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Background/objectives: Mind-body exercise has positive effects on cognitive performance, according to clinical observation and experts' recommendations. However, its potential benefits for the cognitive function of aging adults are uncertain and still lack systematic estimations. Therefore, we conducted a systematic review and meta-analysis to evaluate the overall efficacy and effectiveness of mind-body exercises for cognitive performance in aging individuals with or without cognitive impairment., Design: A systematic review and meta-analysis., Setting and Participants: We searched related trials through June 2018 from four databases: Medline, Embase, PsycINFO (all via Ovid), and the Cochrane Library/Central Register of Controlled Trials., Measurements: Methodological quality was assessed using the Cochrane Risk of Bias Tool. A meta-analysis of comparative effects was performed using Review Manager v.5.3 software, and publication bias was examined using Egger's test., Results: A total of 32 randomized controlled trials with 3624 participants were ultimately included in this meta-analysis. The results revealed that mind-body exercises as a whole had benefits in improving global cognition compared with that of the control group (mean difference [MD] = 0.92; 95% confidence interval [CI] = 0.33-1.51; p = .002) and were more effective than control interventions in promoting cognitive flexibility (MD = -8.80; 95% CI = -15.22 to -2.38; p = .007), working memory (MD = 0.32; 95% CI = 0.01-0.64; p = .05), verbal fluency (standardized mean difference [SMD] = 0.27; 95% CI = 0.09-0.45; p = .003), and learning (SMD = 0.24; 95% CI = 0.10-0.39; p = .001) on cognitively intact or impaired older adults. In dose-subgroup analysis, only moderate exercise intensity (60-120 min per week) significantly increased global cognition scores compared with those of the control group (MD = 1.15; 95% CI = 0.34-1.97; p = .006)., Conclusion: Mind-body exercises, especially tai chi and dance mind-body exercise, are beneficial for improving global cognition, cognitive flexibility, working memory, verbal fluency, and learning in cognitively intact or impaired older adults. Moderate intensity is recommended as the optimal dose for older adults. J Am Geriatr Soc 67:749-758, 2019., (© 2018 The American Geriatrics Society.)

Objectives: To examine whether combined center- and home-based Tai Chi training can improve cognitive ability and reduce physiological fall risk in older adults with amnestic mild cognitive impairment (a-MCI)., Design: Randomized controlled trial., Setting: Chiang Mai, Thailand., Participants: Adults aged 60 and older who met Petersen's criteria for multiple-domain a-MCI (N = 66)., Intervention: Three weeks center-based and 12 weeks home-based Tai Chi (50 minutes per session, 3 times per week)., Measurements: Cognitive tests, including Logical Memory (LM) delayed recall, Block Design, Digit Span forward and backward, and Trail-Making Test Part B-A (TMT B-A), and fall risk index using the Physiological Profile Assessment (PPA)., Results: At the end of the trial, performance on LM, Block Design, and TMT B-A were significantly better for the Tai Chi group than the control group after adjusting for baseline test performance. The Tai Chi group also had significantly better composite PPA score and PPA parameter scores: knee extension strength, reaction time, postural sway, and lower limb proprioception., Conclusion: Combined center- and home-based Tai Chi training three times per week for 15 weeks significantly improved cognitive function and moderately reduced physiological fall risk in older adults with multiple-domain a-MCI. Tai Chi may be particularly beneficial to older adults with this condition., (© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.)

