Tai chi appears to help balance in mild to moderate Parkinson's

Tai chi may help improve balance in patients with mild to moderate Parkinson's disease, according to a new study.

Researchers in Oregon performed a randomized, controlled trial to assess whether tai chi could help improve postural control in Parkinson's disease. Patients whose disease was rated as stage 1 to 4 on the Hoehn and Yarhr scale (range, 1 to 5, with higher scores indicating more severe disease) were randomly assigned to perform tai chi, resistance training, or stretching in 60-minute exercise sessions twice a week for 24 weeks. The study's primary outcomes were changes from baseline in the limits of stability test, which measures maximum excursion and directional control on a scale of 0% to 100%; secondary outcomes examined gait, strength, functional reach, scores on timed up-and-go tests, falls, and motor scores on the Unified Parkinson's Disease Rating Scale. The study results appeared in the Feb. 9 New England Journal of Medicine.

One hundred ninety-five patients were randomly assigned to one of the three study groups, with each group assigned 65 patients. One hundred sixty-four patients (84%) had stage 2 or higher disease, and the mean age in each study group was approximately 69 years. Approximately 37% of all patients were women. One hundred seventy-six patients completed the interventions as assigned, and complete data on all outcome measures were available for 185 patients at follow-up. No significant differences in demographics or primary outcomes were noted between patients who did and did not complete the trial.

At 24 weeks, maximum excursion and directional control were both consistently better in the tai chi group than in the resistance training and stretching groups (between-group difference in change from baseline, 5.55 percentage points and 11.98 percentage points, respectively, for maximum excursion and 10.45 percentage points and 11.38 percentage points, respectively, for directional control). Patients in the tai chi group also had better results on all secondary outcomes than did patients in the stretching group and had better stride length and functional reach than the resistance training group. Fall incidence was lower in the tai chi group compared with the stretching group but not the resistance training group. Effects of tai chi remained evident three months after the intervention, and serious adverse events were not seen.

The authors acknowledged that their trial could not be blinded and did not involve a no-exercise control group. However, they concluded that tai chi seems to be an effective way to improve postural stability and functional ability in patients with mild to moderate Parkinson's disease and also showed benefit for fall reduction compared with stretching. The lack of adverse events, they noted, indicates that tai chi is a potentially safe and useful intervention in this population.