Biography

1
Biography

• Geriatric Fellowship
• St. Vincent Hospital, Indianapolis, IN
• Family Medicine Residency
• St. Vincent Hospital, Indianapolis, IN
• Interest in how to decrease fall risk improve
  QOL in geriatric population

2
An Alternative Prescription for Exercise

• Phillis M. Parker, MD

3
Questions

• How many have heard of Tai Chi (TC)?
• How many know the basic concept associated
  benefits of TC?
• How many know most current evidence supporting
  its use?
• How many know where to direct patients/family
  members when initiating such a program?

4
Objectives

• Familiarize care providers with
• How TC might fit into an exercise Rx
• Basic history concept of TC
• Assoc health benefits of TC
• Discuss most current research supporting use of
  Tai Chi
• Educate care providers on
• Potential resources when trying to initiate a TC
  exercise program

5
Physical Activity

• Promoting it is one of the most important
  effective preventive therapeutic interventions
  in older adults
• Counseling by a healthcare provider is an
  important way of promoting
• Referral of pts to community resources,
  particularly evidence-based programs, is important

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Preventative Health Benefits

• Regular physical activity in older adults
• Improves cardio-respiratory muscular fitness
• Reduces risk of
• CAD, CVA, HTN, some lipid d/os, DM2, Colon CA,
  Breast CA, Osteoporosis Depression
• Unhealthy weight gain
• Falls Sarcopenia

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Therapeutic Benefits

• Clinical practice guidelines identify a
  substantial therapeutic role for physical
  activity in
• CAD, PVD, HTN, DM2, OA, Osteoporosis, Obesity
• Also role in management of
• Depression, Anxiety, Pain, CHF, Sleep d/os, CVA,
  Dementia, Constipation, Prevention of DVT

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Economic Benefits

• Regularly active adults are consistently reported
  to have lower medical expenditures than sedentary
  adults

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• So.Get Your Patients Moving!!!

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Type of exercise Frequency/duration Examples of activity Examples of targeted condition
Aerobic 150 mins of moderate-intensity activity each week, spread throughout week, or 75 mins of vigorous-intensity activity each week, spread throughout the week Walking, running, swimming, bicycling Many conditions, including cardiovascular disease, cancer, diabetes, and depression
Muscle strengthening 2 days each week Resistance training (eg, using weight machines) Falls, frailty
Flexibility As necessary to maintain adequate flexibility 2 days/wk Stretching Osteoarthritis
Balance training 3 days/wk Backward walking, heel-to-toe walking, Tai Chi exercise Falls, osteoporosis
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Tai Chi

• History
• Developed in ancient China
• Accounts of history vary regarding who origin is
  accredited to
• Chang San Feng (Taoist monk)
• Sometime btw 12th to 19th century
• Supreme ultimate fist

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• History
• Started as martial art/means of self defense
• Over time used for health purposes
• Practice supports balance of Yin/Yang thereby
  supporting flow of Qi (vital energy/life force)

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• Movements
• Many different styles
• Most modern styles trace their development to at
  least 1 of the 5 traditional schools Chen, Yang,
  Wu (Hao), Wu Sun
• All invoke slow, relaxed, graceful movements
• Each flows into the next
• Body is in constant motion

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• Movements
• Posture and concentration are important
• Deep, relaxed, focused breathing
• Can be practiced alone or in groups

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Benefits

• People practice TC for various health-related
  purposes
• Benefits assoc with low-impact, weight-bearing,
  aerobic exercise
• Improve physical condition, muscle strength,
  coordination, and flexibility
• Improve balance and decrease risk of falls,
  especially in elderly
• Ease pain and stiffness
• Improve sleep
• Enhance overall feeling of wellness

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• http//www.youtube.com/watch?vnNWPk6tYoUMfeature
  player_detailpage

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• 2007 National Health Interview Survey
• Comprehensive survey of CAM use by Americans
• 2.3 million in United States used Tai Chi in past
  12 months

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• Dont Be Afraid To Start.Youre Not The Only One
  Doing It!