Objectives: To determine the effects of tai chi training on functional performance and walking with and without the addition of the performance of a cognitive task, in older adults living in supportive housing facilities., Design: Secondary data analysis comparing a single-blind, randomized controlled trial of tai chi training with an attention-matched educational control intervention with crossover to tai chi., Setting: Two supportive housing facilities., Participants: Sixty-six men and women living in supportive housing facilities entered the study, and 57 aged 87±7 completed all study procedures., Intervention: Interventions consisted of two 1-hour-long instructor-led group sessions per week for 12 weeks. Tai chi training consisted of movements based upon the Yang-style short form. Educational sessions consisted of lectures and discussions of age-related health topics., Measurements: Subjects were tested for physical function (Short Physical Performance Battery, SPPB), balance (Berg Balance Scale, BBS), mobility (timed up-and-go, TUG), and walking speed under normal and cognitive dual-task conditions., Results: The tai chi group exhibited greater improvement in SPPB scores (baseline 8.1±2.9, follow-up 9.0±2.6) than controls (baseline 8.2±2.6, follow-up 8.2±2.6) (P=.005). Tai chi also increased normal and dual-task walking speed (P<.001) yet did not affect BBS (P=.02) or TUG (P=.02) after accounting for multiple comparisons. The dual-task cost (percentage change) to walking speed was unaffected. After the crossover tai chi intervention, the control group improved performance in the SPPB, BBS, and TUG, and increased walking speed under normal and dual-task conditions (P=.008)., Conclusion: Tai chi training may be a safe and effective therapy to help improve physical function and dual-task walking in very old adults living in supportive housing facilities., (© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.)

Objectives: To summarize and critically evaluate research on the effects of Tai Chi on cognitive function in older adults., Design: Systematic review with meta-analysis., Setting: Community and residential care., Participants: Individuals aged 60 and older (with the exception of one study) with and without cognitive impairment., Measurements: Cognitive ability using a variety of neuropsychological testing., Results: Twenty eligible studies with a total of 2,553 participants were identified that met inclusion criteria for the systematic review; 11 of the 20 eligible studies were randomized controlled trials (RCTs), one was a prospective nonrandomized controlled study, four were prospective noncontrolled observational studies, and four were cross-sectional studies. Overall quality of RCTs was modest, with three of 11 trials categorized as high risk of bias. Meta-analyses of outcomes related to executive function in RCTs of cognitively healthy adults indicated a large effect size when Tai Chi participants were compared with nonintervention controls (Hedges' g = 0.90; P = .04) and a moderate effect size when compared with exercise controls (Hedges' g = 0.51; P = .003). Meta-analyses of outcomes related to global cognitive function in RCTs of cognitively impaired adults, ranging from mild cognitive impairment to dementia, showed smaller but statistically significant effects when Tai Chi was compared with nonintervention controls (Hedges' g = 0.35; P = .004) and other active interventions (Hedges' g = 0.30; P = .002). Findings from nonrandomized studies add further evidence that Tai Chi may positively affect these and other domains of cognitive function., Conclusion: Tai Chi shows potential to enhance cognitive function in older adults, particularly in the realm of executive functioning and in individuals without significant impairment. Larger and methodologically sound trials with longer follow-up periods are needed before more-definitive conclusions can be drawn., (© Published 2013. This article is a U.S. Government work and is in the public domain in the U.S.A.)

Objectives: To investigate the dissemination potential of a Tai Ji Quan-based program, previously shown to be efficacious for reducing risk of falls in older adults, through outpatient clinical settings., Design: A single-group pre/post design in which participants attended a twice-weekly Tai Ji Quan training program for 24 weeks., Setting: Communities in Lane County, Oregon., Participants: Independently living individuals (N=379) aged 65 and older., Measurements: Using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, the primary outcome was the proportion of participating healthcare providers who made referrals. Secondary outcomes were the proportion of referred individuals agreeing to participate and enrolling in the program, and measures of program implementation, maintenance, and effectiveness (on measures of falls, balance, gait, physical performance, and balance efficacy)., Results: Of the 252 providers invited to participate, 157 made referrals (62% adoption rate). Of 564 individuals referred, 379 (67% reach) enrolled in the program, which was successfully implemented in senior and community centers with good fidelity, 283 completed the program (75% retention), and 212 of these attended 75% or more of the 48 sessions. Participants reported a reduction in falls, with an incidence rate of 0.13 falls per person-month, and showed significant improvement from baseline in all outcome measures. A 3-month postintervention follow-up indicated encouraging levels of program maintenance among providers, participants, and community centers., Conclusion: Healthcare providers successfully implemented a protocol to refer individuals at risk of falling to a Tai Ji Quan-based program. The evidence-based program appears readily scalable and exportable, with potential for substantial clinical and public health effect., (© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.)

