The purpose of this present study was to examine the effect of Taichi softball (TCSB) on physical function in Chinese older adults. Eighty Chinese older adults were randomly assigned into either an experimental group experiencing four 90-minute TCSB sessions weekly for seven consecutive weeks or a control group. At baseline and 7 weeks later, all participants were asked to perform physical functional tests for both lower and upper limbs. Multiple separate Analyses of Variance (ANOVA) with repeated measures were applied to evaluate the effects of TCSB on function-related outcomes between baseline and postintervention in the two groups. The findings indicate that a short-term and intensive TCSB training program does not only improve low limb-related physical function such as dynamic balance and leg strength, but also strengthen upper limb-related physical function (e.g., arm and forearm strength, shoulder mobility, fine motor control, handgrip strength, and fine motor function). Health professionals could take into account TCSB exercise as an alternative method to help maintain or alleviate the inevitable age-related physical function degeneration in healthy older adults. In addition, researchers could investigate the effect of TCSB exercise on physical function in special populations such as patients with different chronic diseases or neurological disorder (e.g., Parkinson’s disease).
The total population of adults aged 60 years or older has reached about 123 million in 2013 in China, which accounts for more than 9% of the Chinese population, nearly one in nine citizens. By 2050, this age group is expected to grow to be about 330 million, more than doubling the number in 2013 [
A great number of studies have been conducted to investigate age-related decline on postural stability, mobility, and hand function. Consistent findings indicate that aging is related to worse performance on postural stability [
Understanding neural mechanism of age-related motor deficits is critical. A degenerative motor cortical region and corpus callosum contribute to an impairment on postural stability and gait [
The fact that an aging population has become larger, which is directly associated with costly geriatric care, stimulates researchers to keep searching for methods to mitigate age-related motor deficits. The ability to prevent brain changes and motor deficits is critical for the older population to efficiently perform daily routines such as cooking, driving, and typing. With an exception of the pharmaceutical method, aerobic exercise interventions hold promise for ameliorating motor deficits associated with normal aging [
One strategy to mitigate or reverse age-related decline in motor function is to actively participate in physical activity or exercise training. Exercise and other types of physical activities have been recommended in order to gain health benefits in aged individuals. TCSB is a progressive form of health-promoting Taichi exercise that requires practitioners to hold a racket and control a softball on the surface of the racket while performing a Taichi form [
The study included 80 individuals recruited from a senior living community in the northeast region of China. The individuals were considered eligible for participation in the present study if they (a) were at the age of 55 and above, (b) were free of musculoskeletal injuries or any restricted mobility in both lower and upper limbs, (c) did not currently participate in any other behavioral studies or instructor-led exercise program, (d) are free of vision impairment, and (e) had no severe neurological disease.
Primary outcome measures included functional tests for the lower and upper limbs. The outcome measure of the lower limbs involved leg strength and dynamic balance. The outcome measures of the upper limb involved shoulder mobility, handgrip strength, fine motor function, upper body strength and endurance, and fine motor control.
Leg strength was measured with the 30 s Chair Stand Test. Jones et al. [
Dynamic balance was measured with the Time Up and Go Test, which was found to have good intrarater and interrater reliability (
The Back Scratch Test was used for measuring shoulder mobility (left and right sides) [
The Arm Curl Test was used to measure upper body strength [
The maximum isometric strength of the hand and forearm muscles was measured using Handgrip Strength Test (criteria validity = .98 and interrater reliability = .996) with a handgrip dynamometer [
The Spiral Drawing Test was used for measuring fine movement control. The participant was asked to trace a picture of spiral template on a piece of paper. The participant was instructed to place the pen in the middle of the spiral before tracing starts and then try to trace the spiral as accurately and as fast as possible using their dominant hand and then nondominant hand. The spiral drawing performance was visually evaluated based on the Archimedes Spiral Drawing Test of the International Cooperative Ataxia Rating Scale [
Moberg Pickup Test (test-retest reliability = .91 and high discriminative validity) was used to measure fine motor function associated with the ability of perceiving constant touch, precision grip, and cutaneous feedback [
To better understand the effect of TCSB on motor function in older adults, data collection regarding demographic information of participants was performed, including age, gender, marital status, education level, body weight (kg), body height (cm), and monthly income. For obtaining BMI level, body weight and height were assessed through the use of digital scales (Health Meter).