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Current Research

• Review of Tai Chi as an Effective Exercise on
  Falls Prevention in Elderly
• Research in Sports Medicine
• January 2012
• Objective Systematic review of recent literature
  on TCs effectiveness for reducing fall risk in
  elders
• Analysis Following balance measure were reported
  as the main outcome of these studies fall
  surveillance, fear of falling, functional balance
  measures, lab-based balance measures
• Results
• Majority of studies demonstrated reductions in
  total number of falls fear of falling
• Significant improvements in lab-based balance
  measures

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• Interventions for preventing falls in older
  people living in the community
• Cochrane Database review
• September 2012
• Objective To assess the effects of interventions
  designed to reduce the incidence of falls in
  older people living in the community
• Analysis Compared rate of falls risk of
  falling between intervention and control groups
• Results
• Reduction in rate of falls bordered on
  statistical significance
• Risk of falling was significantly reduced

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• Efficacy of supervised Tai Chi exercises versus
  conventional physical therapy exercises in fall
  prevention for frail older adults a randomized
  controlled trial
• Disability and Rehabilitation
• November 2012
• Objective To compare the effectiveness of
  supervised TC exercises vs the conventional PT
  exercises in a personalized rehabilitation
  program in terms of the incidence severity of
  falls in a frail older population
• Analysis Fall incidence and severity assessed
• Results
• Both interventions demonstrated a protective
  effect on falls
• TC showed a greater one as compared to
  conventional PT exercises

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• Ready.Set.Go!

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Getting Started

• Any reason not to do it?
• Existing fitness level?
• Most important recommendation for avoiding
  activity-related injuries is to increase physical
  activity gradually
• Risk of injury is directly related to size of gap
  btw a persons usual level new level of
  activity
• Series of small increments in activity, each
  followed by a period of adaptation, assoc with
  lower rates of musculoskeletal injury
• Discuss time commitment
• Give useful resources
• Follow up

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• Given that the care of geriatric pts often
  involves a team, ensure the activity
  recommendation is communicated to all healthcare
  providers
• Physician
• Physical therapist
• Consultants
• Aides
• Family members

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Resources

• Books/Home videos
• Can do by self over time with experience
• Consider benefits of group setting
• Dr. Paul Lam
• http//usa.taichiproductions.com
• Books
• DVDs

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• Classes
• Contact fitness center, health club, senior
  center
• Mindful Movement Studio
• Sun Style Tai Chi
• 317-257-MIND (6463)
• Tai chi instructors don't have to be licensed or
  attend a standard training program
• Ask about an instructor's training and experience
• Get recommendations if possible

27

• http//www.ncoa.org
• Fall prevention
• Tai Chi Moving for Better Balance Program

28
Bibliography

• Ham RJ, Sloane PD, eds. Primary Care Geriatrics
  A Case-Based Approach. 5th ed. Philadelphia
  Mosby Elsevier 2007.
• Gillespie LD, Robertson MC, Gillespie WJ,
  Sherrington C, Gates S, Clemson LM, Lamb SE.
  Interventions for preventing falls in older
  people living in the community. Cochrane Database
  of Systematic Reviews 2012, Issue 9. Art. No.
  CD007146. DOI 10.1002/14651858.CD007146.pub3.
• Molly M. Schleicher, Lauren Wedam Ge Wu (2012)
  Review of tai Chi as an Effective Exercise on
  Falls Prevention in Elderly, Res Sports Med,
  201, 37-58.
• Tousignant, M. et al. (2012) Efficacy of
  supervised Tai Chi exercises versus conventional
  physical therapy exercises in fall prevention for
  frail older adults a randomized controlled
  trial. Disabil Rehab, 34 21, 1-7.
• Pacala JT, Sullivan GM, eds. Geriatrics Review
  Syllabus A Core Curriculum in Geriatric
  Medicine. 7th ed. New York American Geriatrics
  Society 2010.
• http//www.ncoa.org