Objectives: To compare the effectiveness of tai chi and low-level exercise in reducing falls in older adults; to determine whether mobility, balance, and lower limb strength improved and whether higher doses of tai chi resulted in greater effect., Design: Randomized controlled trial., Setting: Eleven sites throughout New Zealand., Participants: Six hundred eighty-four community-residing older adults (mean age 74.5; 73% female) with at least one falls risk factor., Intervention: Tai chi once a week (TC1) (n = 233); tai chi twice a week (TC2) (n = 220), or a low-level exercise program control group (LLE) (n = 231) for 20 wks., Measurements: Number of falls was ascertained according to monthly falls calendars. Mobility (Timed-Up-and-Go Test), balance (step test), and lower limb strength (chair stand test) were assessed., Results: The adjusted incident rate ratio (IRR) for falls was not significantly different between the TC1 and LLE groups (IRR = 1.05, 95% confidence interval (CI) = 0.83-1.33, P = .70) or between the TC2 and LLE groups (IRR = 0.88, 95% CI = 0.68-1.16, P = .37). Adjusted multilevel mixed-effects Poisson regression showed a significant reduction in logarithmic mean fall rate of -0.050 (95% CI = -0.064 to -0.037, P < .001) per month for all groups. Multilevel fixed-effects analyses indicated improvements in balance (P < .001 right and left leg) and lower limb strength (P < .001) but not mobility (P = .54) in all groups over time, with no differences between the groups (P = .37 (right leg), P = .66 (left leg), P = .21, and P = .44, respectively)., Conclusion: There was no difference in falls rates between the groups, with falls reducing similarly (mean falls rate reduction of 58%) over the 17-month follow-up period. Strength and balance improved similarly in all groups over time., (© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.)

Objectives: To evaluate the effectiveness of Tai Chi Chuan in fall prevention in elderly people living at home with a high risk of falling., Design: Randomized controlled trial., Setting: Two industrial towns in the western part of the Netherlands., Participants: Two hundred sixty-nine elderly people (average age 77) living at home with a high risk of falling., Interventions: The intervention group received Tai Chi Chuan training for 1 hour twice a week for 13 weeks; the control group received usual care. Both groups received a brochure containing general information on how to prevent fall incidents., Measurements: Primary outcome was the number of falls over 12 months. Secondary outcomes were balance, fear of falling, blood pressure, heart rate at rest, forced expiratory volume during the first second, peak expiratory flow, physical activity, and functional status., Results: After 12 months, no lower fall risk in the Tai Chi Chuan group was observed than in the control group (adjusted hazard ratio=1.16; 95% confidence interval=0.84-1.60), and there were no significant intervention effects on the secondary outcome measures., Conclusion: These results suggest that Tai Chi Chuan may not be effective in elderly people at a high risk of falling who live at home.

Objectives: To determine the effectiveness of a 16-week community-based tai chi program in reducing falls and improving balance in people aged 60 and older., Design: Randomized, controlled trial with waiting list control group., Setting: Community in Sydney, Australia., Participants: Seven hundred two relatively healthy community-dwelling people aged 60 and older (mean age 69)., Intervention: Sixteen-week program of community-based tai chi classes of 1 hour duration per week., Measurements: Falls during 16 and 24 weeks of follow-up were assessed using a calendar method. Balance was measured at baseline and 16-week follow-up using six balance tests., Results: Falls were less frequent in the tai chi group than in the control group. Using Cox regression and time to first fall, the hazard ratio after 16 weeks was 0.72 (95% confidence interval (CI)=0.51-1.01, P=.06), and after 24 weeks it was 0.67 (95% CI=0.49-0.93, P=.02). There was no difference in the percentage of participants who had one or more falls. There were statistically significant differences in changes in balance favoring the tai chi group on five of six balance tests., Conclusion: Participation in once per week tai chi classes for 16 weeks can prevent falls in relatively healthy community-dwelling older people.

