Is Tai Chi effective in reducing falls and fear of falling, and in improving balance amongst older people?
Date of publication of the systematic review: September/October 2010
Design
Systematic review of 9 randomized controlled trials (RCTs).
Participants
2203 healthy older people aged ≥ 50. The reviewers did not report mean age and gender proportion of the participants.
Intervention
Tai Chi exercise programs ranged from 16 to 120 hours.
Comparator
Comparison 1: Tai Chi versus control group receiving no exercise prescription;
Comparison 2: Tai Chi versus control group receiving low intensity exercise prescription.
Major Outcomes
Outcome 1: Fall incidence at the end of the program;
Outcome 2: Fear of falling measured with Falls Efficacy Scale at the end of program;
Outcome 3: Static balance measured with indirect method (e.g. single-leg stance) at the end of treatment.
Settings
Most studies were conducted in community settings, while others were conducted in institutional settings for the aged.
Comparison    Tai Chi versus control group receiving no exercise prescription
Main Results
Compared to no exercise controls, Tai Chi did not show significant effect on fall incidence (Pooled relative risk reduction (Pooled RRR): 0.21%, 95% CI: -0.03 to 0.40) and static balance (pooled standardized mean difference (pooled SMD): 1.11, 95% CI: -0.25 to 2.46); but significantly reduced fear of falling (pooled SMD: 0.37, 95% CI: 0.03 to 0.70).
Comparison 1: Tai Chi versus no exercise controls amongst older people
Outcomes No. of studies (Total no. of participants) Incidence rate/ No. of participants Heterogeneity test (I2) Pooled RRR (95% CI) Overall quality of evidence*
Intervention Comparator
1 5 (Not reported) Not reported Not reported 68.6% 0.21 (-0.03 to 0.40) Low
Outcomes No. of studies (Total no. of participants) Standardized mean/ No. of participants Heterogeneity test (I2) Pooled SMD (95% CI) Overall quality of evidence*
Intervention Comparator
2 3 (Not reported) Not reported Not reported Insignificant but exact value was not reported. 0.37 (0.03 to 0.70) Low
3 2 (Not reported) Not reported Not reported Insignificant but exact value was not reported. 1.11 (-0.25 to 2.46) Low
Keys: RRR = relative risk reduction; SMD = standardized mean difference; CI = confidence interval.
Comparison    Tai Chi versus control group receiving low intensity exercise prescription
Main Results
Compared to low intensity exercise controls, Tai Chi showed significant reduction on fall incidence (Pooled RRR: 0.49, 95% CI: 0.32 to 0.62) and significant improvement on static balance (pooled SMD: 0.47, 95% CI: 0.23 to 0.72).
Comparison 2: Tai Chi versus low intensity exercise controls in older people
Outcomes No. of studies (Total no. of participants) Incidence rate/ No. of participants Heterogeneity test (I2) Pooled RRR (95% CI) Overall quality of evidence*
Intervention Comparator
1 2 (not reported) Not reported Not reported Insignificant but exact value was not reported 0.49 (0.32 to 0.62) Low
Outcomes No. of studies (Total no. of participants) Standardized mean/ No. of participants Heterogeneity test (I2) Pooled SMD (95% CI) Overall quality of evidence*
Intervention Comparator
3 2 (not reported) Not reported Not reported Insignificant but exact value was not reported 0.47 (0.23 to 0.72) Low
Keys: RRR = relative risk reduction; SMD = standardized mean difference; CI = confidence interval.
Comparison    Tai Chi versus control group receiving no exercise prescription
Main Results
Compared to no exercise controls, Tai Chi did not show significant effect on fall incidence (Pooled relative risk reduction (Pooled RRR): 0.21%, 95% CI: -0.03 to 0.40) and static balance (pooled standardized mean difference (pooled SMD): 1.11, 95% CI: -0.25 to 2.46); but significantly reduced fear of falling (pooled SMD: 0.37, 95% CI: 0.03 to 0.70).
Comparison 1: Tai Chi versus no exercise controls amongst older people
Outcomes 1
No. of studies (Total no. of participants) 5 (Not reported)
Incidence rate/ No. of participants Intervention Not reported
Comparator Not reported
Pooled RRR (95% CI) 0.21 (-0.03 to 0.40)
Overall quality of evidence* Low
Outcomes 2 3
No. of studies (Total no. of participants) 3 (Not reported) 2 (Not reported)
Standardized mean/ No. of participants Intervention Not reported Not reported
Comparator Not reported Not reported
Pooled SMD (95% CI) 0.37 (0.03 to 0.70) 1.11 (-0.25 to 2.46)
Overall quality of evidence* Low Low
Keys: RRR = relative risk reduction; SMD = standardized mean difference; CI = confidence interval.
Comparison    Tai Chi versus control group receiving low intensity exercise prescription
Main Results
Compared to low intensity exercise controls, Tai Chi showed significant reduction on fall incidence (Pooled RRR: 0.49, 95% CI: 0.32 to 0.62) and significant improvement on static balance (pooled SMD: 0.47, 95% CI: 0.23 to 0.72).
Comparison 2: Tai Chi versus low intensity exercise controls in older people
Outcomes 1
No. of studies (Total no. of participants) 2 (not reported)
Incidence rate/ No. of participants Intervention Not reported
Comparator Not reported
Pooled RRR (95% CI) 0.49 (0.32 to 0.62)
Overall quality of evidence* Low
Outcomes 3
No. of studies (Total no. of participants) 2 (not reported)
Standardized mean/ No. of participants Intervention Not reported
Comparator Not reported
Pooled SMD (95% CI) 0.47 (0.23 to 0.72)
Overall quality of evidence* Low
Keys: RRR = relative risk reduction; SMD = standardized mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to no exercise controls, Tai Chi did not provide beneficial effect on reducing fall incidence and improving static balance. Tai Chi is effective in reducing fear of falling amongst older people. Compared to low intensity exercise controls, Tai Chi was effective in reducing fall incidence and in improving static balance amongst older people. For all outcomes in these two comparisons, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
Adverse events were not reported in this review.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/20558197
The synopsis is based on the following article:
Logghe IH, Verhagen AP, Rademaker AC, Bierma-Zeinstra S, van Rossum E, Faber MJ, et al. The effects of Tai Chi on fall prevention, fear of falling and balance in older people: a meta-analysis. Prev Med. 2010 Sep-Oct;51(3-4):222-7.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.