The Influence of Intense Tai Chi Training onPhysical Performance and Hemodynamic Outcomesin Transitionally Frail, Older AdultsSteven L. Wolf,1Michael O’Grady,1Kirk A. Easley,2Ying Guo,2Reto W. Kressig,3and Michael Kutner21Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia.2Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia.3Geneva University Hospitals, Switzerland.Background. Few data exist to evaluate whether Tai Chi (TC) training improves physical performance andhemodynamic outcomes more than a wellness education (WE) program does among older fallers transitioning to frailty.Methods. This 48-week randomized clinical trial was provided at 10 matched pairs of congregate living facilities inthe Atlanta metropolitan area to 291 women and 20 men, who were transitionally frail, 70 years old, and had fallen atleast once within the past year. Pairs of facilities were randomized to either TC exercise (n ¼ 158) or WE (control) inter-ventions (n ¼ 153) over 48 weeks. Physical performance (freely chosen gait speed, reach, chair-rises, 3608 turn, pickingup an object from the floor, and single limb support) and hemodynamic outcomes (heart rate and blood pressure)were obtained at baseline and after 4, 8, and 12 months.Results. Mean percent change (baseline to 1 year) for gait speed increased similarly in both cohorts (TC: 9.1% andWE: 8.2%; p ¼ .78). However, time to complete three chair-rises decreased 12.3% for TC and increased 13.7% for WE( p ¼ .006). Baseline to 1 year mean percent change decreased among TC and increased within WE cohorts for: bodymass index (–2.3% vs 1.8%; p , .0001), systolic blood pressure (–3.4% vs 1.7%; p ¼ .02), and resting heart rate (–5.9%vs 4.6%; p , .0001).Conclusions. TC significantly improved chair-rise and cardiovascular performance. Because TC training reduced falloccurrences in this cohort, factors influencing functional and cardiovascular improvements may also favorably impactfall events.EXERCISE programs can decrease falls (1–3), improvemuscle strength (4–6), and enhance gait and posturalstability (7,8) in healthy older persons. The Frailty andInjuries: Cooperative Studies on Intervention Techniques(FICSIT) Trial (9) showed that Tai Chi (TC) exercise ata modest intensity produced a 47.5% reduction in risk ofmultiple falls (10) and participants were less fearful offalling (11). In contrast, transitionally frail older adultsparticipating in a 1-year program of TC training experienceda reduction in their risk by 25% compared to that ofparticipants in a wellness education WE program (12). Fallrates were reduced by 40% from 12 weeks to 48 weeks oftraining suggesting that a latency period exists before thebenefits of training are appreciated. Moreover, older adultswho are physically active for less than an hour per week(13) can also reduce the risk of falls over a 6-month follow-up period.Although reducing falls is important to older adults whoare becoming frail, exploring the extent to which TC willaffect hemodynamic outcomes and physical performance inthis cohort is also important, because mobility and health-related quality of life are also impacted by these outcomes.This article explores the extent and time course over whichTC impacts measures of physical performance and cardio-vascular function in this cohort.METHODSResearch Design and ParticipantsData were collected from 311 participants (age range:70–97 years; mean age: 80.9 years) recruited from 20independent congregate living facilities in the greater At-lanta area. Details regarding the design, methodology, andinclusion exclusion criteria have been reported previously(14). Sites were randomized in pairs with each pair receivingeither the TC or WE intervention and enrolled 15–19participants. All participants provided written informedconsent.Medical history and physical examinations were obtainedat baseline to rule out the possibility of occult cardiovasculardisease or other medical or psychological conditions thatcould adversely influence participation. Participants aver-aged 5.6 comorbidities, the most prevalent of which includedosteoarthritis, visual dysfunction, and hypertension.InterventionsThe TC intervention consisted of 1-hour group exerciseconducted twice weekly. Participants were asked tocomplete and return weekly exercise logs and were taughtbehavioral skills and strategies relevant to each move-ment form. Six of the 24 simplified TC forms were used.All TC exercise was standardized by having the two184Journal of Gerontology: MEDICAL SCIENCES Copyright 2006 by The Gerontological Society of America2006, Vol. 61A, No. 2, 184–189instructors practice with one another until their executionof the movement forms to be taught in each class wereidentical.Participants progressed from often being dependent onassistive devices for upright support to performing 2continuous minutes of TC without support. ‘‘Intense’’ TCwas defined as two sessions per week at increasing durationsstarting at 60 minutes of contact time and progressing to90 minutes over 48 weeks. In addition, participants wereasked to supplement their TC training with home-basedexercise, with the goal of exercising 4–5 days per week,10–30 minutes per day. The actual ‘‘work’’ time, exclusiveof warm-up and cool-down, progre ssed from approximately10 to 50 minutes.The WE program was given at participating facilities foran hour each week and consisted of prepar ed lectures onfalls prevention; exercise and balance; diet and nutrition;pharmacological management; legal issues relevant tohealth; age-rel ated changes in body function; and mentalhealth (stress, depression). The total time for individualattention from each instructor to participants in each groupwas comparable. All outcome measures were obtained atbaseline and after 4, 8, and 12 months of the interventions.Physical PerformanceThe participants’ physical status was measured byperformance-based tests, chosen because of their previouslyestablished reliability and validity, simpli city to administer,and clinical utility and included gait speed, functional reachtest, time to rise from a chair three times, time to completea 3608 turn, time required to pick up an object from thefloor, and duration of single limb support wi th eyes openand closed. All tests were performed within a single testingsession with adequate rest between tests. The average ofthree