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Tai Chi versus health education as a frailty intervention for community-dwelling older adults with hypertension
Kohn JN, Lobo JD, Troyer EA, Ang G, Wilson KL, Walker AL, Spoon C, Pruitt C, Tibirica L, Pung MA, Redwine LS, Hong S
Aging Clinical and Experimental Research 2023 Oct;35(10):2051-2060
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Frailty is associated with poor outcomes among older adults with hypertension and complicates its pharmacological management. Here, we assessed whether 12 weeks of instructor-guided, group Tai Chi (TC) practice improved frailty relative to Healthy Aging Practice-centered Education (HAP-E) classes in older adults with hypertension. METHODS: Secondary analysis of a randomized controlled trial in San Diego County, USA, of 167 community-dwelling individuals aged >= 60 yrs (70% female; 72.1 +/- 7.5 yrs), defined as non-frail (66%) or frail (34%) based on 53 item deficit accumulation frailty index (FI). Linear mixed-effects models were used to assess pre-to-post intervention differences in FI and logistic regression to explore differential odds of clinically meaningful FI change. RESULTS: One hundred thirty-one participants completed post-intervention assessments. Frailty decreased pre-to-post intervention in the TC (deltaFI = -0.016, d = -0.39, -0.75 to -0.03), but not the HAP-E arm (deltaFI = -0.009, d = -0.13, -0.52 to 0.27), despite no significant group differences between the TC and HAP-E arms (d = -0.11, -0.46 to 0.23). Furthermore, greater odds of improved FI were observed for frail participants in the TC (OR = 3.84, 1.14 to 14.9), but not the HAP-E (OR = 1.34, 0.39 to 4.56) arm. Subgroup analysis indicated treatment effects in TC were attributed to frail participants (frail deltaFI = -0.035, d = -0.68, -1.26 to -0.08; non-frail: deltaFI = -0.005, d = -0.19, -0.59 to 0.22), which was not the case in the HAP-E arm (frail deltaFI = -0.017, d = -0.23, -0.81 to 0.35; non-frail: deltaFI = -0.003, d = -0.07, -0.47 to 0.33). Frail participants were no more likely to drop-out of the study than non-frail (71% versus 69% retained). CONCLUSIONS: Twelve weeks of twice-weekly guided TC practice was well-tolerated, associated with decreases in frailty, and increased odds of clinically meaningful FI improvement at post-intervention.

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