TitleTai chi and postural stability in patients with Parkinson's disease.
Publication TypeJournal Article
Year of Publication2012
AuthorsLi, F, Harmer, P, Fitzgerald, K, Eckstrom, E, Stock, R, Galver, J, Maddalozzo, GF, Batya, SS
JournalThe New England journal of medicine
Volume366
Issue6
Pagination511-9
Date Published2012 Feb 9
KeywordsTai Ji
Abstract

Patients with Parkinson's disease have substantially impaired balance, leading to diminished functional ability and an increased risk of falling. Although exercise is routinely encouraged by health care providers, few programs have been proven effective. Movement impairments, especially loss of the ability to maintain standing balance, adversely affect function and quality of life in patients with Parkinson's disease.1,2 With progression of the disease, patients lose postural stability and have gait dysfunction, difficulty managing activities of daily living, and frequent falls.3,4 Although some motor dysfunction, such as tremor, may be alleviated with drug therapy, characteristics such as postural instability are less responsive to medication and require alternative approaches.5,6 Exercise is an integral part of the management of Parkinson's disease because physical activity has been shown to retard the deterioration of motor functions and to prolong functional independence.7-9 Resistance-based exercises that address deficits in balance and strength have shown positive effects.10-12 However, they require safety monitoring and are equipment-dependent. Research on alternative forms of exercise that could improve balance, gait, and function in patients with Parkinson's disease is scarce. Tai chi, a balance-based exercise, has been shown to improve strength, balance, and physical function and to prevent falls in older adults.13-15 Two pilot studies suggest that it may also improve axial symptoms of Parkinson's disease, such as postural stability.16,17 However, there exist few data from large-scale randomized trials that have addressed the efficacy of tai chi in this context. The primary aim of this study was to examine whether a tailored tai chi program could improve postural stability in patients with Parkinson's disease. Because the program emphasized rhythmic weight shifting, symmetric foot stepping, and controlled movements near the limits of stability, we hypothesized that tai chi would be more effective in improving postural stability in limits-of-stability tasks than a resistance-based exercise regimen or low-impact stretching (control).

DOI10.1056/NEJMoa1107911