By Dr Ananya Mandal, MD
A new study found that a six-month program of Tai Chi exercises helped people with various stages of Parkinson's disease improve stability, their ability to walk and reduced the frequency of falls.
The study, published in the New England Journal of Medicine compared a six-month tailored Tai Chi program to resistance training and stretching to see which was most effective at improving functional movement, walking and balance for Parkinson's patients.
Parkinson's is a neurological disorder caused by a loss of neurons that produce dopamine, a chemical involved with muscle function and movement coordination. That can result in tremors, stiffness, poor coordination and more difficulty doing daily activities. It can also lead to a higher risk of falls, which can cause serious injuries. Tai Chi, a discipline that incorporates slow, deliberate movements, plus breathing, has health benefits that include reducing stress and improving balance and posture.
For the study the researchers randomly assigned 195 men and women ages 40 to 85 who were in stages one to four of Parkinson's disease (on a scale of one to five) to the exercise groups. The study participants were randomly assigned to an hour long, twice weekly sessions of Tai Chi, resistance training or stretching for six months. Researchers assessed their status at the beginning of the study, at three and six months, and three months after the study ended.
At the end of the study the Tai Chi group did better than the stretching group on a few measures: leaning without losing balance, having better directional control of their body, and walking skills. They outperformed the resistance training group on balance and stride length. Those in the Tai Chi group also reduced their frequency of falls more than the stretching group, and on a par with the resistance group. Three months after the study ended, those in the Tai Chi group were able to maintain the benefits they had gained.
“Since many training features in the program are functionally oriented,” said Oregon Research Institute scientist Fuzhong Li in a news release, “the improvements in the balance and gait measures that we demonstrated highlight the potential of Tai Chi-based movements in rehabilitating patients with these types of problems and, consequently, easing cardinal symptoms of Parkinson's disease and improving mobility, flexibility, balance and range of motion.” Li was the lead author of the study.
Li explained that Tai Chi has several advantages. “It is a low-cost activity that does not require equipment, it can be done anywhere, at any time, and the movements can be easily learned. It can also be incorporated into a rehabilitation setting as part of existing treatment. Similarly, because of its simplicity, certain aspects of this Tai Chi program can also be prescribed to patients as a self-care/home activity.”
Dr. Chenchen Wang, who is studying tai chi for arthritis and fibromyalgia, said the results of the Parkinson's research were “dramatic and impressive.” She heads the Center for Complementary and Integrative Medicine at Tufts Medical Center in Boston. She added that one of the strengths of the study was that researchers could measure the results directly instead of relying on the patients' own reports. But a placebo effect can't be totally discounted, she said, since the participants knew which exercise program they were assigned and that could have influenced results.
The findings will receive a lot of attention in the Parkinson’s community, said Blair Ford, medical adviser with the Parkinson’s Disease Foundation and a professor of clinical neurology at Columbia University in New York. “Tai chi and probably equivalent methods are helpful at improving balance and decreasing falls and that’s very, very important for Parkinson’s disease,” Ford said in a Feb. 7 telephone interview. The study “might just get tai chi on the map as a conjunctive treatment for Parkinson’s. Medications alone don’t prevent falling.”
Andrew Feigin, a neurologist specializing in Parkinson’s disease at the North Shore-LIJ Medical Group in Great Neck, New York, said the findings give scientific backing to doctor recommendations that patients try exercises like tai chi to improve balance. “Balance and gait are problems that people with Parkinson’s disease have,” said Feigin, who wasn’t an author of paper. “Things like stretching and resistance aren’t really working on balance. Tai chi really focuses on improvements in balance. It’s nice to get some actual data that shows doing those things can be helpful.”
“The results from this study are quite impressive,” says Ray Dorsey, a neurologist and associate professor at Johns Hopkins School of Medicine in Baltimore. “It's always difficult to compare results across studies, but the magnitude of the impact that they had is larger, in some cases, than what is seen with medications in Parkinson's,” says Dorsey, who also directs the Movement Disorders Center and Neurology Telemedicine at Johns Hopkins. He was not involved in the research.
Estimates vary, but at least 500,000 people in the United States have Parkinson's and as many as 10 million people worldwide are living with the disorder, according to the Parkinson’s Disease Foundation, based in New York. Men are more probable than women to have the disease. The study was paid for by the National Institute of Neurological Disorders and Stroke.