The effects of a Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults living in long-term care facilities: A single group design with multiple time points

doi:10.1016/j.ijnurstu.2006.11.008

International Journal of Nursing Studies

Volume 45, Issue 4, April 2008, Pages 501-507

https://doi.org/10.1016/j.ijnurstu.2006.11.008 Get rights and content

Abstract

Background

Studies support the positive effects that Tai Chi has on the physical health of older adults. However, many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred.

Objective

To test the effects of a newly-developed, Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults who resided in long-term care facilities.

Design

A single group design with multiple time points: three pre-tests, one month apart; four post-tests at one month, two months, three months, and six months after intervention started.

Settings

Two 300–400 bed veteran homes in Taiwan.

Participants

The 51 male older adults were recruited through convenience sampling, and 41 of them completed six-month study. Inclusion criteria included: (1) aged 65 and over; (2) no previous training in Tai Chi; (3) cognitively alert and had a score of at least eight on the Short Portable Mental Status Questionnaire; (4) able to walk without assistance; and (5) had a Barthel Index score of 61 or higher. Participants who had dementia, were wheel-chair bound, or had severe or acute cardiovascular, musculoskeletal, or pulmonary illnesses were excluded.

Methods

The STEP was implemented three times a week, 50 min per session for six months. The outcome measures included cardio-respiratory function, blood pressure, balance, hand-grip strength, lower body flexibility, and physical health actualization.

Results

A drop in systolic blood pressure $(p = . 017)$ and diastolic blood pressure (p<.001) was detected six months after intervention started. Increase in hand-grip strength from pre to post intervention was found (left hand: p<.001; right hand: $p = . 035$ ). Participants also had better lower body flexibility after practicing STEP $(p = . 038)$ .

Conclusions

Findings suggest that the STEP be incorporated as a floor activity in long-term care facilities to promote physical health of older adults.

Section snippets

What is already known about the topic?

1.
Studies support the positive effects that Tai Chi has on the physical health of older adults.
2.
Many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred.
3.
A simplified Tai Chi style, called the Simplified Tai-Chi Exercise Program (STEP), was specifically designed for the older adults who frequently feature a variety of chronic illnesses.

What this paper adds

1.
The STEP intervention significantly decreased systolic and diastolic blood pressure of older adults resided in long-term care facilities.
2.
The special design and emphasis of STEP led to the significant improvement of hand-grip strength and lower body flexibility in addition to the decrease of blood pressure typically reported in Tai Chi studies.

Design

A single group design with multiple time points was employed. Before the implementation of STEP, data were collected once a month for three months to understand the impact of nature aging on the physical health of the elderly subjects; and then, four times after intervention started: one month, two months, three months, and six months to assess the change in older adults’ physical health status. The subjects served as their own control, thus avoiding the characteristics differences of the

Self-actualization of physical health status

As shown in Table 1, the mean SF-36 physical health status scores remained fairly stable from 54.9±6.8 at pre-test I to 58.6±6.9 at post-test IV (GEE $p = . 635$ ). Similar results were found when only available observations were used to fit a linear mixed model, using compound symmetry as the repeated covariance type $(p = . 699)$ . This was done as a form of sensitivity analysis to assess the effect of data imputation on the results. Moreover, the mean pre and post test scores were not significantly

Discussion

We investigated the effect of the STEP intervention on the physical health of older adults resided in long-term care facilities. Results of comparisons among three pre-tests indicated a significant deterioration in elderly subjects’ body flexibility before the STEP intervention. However, after one month of the STEP practice, subjects’ hand-gripping strength significantly improved, and at the end of six months intervention, the blood pressure, both systolic and diastolic, decreased. Yet, balance

Acknowledgments

Sincere appreciation is directed by our group to the National Science Council, Taiwan for funding this study (NSC 92-2314-B-242-002); to Professors Mariah Snyder and Frank Belcastro for their superlative manuscript editing; to the 51 wonderful participants and the staff of Nan-Tzy and Gang-Shan Veteran Homes for their generous participation. An abstract of this study was presented at the 16th International Nursing Research Congress, Waikoloa, Hawaii in July, 2005.

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The results indicate that the Seated form of Tai Chi intervention had a significant effect on improving perceptions of QOL; namely overall QOL, general health and all associated domains (physical and psychological health, social relations and the environment) of the WHOQOL-BREF. This finding supports those of previous studies that indicate that Tai Chi significantly improves QOL,8,12,14,15,23,28 and its domains of general health30; and physical, psychological health.14,23,28 These findings also support previous studies that indicate Tai Chi has a positive effect on depression symptoms.14,15,17
Compare the effect of seated Tai Chi exercise (intervention) to usual activities on quality of life and depression symptoms in older people using wheelchairs.
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One long-term care facility in Taiwan.
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Quality of Life (WHOQOL (BREF)); depression symptoms (GDS-SF)
Participants in the Tai Chi group (M = 3.76, SD = 3.65) recorded significantly lower GDS-SF scores than participants in the control (M = 7.76, SD = 5.15) and the Tai Chi group registered significantly higher scores across overall QOL [p = 0.03], general health [p = 0.04], and the associated domains: physical health [p = 0.00], psychological health [p = 0.02], social relations [p = 0.00], and environment [p = 0.00].
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^☆: The work was performed at Fooyin University, Kaohsiung, Taiwan. This study was funded by the National Science Council, Taiwan (NSC 92-2314-B-242-002).

View full text

The effects of a Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults living in long-term care facilities: A single group design with multiple time points☆

Abstract

Background

Objective

Design

Settings

Participants

Methods

Results

Conclusions

Section snippets

What is already known about the topic?

What this paper adds

Design

Self-actualization of physical health status

Discussion

Acknowledgments

The Practice of Nursing Research: Conduct, Critique, & Utilization

Changes in haemodynamic parameters following Tai Chi Chuan and aerobic exercise in patients recovering from acute myocardial infarction

Postgraduate Medical Journal

The effects of Tai Chi on symptom control in patients with chronic illness

Journal of Nursing

A research-based use of Tai Chi/movement therapy as a nursing intervention

Journal of Holistic Nursing

Frail elders’ views of Tai Chi

Journal of Nursing Research

Development of the Simplified Tai-Chi Exercise Program (STEP) for frail older adults

Complementary Therapies in Medicine

Mind-body fitness: encouraging prospects for primary and secondary prevention

Journal of Cardiovascular Nursing

ADL status in stroke: relative merits of three standard indexes

Archives of Physical Medicine and Rehabilitation

The role of exercise in falls prevention for older patients

Nursing Times

The effect of Tai Chi Chuan training on balance, kinesthetic sense, and strength

Perceptual and Motor Skills

The Tao of Tai Chi Chuan: Way to Rejuvenation

Two-year trends in cardiorespiratory function among older Tai Chi Chuan practitioners and sedentary subjects

Journal of the American Geriatrics Society

12-month Tai Chi training in the elderly: Its effect on health fitness

Medicine and Science in Sports and Exercise