Objectives: To evaluate the effects of a behavioral intervention, Tai Chi, on resting and vaccine-stimulated levels of cell-mediated immunity (CMI) to varicella zoster virus (VZV) and on health functioning in older adults., Design: A prospective, randomized, controlled trial with allocation to two arms (Tai Chi and health education) for 25 weeks. After 16 weeks of intervention, subjects were vaccinated with VARIVAX, the live attenuated Oka/Merck VZV vaccine licensed to prevent varicella., Setting: Two urban U.S. communities between 2001 and 2005., Participants: A total of 112 healthy older adults aged 59 to 86., Measurements: The primary endpoint was a quantitative measure of VZV-CMI. Secondary outcomes were scores on the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36)., Results: The Tai Chi group showed higher levels of VZV-CMI than the health education group (P<.05), with a significant rate of increase (P<.001) that was nearly twice that found in the health education group. Tai Chi alone induced an increase in VZV-CMI that was comparable in magnitude with that induced by varicella vaccine, and the two were additive; Tai Chi, together with vaccine, produced a substantially higher level of VZV-CMI than vaccine alone. The Tai Chi group also showed significant improvements in SF-36 scores for physical functioning, bodily pain, vitality, and mental health (P<.05)., Conclusion: Tai Chi augments resting levels of VZV-specific CMI and boosts VZV-CMI of the varicella vaccine.

Objectives: To compare the effect of two 10-week balance training programs, Combined Balance and Step Training (CBST) versus tai chi (TC), on balance and stepping measures., Design: Prospective intervention trial., Setting: Local senior centers and congregate housing facilities., Participants: Aged 65 and older with at least mild impairment in the ability to perform unipedal stance and tandem walk., Intervention: Participants were allocated to TC (n = 107, mean age 78) or CBST, an intervention focused on improving dynamic balance and stepping (n = 106, mean age 78)., Measurements: At baseline and 10 weeks, participants were tested in their static balance (Unipedal Stance and Tandem Stance (TS)), stepping (Maximum Step Length, Rapid Step Test), and Timed Up and Go (TUG)., Results: Performance improved more with CBST than TC, ranging from 5% to 10% for the stepping tests (Maximum Step Length and Rapid Step Test) and 9% for TUG. The improvement in TUG represented an improvement of more than 1 second. Greater improvements were also seen in static balance ability (in TS) with CBST than TC., Conclusion: Of the two training programs, in which variants of each program have been proven to reduce falls, CBST results in modest improvements in balance, stepping, and functional mobility versus TC over a 10-week period. Future research should include a prospective comparison of fall rates in response to these two balance training programs.

Objectives: To determine whether an intense tai chi exercise program could reduce fear of falling better than a wellness education (WE) program in older adults who had fallen previously and meet criteria for transitioning to frailty., Design: Cluster-randomized, controlled trial of 48 weeks' duration., Setting: Ten matched pairs of congregate living facilities in the greater Atlanta area., Participants: Sample of 291 women and 20 men, aged 70 to 97., Measurements: Activity-related fear of falling using the Activities-Specific Balance Confidence Scale (ABC) and the Fall Efficacy Scale at baseline and every 4 months for 1 year. Demographics, time to first fall and all subsequent falls, functional measures, Centers for Epidemiologic Studies Depression Scale, medication use, level of physical activity, comorbidities, and adherence to interventions., Results: Mean ABC was similar in both cohort groups at the time of randomization but became significantly higher (decreased fear) in the tai chi cohort at 8 months (57.9 vs 49.0, P<.001) and at study end (59.2 vs 47.9, P<.001). After adjusting for covariates, the mean ABC after 12 months of intervention was significantly greater in the tai chi group than in the WE group, with the differences increasing with time (mean difference at 12 months=9.5 points, 95% confidence interval=4.8-14.2, P<.001)., Conclusion: Tai chi led to a significantly greater reduction in fear of falling than a WE program in transitionally frail older adults. The mean percentage change in ABC scores widened between tai chi and WE participants over the trial period. Tai chi should be considered in any program designed to reduce falling and fear of falling in transitionally frail older adults.

