09 February 2012
Li F, Harmer, P, Fitzgerald K, Eckstrom E, Stock R, Galver J Maddalozzo G, Batya S
Background: Patients
with Parkinson's disease have substantially impaired balance, leading
to diminished functional ability and an increased risk of falling.
Although exercise is routinely encouraged by health care providers, few
programs have been proven effective.
Methods: We
conducted a randomized, controlled trial to determine whether a
tailored tai chi program could improve postural control in patients with
idiopathic Parkinson's disease. We randomly assigned 195 patients with
stage 1 to 4 disease on the Hoehn and Yahr staging scale (which ranges
from 1 to 5, with higher stages indicating more severe disease) to one
of three groups: tai chi, resistance training, or stretching. The
patients participated in 60-minute exercise sessions twice weekly for 24
weeks. The primary outcomes were changes from baseline in the
limits-of-stability test (maximum excursion and directional control;
range, 0 to 100%). Secondary outcomes included measures of gait and
strength, scores on functional-reach and timed up-and-go tests, motor
scores on the Unified Parkinson's Disease Rating Scale, and number of
falls.
Results: The
tai chi group performed consistently better than the
resistance-training and stretching groups in maximum excursion
(between-group difference in the change from baseline, 5.55 percentage
points; 95% confidence interval [CI], 1.12 to 9.97; and 11.98 percentage
points; 95% CI, 7.21 to 16.74, respectively) and in directional control
(10.45 percentage points; 95% CI, 3.89 to 17.00; and 11.38 percentage
points; 95% CI, 5.50 to 17.27, respectively). The tai chi group also
performed better than the stretching group in all secondary outcomes and
outperformed the resistance-training group in stride length and
functional reach. Tai chi lowered the incidence of falls as compared
with stretching but not as compared with resistance training. The
effects of tai chi training were maintained at 3 months after the
intervention. No serious adverse events were observed.
Conclusions: Tai
chi training appears to reduce balance impairments in patients with
mild-to-moderate Parkinson's disease, with additional benefits of
improved functional capacity and reduced falls.
