Chronic pain is associated with poorer cognition and mobility, and fall risk in older adults.
To investigate the feasibility of a randomized controlled trial of mind-body exercise (Tai Chi) versus light physical exercise in older adults with multisite pain.
Adults aged ≥ 65 years with multisite pain who reported falling in the past year or current use of an assistive device were recruited from Boston area communities. Participants were randomized to either a Tai Chi or a light physical exercise program, offered twice weekly for 12 weeks. The primary outcomes were feasibility and acceptability. Secondary outcomes included pain characteristics, cognition, physical function, gait mobility, fear of falling, and fall rate.
Of 176 adults screened, 85 were eligible, and 54 consented and enrolled (average age 75 ± 8 years; 96.30% white; 75.93% female). The dropout rate was 18% for Tai Chi and 12% for light physical exercise. For those completing the study, exercise class attendance rate was 76% for Tai Chi and 82% for light physical exercise. There were no significant group differences in most secondary outcomes. Tai Chi significantly lowered pain severity (4.58 ± 1.73 to 3.73 ± 1.79, p < 0.01) and pain interference (4.20 ± 2.53 to 3.16 ± 2.28, p < 0.05), reduced fear of falling (90.82 ± 9.59 to 96.84 ± 10.67, p < 0.05), and improved several single-task and dual-task gait variables, while light physical exercise did not change these measures.
Discussion and conclusions
This study demonstrated the feasibility and acceptability of conducting a larger randomized controlled trial in older adults with multisite pain. Study findings and challenges encountered will inform future research.
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Leveille SG, Ling S, Hochberg MC et al (2001) Widespread musculoskeletal pain and the progression of disability in older disabled women. Ann Intern Med 135:1038–1046
Eggermont LH, Bean JF, Guralnik JM et al (2009) Comparing pain severity versus pain location in the MOBILIZE Boston study: chronic pain and lower extremity function. J Gerontol Ser A Biol Sci Med Sci 64:763–770. https://doi.org/10.1093/gerona/glp016
Lee DM, Pendleton N, Tajar A et al (2010) Chronic widespread pain is associated with slower cognitive processing speed in middle-aged and older European men. Pain 151:30–36. https://doi.org/10.1016/j.pain.2010.04.024
Leveille SG, Jones RN, Kiely DK et al (2009) Chronic musculoskeletal pain and the occurrence of falls in an older population. J Am Med Assoc 302:2214–2221. https://doi.org/10.1001/jama.2009.1738
Chou CH, Hwang CL, Wu YT (2012) Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis. Arch Phys Med Rehabil 93:237–244. https://doi.org/10.1016/j.apmr.2011.08.042
Bauman A, Merom D, Bull FC et al (2016) Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence, and interventions to promote “active aging”. Gerontologist 56:S268–S280. https://doi.org/10.1093/geront/gnw031
Buchman AS, Boyle PA, Leurgans SE et al (2011) Cognitive function is associated with the development of mobility impairments in community-dwelling elders. Am J Geriatr Psychiatry Off J Am Assoc Geriatric Psychiatry 19:571–580. https://doi.org/10.1097/JGP.0b013e3181ef7a2e
Segev-Jacubovski O, Herman T, Yogev-Seligmann G et al (2011) The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk? Expert Rev Neurother 11:1057–1075. https://doi.org/10.1586/ern.11.69
Eggermont LH, Milberg WP, Lipsitz LA et al (2009) Physical activity and executive function in aging: the MOBILIZE Boston Study. J Am Geriatr Soc 57:1750–1756. https://doi.org/10.1111/j.1532-5415.2009.02441.x
van der Leeuw G, Eggermont LH, Shi L et al (2016) Pain and cognitive function among older adults living in the community. J Gerontol A Biol Sci Med Sci 71:398–405. https://doi.org/10.1093/gerona/glv166
Wayne PM, Kaptchuk TJ (2008) Challenges inherent to t’ai chi research: part II—defining the intervention and optimal study design. J Altern Complement Med 14:191–197
Wayne PM, Kaptchuk TJ (2008) Challenges inherent to T’ai Chi research: part I—T’ai Chi as a complex multicomponent intervention. J Altern Complement Med 14:95–102. https://doi.org/10.1089/acm.2007.7170A
Zheng G, Liu F, Li S et al (2015) Tai Chi and the protection of cognitive ability: a systematic review of prospective studies in healthy adults. Am J Prev Med 49:89–97. https://doi.org/10.1016/j.amepre.2015.01.002
Huang Y, Liu X (2015) Improvement of balance control ability and flexibility in the elderly Tai Chi Chuan (TCC) practitioners: a systematic review and meta-analysis. Arch Gerontol Geriatr 60:233–238. https://doi.org/10.1016/j.archger.2014.10.016
Wolf SL, Barnhart HX, Kutner NG et al (1996) Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and injuries: cooperative studies of intervention techniques. J Am Geriatr Soc 44:489–497
Leung DP, Chan CK, Tsang HW et al (2011) Tai chi as an intervention to improve balance and reduce falls in older adults: a systematic and meta-analytical review. Altern Ther Health Med 17:40–48