Objectives: To determine the effectiveness of tai chi on self-rated sleep quality and daytime sleepiness in older adults reporting moderate sleep complaints., Design: Randomized, controlled trial with allocation to tai chi or exercise control., Setting: General community., Participants: One hundred eighteen women and men aged 60 to 92., Intervention: Participants were randomized into tai chi or low-impact exercise and participated in a 60-minute session, three times per week, for 24 consecutive weeks., Measurements: Primary outcome measures were the seven subscales of the Pittsburgh Sleep Quality Index (PSQI), PSQI global score, and Epworth Sleepiness Scale (ESS). Secondary outcome measures were physical performance (single leg stand, timed chair rise, 50-foot speed walk) and 12-item short form (SF-12) physical and mental summary scores., Results: Tai chi participants reported significant improvements in five of the PSQI subscale scores (sleep quality, sleep-onset latency, sleep duration, sleep efficiency, sleep disturbances) (P<.01), PSQI global score (P=.001), and ESS scores (P=.002) in comparison with the low-impact exercise participants. Tai chi participants reported sleep-onset latency of about 18 minutes less per night (95% confidence interval (CI)=-28.64 to -7.12) and sleep duration of about 48 minutes more per night (95% CI=14.71-82.41) than low-impact exercise participants. Tai chi participants also showed better scores in secondary outcome measures than low-impact exercise participants. Both groups reported improvements in SF-12 mental summary scores., Conclusion: Older adults with moderate sleep complaints can improve self-rated sleep quality through a 6-month, low- to moderate-intensity tai chi program. Tai chi appears to be effective as a nonpharmacological approach to sleep enhancement for sleep-disturbed elderly individuals.

Objectives: To determine whether an intense tai chi (TC) exercise program could reduce the risk of falls more than a wellness education (WE) program in older adults meeting criteria for transitioning to frailty., Design: Randomized, controlled trial of 48 weeks duration., Setting: Twenty congregate living facilities in the greater Atlanta area., Participants: Sample of 291 women and 20 men aged 70 to 97., Measurements: Demographics, time to first fall and all subsequent falls, functional measures, Sickness Impact Profile, Centers for Epidemiologic Studies-Depression Scale, Activities-specific Balance Confidence Scale, Falls Efficacy Scales, and adherence to interventions., Results: The risk ratio (RR) of falling was not statistically different in the TC group and the WE group (RR=0.75, 95% confidence interval (CI)=0.52-1.08), P=.13). Over the 48 weeks of intervention, 46% (n=132) of the participants did not fall; the percentage of participants that fell at least once was 47.6% for the TC group and 60.3% for the WE group., Conclusion: TC did not reduce the RR of falling in transitionally frail, older adults, but the direction of effect observed in this study, together with positive findings seen previously in more-robust older adults, suggests that TC may be clinically important and should be evaluated further in this high-risk population.

Objectives: The vascular endothelium modulates vascular tone by synthesizing and metabolizing vasoactive substances. Endothelium-dependent vasodilation declines with age. This study investigated whether Tai Chi Chuan (TCC) training could enhance endothelial function in the skin vasculature of older men., Setting: Community setting., Design: Basic hemodynamic characteristics and skin vascular response to endothelium-dependent and -independent vasodilators were studied., Participants: Ten older men who practiced TCC, 10 older healthy sedentary men, and 12 younger healthy sedentary men. The older TCC subjects had practiced classical Yang TCC for a mean +/- standard deviation of 11.2 +/- 3.4 years; mean attendance was 5.1 +/- 1.8 times weekly. Sedentary subjects had not participated in any regular exercise training for at least 5 years., Measurements: Different doses of 1% acetylcholine (ACh) and 1% sodium nitroprusside (SNP) were iontophoretically applied to the skin of subjects' lower legs, and cutaneous microvascular perfusion responses were determined by laser doppler measurements. Additionally, arterial and venous hemodynamic variables were measured by impedance plethysmograph., Results: The older TCC group had higher lower leg arterial blood flow (LABF); LABF in response to reactive hyperemia; and lower leg venous capacity, tone and blood flow than their sedentary counterparts, but the older TCC group displayed similar arterial and venous hemodynamic variables to the younger sedentary group. The younger sedentary group had a higher ACh-induced cutaneous perfusion and a higher ratio of ACh- to SNP-induced cutaneous perfusion than the two older groups. The older TCC group showed a higher ACh-induced cutaneous perfusion and a higher ratio of ACh- to SNP-induced cutaneous perfusion than the older sedentary group. Skin vascular responses to SNP did not differ significantly between the three groups., Conclusions: Regular practice of TCC is associated with enhanced endothelium-dependent dilation in skin vasculature of older individuals. Moreover, TCC training may delay the age-related decline of venous compliance and hyperemic arterial response.