Evaluating Exercise Prescription and Instructional Methods Used in Tai Chi Studies Aimed at Improving Balance in Older Adults: A Systematic Review

J Am Geriatr Soc. 2016 Oct;64(10):2074-2080. doi: 10.1111/jgs.14242. Epub 2016 Aug 22.


Objectives: To develop an evaluation instrument to determine to what extent Tai Chi interventions aimed at improving the balance of older adults disclosed their exercise prescription (Ex Rx ) and instructional methods and met best-practice exercise recommendations for balance improvement.

Design: Review.

Setting: PubMed, Scopus, and CINAHL databases were searched from their inception until August 22, 2014.

Participants: Adults aged 60 and older without debilitating disease.

Measurements: Three electronic databases were searched to identify randomized controlled trials (RCTs) of Tai Chi interventions aimed at improving balance in older adults without severe debilitating diseases. Three Ex Rx (frequency, time, intervention length) and 10 instructional (e.g., style, number of forms) methods of the included RCTs were evaluated.

Results: Twenty-seven interventions were identified from 26 RCTs. On average, Tai Chi was performed for a mean 56.5 ± 14.4 minutes per session for 2.8 ± 1.4 sessions per week for 19.7 ± 12.7 weeks. Most interventions reported all three Ex Rx methods items, with a mean reporting rate of 92.6 ± 19.2%. For the 10 instructional methods items, the mean reporting rate was 41.1 ± 18.0%, significantly lower than for the Ex Rx methods items (P < .001). Fewer than half of the interventions reported unsupervised practice (15%), progression (22%), or the use of breathing (30%) and relaxation (15%) techniques. The instructional methods items most important for targeting Tai Chi practice to improve balance were not routinely disclosed, with only 15% reporting names of forms and 52% reporting movement principles.

Conclusion: Most Tai Chi interventions disclosed their Ex Rx methods yet routinely failed to report instructional methods. To increase the effectiveness of Tai Chi to improve balance in older adults, future RCTs should disclose their Ex Rx and instructional methods, especially methods that target balance.

Keywords: elderly; fall prevention; neuromotor exercise; physical activity; sensorimotor control.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Exercise Therapy / methods*
  • Exercise* / physiology
  • Exercise* / psychology
  • Humans
  • Middle Aged
  • Models, Educational*
  • Postural Balance*
  • Practice Patterns, Physicians'
  • Randomized Controlled Trials as Topic
  • Tai Ji* / education
  • Tai Ji* / methods