By Katie Linz, OT
Occupational Therapist, Maryland

What if there was a fun exercise program that research has proven can improve balance, cognitive performance, and psycho-emotional well-being for increased sleep? What if it can be performed inside or outside, individually or with friends, and requires little to no extra equipment? 

Let me tell you a little bit about Tai Chi. A centuries-old martial art practice originating in China, the slow and soft, rhythmic, dance-like, bilateral upper extremity movements progress along the typical lower extremity stances for balance. Tai Chi has become popular in therapeutic activities recently due to the increased need for a high reward, low energy practice post-pandemic. No certification is necessary to get started today, if clinically and medically appropriate, to reap the benefits of functional balance, cognitive challenges, and improved sleep among patients.

Balance Benefits of Tai Chi for Older Adults

Occupational therapists implement balance interventions for clients in order to reduce fall risk when reaching in cabinets for dishes, picking up items off the floor, or adjusting the blinds with both hands. The well-known risk factors for falls include previous falls, visual impairment, and muscle weakness in addition to the environmental risk factors such as clutter and poor footwear. 

However, an often glossed-over risk factor is the fear of falling. Research shows that around 50% of older adults significantly reduce community outings when dealing with this form of anxiety. A study that recorded and analyzed baseline and post-intervention measurements from the Falls Efficacy Scale International, Timed Up and Go, and Tinetti tests, confirmed a Tai Chi Chuan program improved balance and significantly reduced the fear of falling in a group of community-dwelling older adults. 

The idea is that by educating a person on how to instill calm concentration and attention during movements, shift their center of gravity, and perform multidirectional stepping, the person will practice improved balance and calm stress reactivity thus reducing fall risk. 

Cognitive Benefits of Tai Chi for Older Adults

The Covid-19 pandemic brought with it a decrease in community outings thus decreasing social interactions, mobility, and mood amongst all. Since increased stress levels can accelerate cognitive decline in older adults and there is a lack of pharmaceutical treatments available for blossoming cognitive impairments, motor learning interventions that can simultaneously reduce stress need to be resurfaced. 

Researchers hypothesize that Tai Chi could improve motor learning for those needing to relearn skills lost during the pandemic. These specific researchers assessed brain-derived neurotrophic factors (BDNF), a molecule that assists in neuroplasticity. After patients performed 10 weeks of biweekly 40-minute Tai Chi (specifically 8-form, Yang-style) sessions, researchers found significantly higher BDNF levels in the intervention group vs the control group. The authors concluded Tai Chi practice improved patients’ visuospatial processing, inhibitory control, mental switching, and learning of fast movements, while also decrementing depressive symptoms and perceived stress. 

Lastly, researchers add “a sufficient cognitive challenge seems to play a greater role in obtaining cognitive benefits than high doses of intervention sessions.” Additional research found that “Tai Chi was shown to trigger angiogenesis and reduce the inflammatory state of the brain, thus bringing about cognitive improvement.” Not convinced about the benefits yet? Well did you know research also shows Tai Chi can improve sleep in those with insomnia?!

Sleep Benefits of Tai Chi for Older Adults

Dr. Parco Siu and fellow experts in health and psychology performed a randomized clinical trial to see if Tai Chi could effectively improve sleep like conventional exercises. Using actigraphy versus subjective measurements, researchers realized Tai Chi was just as effective and outcomes lasted 24 months post clinical trials for participants over 60 years old. All participants experienced improved sleep quality and reductions of wake time after sleep; some participants experienced a cease in insomnia altogether. 

Tai Chi is considered a mind-body exercise and employs the mind arguably more than conventional exercises. Furthermore, approximately 30% of individuals with sleep problems used mind-body solutions to improve their sleep, according to the US National Health Interview Survey 2017. 

How to Introduce Tai Chi to OT Sessions

Educated on the what and convinced on the why of Tai Chi in therapy? Here’s the how:

• Model the movements for the patient
  • Grade up: increase time in standing prior to a rest break
  • Grade down: facilitate performance in sitting
• Explain how the movements will help that specific person 
  • Examples I have implemented the movements for: “These will help you reach into your cabinet… this next move is similar to how you weight shift in the shower to reach your shampoo.”
• Utilize task-specific training for your patient to perform the functional task with which you’ve integrated Tai Chi movements and principles—show them the improvements! 
• Set up the patient with a HEP (visual, interactive component recommended).
  • Find a Tai Chi program in video /DVD format for your TV or computer
  • Research local in-person Tai Chi classes for reference