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Thursday, February 9, 2012
Tai Chi vs. Other Exercises for Parkinson Disease
A randomized comparison suggests potential benefits from both tai chi and resistance training.
Aiming to assess whether practicing tai chi improves measures of postural stability in patients with Parkinson disease (PD), researchers randomized 185 patients with PD ranging from early to late disease stages to be trained in tai chi, resistance training, or stretching. Training consisted of 60-minute sessions twice weekly for 24 weeks. In the resistance-training group, resistance was added at week 10 and gradually increased from 1% to 5% of body weight. The primary outcome was postural stability at 6 months, measured by maximum excursion and directional control on the limits-of-stability test. Secondary outcomes included measures of gait and knee strength, scores on the functional-reach and timed up-and-go tests, motor scores on the Unified Parkinson's Disease Rating Scale, and number of falls recorded in patient diaries.
At 6 months, the tai chi group performed significantly better than the other two groups on the primary outcome measures (vs. resistance training: maximum excursion, 5.55 percentage points better; directional control, 10.45 percentage points better; vs. stretching: 11.98 and 11.38 percentage points better, respectively). Compared with the resistance-training group, the tai chi group had similar performance on many of the secondary measures and reported nonsignificantly fewer falls. (They reported significantly fewer falls than the stretching group.)
Comment: Because much of the disability in PD arises from gait, balance, and motor dysfunction, and because many experts now prescribe exercise as an intervention, this study provides important insights. The findings add to the growing body of evidence suggesting benefits of various activities in patients with PD. However, it is important not to overinterpret the results. Patients at a wide range of disease stages were included, making generalization and interpretation of effects tricky. Better characterization of pre- and posttreatment falling in the advanced-stage patients, especially those with preexisting fall-related issues, would have been more relevant. Also, medications were quantitated by number, not dose.
Tai chi incorporates movements that enhance balance control through practicing volitional destabilization of the center of mass. Therefore, the tai chi group's better performance on balance measures makes sense. Resistance training prioritizes muscle strengthening and force development and has potential benefits that are distinct from those of tai chi. The resistance training in this study was not particularly intense, especially compared with previous studies (Parkinsonism Relat Disord 2009; 15:752 and Gait Posture 2012 Jan 20; e-pub ahead of print). Similarly, stretching is a very important part of the daily regimen for the PD patient. Therefore, modalities should be selected and tailored to meet the needs of the individual patient.
Published in Journal Watch Neurology February 8, 2012
Citation(s):
Li F et al. Tai chi and postural stability in patients with Parkinson's disease. N Engl J Med 2012 Feb 9; 366:511.
Aiming to assess whether practicing tai chi improves measures of postural stability in patients with Parkinson disease (PD), researchers randomized 185 patients with PD ranging from early to late disease stages to be trained in tai chi, resistance training, or stretching. Training consisted of 60-minute sessions twice weekly for 24 weeks. In the resistance-training group, resistance was added at week 10 and gradually increased from 1% to 5% of body weight. The primary outcome was postural stability at 6 months, measured by maximum excursion and directional control on the limits-of-stability test. Secondary outcomes included measures of gait and knee strength, scores on the functional-reach and timed up-and-go tests, motor scores on the Unified Parkinson's Disease Rating Scale, and number of falls recorded in patient diaries.
At 6 months, the tai chi group performed significantly better than the other two groups on the primary outcome measures (vs. resistance training: maximum excursion, 5.55 percentage points better; directional control, 10.45 percentage points better; vs. stretching: 11.98 and 11.38 percentage points better, respectively). Compared with the resistance-training group, the tai chi group had similar performance on many of the secondary measures and reported nonsignificantly fewer falls. (They reported significantly fewer falls than the stretching group.)
Comment: Because much of the disability in PD arises from gait, balance, and motor dysfunction, and because many experts now prescribe exercise as an intervention, this study provides important insights. The findings add to the growing body of evidence suggesting benefits of various activities in patients with PD. However, it is important not to overinterpret the results. Patients at a wide range of disease stages were included, making generalization and interpretation of effects tricky. Better characterization of pre- and posttreatment falling in the advanced-stage patients, especially those with preexisting fall-related issues, would have been more relevant. Also, medications were quantitated by number, not dose.
Tai chi incorporates movements that enhance balance control through practicing volitional destabilization of the center of mass. Therefore, the tai chi group's better performance on balance measures makes sense. Resistance training prioritizes muscle strengthening and force development and has potential benefits that are distinct from those of tai chi. The resistance training in this study was not particularly intense, especially compared with previous studies (Parkinsonism Relat Disord 2009; 15:752 and Gait Posture 2012 Jan 20; e-pub ahead of print). Similarly, stretching is a very important part of the daily regimen for the PD patient. Therefore, modalities should be selected and tailored to meet the needs of the individual patient.
Published in Journal Watch Neurology February 8, 2012
Citation(s):
Li F et al. Tai chi and postural stability in patients with Parkinson's disease. N Engl J Med 2012 Feb 9; 366:511.
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