JM, Lough M, Gow BJ, Lipsitz L, Novak V, Macklin EA, Peng C-K, Manor B
Frontiers in Human Neuroscience 2015 Jun 9;9(332):Epub
clinical trial
7/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Tai Chi (TC) exercise improves balance and reduces falls in older, health-impaired adults. TC's impact on dual task (DT) gait parameters predictive of falls, especially in healthy active older adults, however, is unknown. PURPOSE: To compare differences in usual and DT gait between long-term TC-expert practitioners and age-gender-matched TC-naive adults, and to determine the effects of short-term TC training on gait in healthy, non-sedentary older adults. METHODS: A cross-sectional study compared gait in healthy TC-naive and TC-expert (24.5 +/- 12 years experience) older adults. TC-naive adults then completed a 6-month, two-arm, wait-list randomized clinical trial of TC training. Gait speed and stride time variability (coefficient of variation %) were assessed during 90s trials of undisturbed and cognitive DT (serial subtractions) conditions. RESULTS: During DT, gait speed decreased (p < 0.003) and stride time variability increased (p < 0.004) in all groups. Cross-sectional comparisons indicated that stride time variability was lower in the TC-expert versus TC-naive group, significantly so during DT (2.11 versus 2.55%; p = 0.027); by contrast, gait speed during both undisturbed and DT conditions did not differ between groups. Longitudinal analyses of TC-naive adults randomized to 6 months of TC training or usual care identified improvement in DT gait speed in both groups. A small improvement in DT stride time variability (effect size 0.2) was estimated with TC training, but no significant differences between groups were observed. Potentially important improvements after TC training could not be excluded in this small study. CONCLUSION: In healthy active older adults, positive effects of short- and long-term TC were observed only under cognitively challenging DT conditions and only for stride time variability. DT stride time variability offers a potentially sensitive metric for monitoring TC's impact on fall risk with healthy older adults.

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