Hall A, Copsey B, Richmond H et al (2017) Effectiveness of Tai Chi for chronic musculoskeletal pain conditions: updated systematic review and meta-analysis. Phys Ther 97:227–238. https://doi.org/10.2522/ptj.20160246
Leveille SG, Kiel DP, Jones RN et al (2008) The MOBILIZE Boston Study: design and methods of a prospective cohort study of novel risk factors for falls in an older population. BMC Geriatr 8:16. https://doi.org/10.1186/1471-2318-8-16
Guralnik JM, Fried LP, Simonsick EM et al (1995) The Women’s Health and Aging Study: health and social characteristics of older women with disability. National Institute of Aging, Bethesda
Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707. https://doi.org/10.1056/NEJM198812293192604
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198
Escobar JI, Burnam A, Karno M et al (1986) Use of the Mini-Mental State Examination (MMSE) in a community population of mixed ethnicity. Cultural and linguistic artifacts. J Nerv Ment Dis 174:607–614
Kirk-Sanchez NJ, McGough EL (2014) Physical exercise and cognitive performance in the elderly: current perspectives. Clin Interv Aging 9:51–62. https://doi.org/10.2147/CIA.S39506
Duzel E, van Praag H, Sendtner M (2016) Can physical exercise in old age improve memory and hippocampal function? Brain 139:662–673. https://doi.org/10.1093/brain/awv407
Keller S, Bann CM, Dodd SL et al (2004) Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 20:309–318
Tan G, Jensen MP, Thornby JI et al (2004) Validation of the brief pain inventory for chronic nonmalignant pain. J Pain Off J Am Pain Soc 5:133–137. https://doi.org/10.1016/j.jpain.2003.12.005
Robertson IH, Ward T, Ridgeway V et al (1996) The structure of normal human attention: the test of everyday attention. J Int Neuropsychol Soc 2:525–534
Tombaugh TN (2004) Trail Making Test A and B: normative data stratified by age and education. Arch Clin Neuropsychol 19:203–214. https://doi.org/10.1016/S0887-6177(03)00039-8
Guralnik JM, Simonsick EM, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94
Penninx BW, Ferrucci L, Leveille SG et al (2000) Lower extremity performance in nondisabled older persons as a predictor of subsequent hospitalization. J Gerontol A Biol Sci Med Sci 55:M691–M697
Paleacu D, Shutzman A, Giladi N et al (2007) Effects of pharmacological therapy on gait and cognitive function in depressed patients. Clin Neuropharmacol 30:63–71. https://doi.org/10.1097/01.wnf.0000240949.41691.95
Springer S, Giladi N, Peretz C et al (2006) Dual-tasking effects on gait variability: the role of aging, falls, and executive function. Mov Disord 21:950–957. https://doi.org/10.1002/mds.20848
Brach JS, Studenski SA, Perera S et al (2007) Gait variability and the risk of incident mobility disability in community-dwelling older adults. J Gerontol Ser A Biol Sci Med Sci 62:983–988
Tinetti ME, Richman D, Powell L (1990) Falls efficacy as a measure of fear of falling. J Gerontol 45:P239–P243
Tinetti ME, Liu WL, Claus EB (1993) Predictors and prognosis of inability to get up after falls among elderly persons. J Am Med Assoc 269:65–70
Wang C, Schmid CH, Rones R et al (2010) A randomized trial of Tai Chi for fibromyalgia. N Engl J Med 363:743–754. https://doi.org/10.1056/NEJMoa0912611
Wang C, Schmid CH, Hibberd PL et al (2009) Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis Rheum 61:1545–1553. https://doi.org/10.1002/art.24832
Wang C, Schmid CH, Iversen MD et al (2016) Comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis: a randomized trial. Ann Intern Med 165:77–86. https://doi.org/10.7326/M15-2143
Donath L, van Dieen J, Faude O (2016) Exercise-based fall prevention in the elderly: what about agility? Sports Med 46:143–149. https://doi.org/10.1007/s40279-015-0389-5
Donath L, Roth R, Zahner L et al (2017) Slackline training (Balancing Over Narrow Nylon Ribbons) and balance performance: a meta-analytical review. Sports Med 47:1075–1086. https://doi.org/10.1007/s40279-016-0631-9
We thank HELP study participants for their engagement in this research. In addition, we thank the directors and staff of the University of Massachusetts Boston Health Services and community agencies who provided valuable support to our project. We thank all research assistants and students who worked on this project.
This work was supported by the National Institute of Health (R21 AG043883).
Conflict of interest
Peter Wayne, one of our research consultants, is the founder and owner of the Tree of Life Tai Chi Center. He was consulted on Tai Chi design and manuscript preparation. The authors declare no other conflicts of interest.
Statement of human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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You, T., Ogawa, E.F., Thapa, S. et al. Tai Chi for older adults with chronic multisite pain: a randomized controlled pilot study. Aging Clin Exp Res 30, 1335–1343 (2018). https://doi.org/10.1007/s40520-018-0922-0
- Chronic pain
- Mind-body exercise