Teixeira (2007) Influence of Ai Chi on balance and fear of falling on older adults (portuguese)

PURPOSE: This study examined the effect of Ai Chi, a variation of T’ai Chi performed in water, on balance and fear of falling in older adults.

RELEVANCE: Falls are a major problem in older adults, leading not only to an increase of incapacity but also to an increase of morbidity and mortality. Complications of falls include fractures, dependence and fear of falling (FOF), among others. When training balance on land, an individual’s performance may be diminished by a lack of confidence or a fear of falling. In an aquatic environment, waters inherent viscosity serves like a postural support, promoting confidence and reducing the fear of falls. Aquatic therapy has the capacity to prevent deterioration in and increase the quality of life within the elderly community as well as promote their independence.

PARTICIPANTS: Thirty community dwelling frail adults, sampled from a day care center were randomly allocated to an experimental or control group. The groups had baseline similarity regarding age, sex, FOF and balance. Inclusion criteria were aged 77-88 yrs with either high or medium risk of falling (POMA score from 0 to 24). Exclusion criteria were any physiotherapy treatment or participation in physical activity during the study and standard contraindications to hydrotherapy19 as well as an absence from the Ai Chi sessions for more than 4 sessions.

METHODS: Balance was assessed with the Performance-Oriented Mobility Assessment (POMA) and FOF with Falls Efficacy Scale (FES). The experimental group received 16 Ai Chi sessions over 6weeks at a community aquatic centre. The control group received no instruction and was encouraged not to change their ADLs. Prior to intervention, 2 familiarization sessions were held

ANALYSIS: The Wilcoxon signed rank test for intra-group comparisons and the Mann-Whitney U test forinter-group comparisons. Cohen’s d was used to calculate clinical effect size after submission of the original thesis.

RESULTS: Following intervention the experimental group showed statistical significant improvements in balance but not in fear of falling, The control group did not show a change in balance, but a significant increase in FOF. Post intervention intergroup comparisons showed significant differences in favor of the experimental group. Clinically significant effects sizes (ES) to the advantage of the experimental group were found of 1.3pts for the tPOMA (balance), with1.1pts and 1.4pts for bPOMA and gPOMA respectively. A clinically significant ES for the FES was also reached (1.5pts).

CONCLUSIONS: Despite the small sample, findings clearly show that an Ai Chi program leads to a clinical relevant increase of both static and dynamic balance in older persons. Ai Chi participants also showed a maintenance of their level of FOF. No follow up has been made, which prevents conclusions about long term effects.

IMPLICATIONE: specially frail elderly, for whom balance exercises in a falls prevention program on land might be difficult or even dangerous and who are not afraid of water should be included in a(community based) aquatic program when available.