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Abstract: The results of a randomized clinical trial (RCT) on the effects of a Tai Chi fall prevention in community-living older people with a high risk of falling in the Netherlands showed no beneficial effects on falls and secondary outcomes (e.g., balance, fear of falling). The aim of this study is to provide insight in process-related factors that may have influenced the effectiveness of the intervention. The intervention consisted of Tai Chi Chuan (TCC) training for 1h twice a week for 13 weeks. We used self-administered questionnaires and registration forms to collect data from participants and instructors. We analyzed quantitative data by means of descriptive statistics and categorized qualitative data based on the content of the answers given. Of the participants, that started the program 89 (79%) completed the intervention, but a minority of 47% attended 80% of more of the lessons. All participants and instructors were positive about the program and most participants reported benefits from the intervention. Suggestions for improvements mainly relate to adjustments of training aspects. The main process-related factors that may be have influenced the lack of beneficial effects on falls and secondary outcomes are the relatively high withdrawal and the low adherence rates. [Copyright &y& Elsevier]

Objective: Tai Chi (TC) is an exercise training that is becoming increasingly popular as an intervention for single fall prevention. This meta-analysis was performed to evaluate the efficacy of TC on fall rate, fear of falling and balance in older people. Methods: Randomized controlled trials published between 1988 and January 2009 were included. In the Netherlands (2009) we used random effects models for the analyses, with data reported as incidence rate ratios (IRR) for falls and standardized mean differences (SMD) for fear of falling and balance. Results: Nine trials (representing 2203 participants) were included in the analyses. Compared with exercise controls, TC participants showed significant improvements in fall rates (2 trials included, IRR: 0.51, 95% CI 0.38–0.68) and static balance (2 trials included, SMD: 0.47, 95% CI 0.23–0.72). Compared with non-exercise controls, no improvement was found for TC participants in fall rates (5 trials, IRR: 0.79, 95% CI 0.60–1.03) or static balance (2 trials, SMD: 0.30, 95% CI −0.50–1.10), but a significant improvement was found for fear of falling (SMD: 0.37, 95% CI=0.03–0.70). Conclusions: Currently there is insufficient evidence to conclude whether TC is effective in fall prevention, decreasing fear of falling and improving balance in people over age 50years. [Copyright &y& Elsevier]