Tai Chi and postural stability in patients with Parkinson’s disease

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 healthcare providers, few programmes have been proven effective.

In this study, the authors conducted a randomised, controlled trial to determine whether a tailored tai chi programme could improve postural control in patients with idiopathic Parkinson’s disease. They randomly assigned 195 patients with stage 1 - 4 disease on the Hoehn and Yahr staging scale (which ranges from 1 to 5, with higher stages indicating more severe disease) to 1 of 3 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 - 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.

The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion and in directional control. 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.

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.

Li F, et al. N Engl J Med 2012;366:511-519.