Following approval from the Institutional Review Board, the director of a senior living community was contacted to request permission to proceed with the study and recruit participants. Residents in the senior living community were invited to attend an information session about the study. After signing informed consent forms, the eligible individuals were randomly assigned into two groups with an equal number of participants in each group [
During the 7-week intervention phase, participants in the experimental group experienced four TCSB sessions per week for 90 minutes, which were taught by a certified Taichi instructor following the instruction routine: (1) 10-minute instructor-led warm-up, (2) 70-minute well-established exercise form, and (3) 10-minute relaxation. A specific TCSB exercise was developed by a Taichi certified instructor in order to improve motor function in both lower and upper limbs. Participants in the control group were asked to keep their original lifestyles during the intervention period.
At the end of the 7-week intervention, a postassessment with similar testing procedures to those of the baseline was administrated to all participants. All tests were conducted at the indoor fitness room of the community centers. Each participant had two trials for each functional test which was administered by an experienced researcher. A 3-minute break between the two tests was implemented to ensure adequate recovery. The best result of the two trials was used for data analysis (Figure
Screening, randomization, and completion of 7 weeks.
All statistical analyses were carried out with IBM SPSS version 23.0. The level of significance for the present study was set at .05. Prior to the beginning of examining the main interest of the present study, preliminary analyses were conducted to examine the demographic variables (e.g., age, gender, and education level). Means and standard deviations were used to summarize continuous data and frequency was used to summarize categorical data. Differences at baseline for the demographic information between the two groups were compared using a
To evaluate the within-group effects of outcome measures between pre- and postintervention, multiple separate pair
The demographic information of participants in both TCSB and control groups is presented in Table
Demographic information of participants at baseline.
Demographic | TCSB ( |
Control ( |
| ||
---|---|---|---|---|---|
Mean (SD) |
|
Mean (SD) |
|
||
Age | 62.2 (3.43) | 62.6 (3.54) | >0.05 | ||
|
|||||
Gender | >0.05 | ||||
Male | 22 (55%) | 24 (60%) | |||
Female | 18 (45%) | 16 (40%) | |||
|
|||||
BMI | >0.05 | ||||
Less than 18.5 | 6 (15%) | 7 (17.5%) | |||
18.5–24.9 (normal) | 15 (37.5%) | 18 (45%) | |||
25–25.9 | 13 (32.5%) | 10 (25%) | |||
30–34.9 | 6 (15%) | 5 (12.5%) | |||
35–39.9 | 0 (0%) | 0 (0%) | |||
|
|||||
Educational level | >0.05 | ||||
High school diploma | 19 (47.5%) | 17 (42.5%) | |||
Associate’s degree | 7 (17.5%) | 7 (17.5%) | |||
Bachelor’s degree | 9 (22.5%) | 11 (27.5%) | |||
Master’s degree or above | 5 (12.5%) | 5 (12.5%) | |||
|
|||||
Marital status | >0.05 | ||||
Single | 10 (25%) | 12 (30%) | |||
Married | 22 (55%) | 23 (57.5%) | |||
Divorced/separated/widowed | 8 (20%) | 5 (12.5%) | |||
|
|||||
Monthly income | 0.783 | ||||
<2,500 | 8 (20%) | 5 (12.5%) | |||
2,500–4,999 | 23 (57.5%) | 26 (65%) | |||
5,000–9,999 | 6 (15%) | 5 (12.5%) | |||
≥10,000 | 3 (7.5%) | 4 (10%) |
Table
Within-group and between-group comparisons for outcome measures at baseline and week 7 (
Measure | Within-group effects | Between-group effects | ||||
---|---|---|---|---|---|---|
Baseline | Week 7 |
|
Baseline–Week 7 | Time by group | ||
Mean (SD) | Mean (SD) | Mean (SD) |
|
| ||
Spiral Drawing Test | 29.58 | <0.0001 | ||||
Taichi softball |
3.11 (.94) | 2.44 (.77) | <0.0001 | .67 (.76) | ||
Control group |
2.18 (.87) | 3.18 (.87) | 0.002 | −.37 (.67) | ||
|
||||||
Moberg Pickup Test | 44.76 | <0.0001 | ||||
Taichi softball |
21.61 (8.35) | 18.39 (6.71) | <0.0001 | 3.22 (3.33) | ||
Control group |
21.11 (8.09) | 21.95 (8.30) | 0.004 | −.84 (1.67) | ||
|
||||||
Handgrip Strength Test | 39.26 | <0.0001 | ||||
Taichi softball |
16.50 (4.00) | 20.58 (4.20) | <0.0001 | −4.08 (4.17) | ||
Control group |
16.63 (4.02) | 16.34 (3.71) | 0.086 | .290 (1.01) | ||
|
||||||
Arm Curl-Up test | 34.09 | <0.0001 | ||||
Taichi softball |
18.31 (5.99) | 22.33 (4.97) | <0.0001 | −4.03 (4.42) | ||
