Health
Balance, falls and t'ai chi for older adults
Balance is at the heart of t'ai chi: every posture is a controlled shift of weight from one leg to the other. It is no surprise, then, that researchers have spent a great deal of effort asking what tai chi practice means for older adults and falls. This page summarises what some of that research studied, carefully and without promises.
Why falls matter
The National Institute on Aging explains that a simple accident, such as tripping on a rug, can change an older person's life, that a broken bone can lead to long-term disability, and that the risk of falling rises with age. It also points out that fear of falling can lead people to avoid activities such as walking or social outings, even though staying active is important. MedlinePlus's page on falls adds that older adults are more likely to break a bone when they fall, and lists leg weakness and slower reflexes among the things that make balance harder to keep.
Balance problems themselves have many causes, from the inner ear to the heart and brain. MedlinePlus's page on balance problems stresses that it is important to see a doctor about them, because they can be a sign of other health problems.
What research has studied
A review of trials
A systematic review and meta-analysis published in BMJ Open in 2017 gathered 18 randomised trials with 3824 participants looking at tai chi and falls in older adults. It reported that the tai chi groups were associated with a lower chance of falling at least once and a lower rate of falls than control groups, and that the effect appeared to increase with how often people exercised. The authors also noted that their results might be influenced by publication bias, a reminder that positive studies are more likely to be published than negative ones.
A trial in people at high risk
A randomised clinical trial reported in JAMA Internal Medicine in 2018 studied 670 adults aged 70 or older who had a history of falls or impaired mobility. It compared a therapeutic tai ji quan programme designed for fall prevention with a multimodal exercise programme and with stretching, and reported fewer falls in the tai ji quan group than in either comparison group. The programme was specifically tailored for this purpose and delivered in a study setting; it is not the same thing as an ordinary community class.
A government summary
The National Center for Complementary and Integrative Health summarises the wider evidence by saying that tai chi may be beneficial for balance and falls in older adults and in people with Parkinson's disease, and that it is unknown whether it helps reduce falls in people who have had a stroke or who have osteoarthritis or heart failure. It also notes that other forms of exercise, particularly balance and functional exercises, were helpful too.
Reading these studies sensibly
- They describe groups of people in particular programmes, not what will happen to any one person.
- Study programmes were structured, supervised and regular; results from casual practice may differ.
- Tai chi was compared with other activities, and other kinds of exercise also helped in some studies.
- Many falls have causes that exercise does not address, such as eyesight, medicines and hazards at home, which is why the NIA lists several steps together.
Adapting practice for balance
Teachers who work with older students commonly adapt the art rather than simplify it away:
- Shorter, narrower stances, so the base of support is comfortable and weight shifts are small.
- Higher postures, with only a gentle bend in the knees.
- Chair support: practising beside a sturdy chair or counter, one hand resting on it, or doing arm movements seated.
- Slower turns, especially where the form pivots on one foot.
- Shorter sessions, with rests, building up over weeks.
- A safe space: good light, a non-slip floor and nothing to trip over.
For more on how tai chi sits alongside other exercise, read t'ai chi as exercise; for stances and the knees, read knees, joints and a lifetime of practice.