Tai Chi

Tai Chi is a slow, flowing movement practice done standing, built on continuous shifts of weight from foot to foot. Across 24 randomised trials it cut the number of older adults who fall by about a quarter, one of the better-tested exercises for falls. A therapeutic version beat a conventional exercise programme head to head in a high-risk group, though that trial's first author licenses the programme.

If you are at risk of falling, Tai Chi is one of the best-tested ways to train balance. Practise at least twice a week, as in the trials with clear results, and give it months, not weeks.

What it is

Tai Chi (tai ji quan) is a Chinese practice of slow, continuous movements performed standing, with steady weight transfer between the legs. It needs no equipment and is usually taught in group classes. There are several traditional styles, such as Yang and Sun.

Tai Ji Quan: Moving for Better Balance is a therapeutic version designed for fall prevention, built from modified forms and therapeutic movement exercises.

About a quarter fewer people fall

A pooled analysis of 24 randomised trials found that Tai Chi reduced the number of older adults who fell by about 24% (risk ratio 0.76). In the 15 trials that counted every fall, the total number of falls was about a third lower.^[1]

It worked both in healthy older adults and in those at high risk of falling. Balance tests improved too, including standing on one leg, reaching forward and walking speed. Two outcomes did not move: a standard battery of physical-performance tests, and a questionnaire on fear of falling.

One caution: the result on fallers showed signs of publication bias, meaning small trials that found nothing may be missing from the record. It stayed significant after the authors corrected for that. Yang-style Tai Chi did better than Sun-style in a subgroup comparison.

How often

Twice-weekly and three-or-more-times-weekly practice each showed a clear benefit; once a week did not reach significance, but that group held only three trials. The formal test for a difference between frequencies was not significant, so this is a weak pattern, not a proven dose.^[2]

The therapeutic form, head to head

The largest head-to-head trial enrolled 670 adults aged 70 and over in Oregon, average age about 78, who had fallen in the previous year or had impaired mobility. They were randomly assigned to two 60-minute classes a week for 24 weeks of the therapeutic form, a conventional mixed programme of balance, aerobic, strength and flexibility exercise, or stretching.^[3]

During the trial, the Tai Chi group had 152 falls, the mixed-exercise group 218 and the stretching group 363. At six months, the therapeutic form cut the fall rate by 58% against stretching and by 31% against the mixed programme. Beating a conventional exercise programme, not just a weak control, is rare in this field.

Two caveats. It is one trial. And its first author founded and owns the company that receives the licensing fee for the programme.

Who it suits, and its limits

Tai Chi worked in healthy and high-risk older adults alike; the head-to-head trial was in high-risk people. Across falls-prevention research, effects are best established in people at elevated risk, and the interventions with moderate-certainty benefit were mostly supervised and ran longer than three months.^[4] How much it adds for a fit middle-aged adult has not been tested.

Tai Chi trains balance; it is not a substitute for the strength and power work that Training mobility and balance sets out. For mind-body exercise and bone, see Bone density.

What to do

Find a regular class. If you have fallen or feel unsteady, the therapeutic form Tai Ji Quan: Moving for Better Balance has the one head-to-head win, from a trial with the conflict of interest noted above.
Go at least twice a week, and plan on months: the strongest trial ran for 24 weeks.
Keep your strength training. Tai Chi covers balance, not muscle and power.
Judge it by your own checks: retest your one-leg stance and how steady you feel every few months.