Control group |
17.89 (5.23) | 17.71 (5.10) | 0.033 | .18 (.51) | ||
|
||||||
Back Scratch Test | 124.58 | <0.0001 | ||||
Taichi softball |
14.57 (4.76) | 10.93 (5.05) | <0.0001 | 3.63 (2.04) | ||
Control group |
14.51 (4.39) | 15.40 (4.69) | <0.0001 | −.89 (2.23) | ||
|
||||||
Chair Stand Test | 117.09 | <0.0001 | ||||
Taichi softball |
13.47 (2.43) | 20.22 (3.32) | <0.0001 | −6.75 (3.70) | ||
Control group |
14.02 (2.61) | 13.13 (1.89) | 0.019 | .89 (2.24) | ||
|
||||||
Timed Up and Go Test | 213.15 | <0.0001 | ||||
Taichi softball |
14.74 (1.22) | 11.16 (.65) | <0.0001 | 3.58 (1.23) | ||
Control group |
14.25 (1.00) | 15.27 (1.61) | <0.0001 | −1.03 (1.47) |
The between-group difference in the change of each outcome measure was then examined by interaction effect of time and group. When compared to the control group, fine motor control [
This randomized, controlled study was designed to examine the effect of a 7-week TCSB training program on motor function in Chinese healthy older adults. The findings of this present study demonstrated that a short-term and intensive TCSB training program could improve not only low limb-related motor function such as dynamic balance and leg strength, but also upper limb-related motor function (e.g., arm and forearm strength, shoulder mobility, fine motor control, handgrip strength, and fine motor function).
The number of individuals over 60 years is exponentially growing and expected to grow from 123 million in 2013 to roughly 330 million by 2050 in China [
Because TCSB was developed according to the principle of Taichi movements, the positive effects on lower limb outcome measures were observed in the present study that provides additional evidence to support the beneficial effects of Taichi-based exercises on leg strength and physical balance for fall prevention purpose [
Based on the encouraging findings, researchers of the present study encourage future studies to compare TCSB with Taichi form for older adults. If TCSB was as effective as Taichi in improving lower limb-related functional capabilities such as leg strength and physical balance, TCSB had more positive effects on upper limb manipulative skill performance than Taichi. In this way, health professionals could establish a more well-rounded Taichi-based exercise program according to the progressive principle [
As we know the control group maintained their normal lifestyles during the intervention period; however, within-group analysis showed that the control group had significant differences in assessment tests such as Spiral Drawing Test, Moberg Pickup Test, Arm Curl-Up Test, Back Scratch Test, Chair Stand Test, and Time Up and Go Test between baseline and after 7 weeks (Table
Although the findings of the present study are promising, some limitations of this study should be mentioned. First of all, due to the present study involving a short-term and intensive TCSB training, whether the lasting positive effects of TCSB on health-related outcomes exist remains unclear. Therefore, a long-term TCSB intervention with a follow-up assessment should be designed. Second, eating habit or diet may affect outcomes, which should be taken into consideration and adjusted in future studies. For the future investigation, the TCSB should be compared to other forms of exercises such as walking, to see if TCSB could be a better overall intervention exercise by not only slowing down the declining trend of movements but also improving.
The findings of the present study indicate that TCSB exercise is potentially effective in strengthening the physical functional health, including leg strength, dynamic balance, mobility, fine motor function and control, hand and forearm muscular strength, handgrip strength, and shoulder mobility, thereby ultimately enhancing the quality of life in older adults. Health professionals could take into account TCSB exercise as an alternative method to help maintain or alleviate the inevitable age-related physical function degeneration in healthy older adults. In addition, researchers could investigate the effects of TCSB function-related outcomes in special populations such as patients with different chronic diseases or Parkinson’s disease.
The authors declare that they have no conflicts of interest.
The primary author is very thankful for his friend (Yankai Shu) from Complementary and Alternative Medicine Lab at Jishou University who gave valuable comments on this study.