Effects of combined physical and cognitive training on fall prevention and risk reduction in older persons with mild cognitive impairment: a randomized controlled study.

OBJECTIVE: The aim of this study is to investigate the effects of combined physical and cognitive training on fall rate and risks of falling in older adults with mild cognitive impairment. DESIGN: The design of this study was an assessor-blinded, randomized controlled trial. SETTING: The setting for this study is the community from Manila, Philippines. SUBJECTS: In total, 92 community-dwelling older persons with mild cognitive impairment (aged 60-83) were randomly allocated to three intervention groups and one waitlist control group. INTERVENTIONS: The physical training, cognitive training, and combined physical and cognitive training intervention programs were delivered for 60 to 90 minutes, one to three times per week for 12 weeks with six-month follow-up. MAIN MEASURES: Participants were assessed at baseline, 12 weeks after baseline, and 36 weeks after baseline for fall incidence, overall fall risk, dynamic balance, walking speed, and lower limb strength. RESULTS: No significant difference was observed across time and groups on fall incidence rate at 12 weeks (P = 0.152) and at 36 weeks (P = 0.954). The groups did not statistically differ in other measures except for a significant improvement in dynamic balance based on Timed Up and Go Test in the combined physical and cognitive training group (9.0 seconds with P = 0.001) and in the cognitive training alone group (8.6 seconds with P = 0.012) compared to waitlist group (11.1 seconds) at 36 weeks. CONCLUSION: There was no significant difference among groups on fall rate and risks of falling post-intervention. Dynamic balance was improved with combined physical and cognitive training and cognitive training alone. Further research with a larger sample size is needed to establish whether or not the interventions are effective.

Does Tai Chi improve balance and reduce falls incidence in neurological disorders? A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effect of Tai Chi on balance and reducing falls incidence in neurological disorders. DATA SOURCES: AMED, Embase, Web of Science, SCOPUS, EBSCO and Medline from inception until February 2018. REVIEW METHOD: Randomized controlled trials of Tai Chi compared with active or no treatment control, measuring balance with the Berg Balance Scale or the Timed Up and Go Test and number of falls in neurological disorders were included. Methodological quality was assessed using PEDro and quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS: A total of 10 studies involving 720 participants were reviewed. Seven studies were in Parkinson's disease and three in stroke. Seven studies were of high methodological quality and three were low. Meta-analyses of balance measured with the Timed Up and Go Test in Parkinson's disease revealed a statistically significant effect of Tai Chi compared to no treatment (weighted mean difference (WMD), -2.13; 95% confidence interval (CI), -3.26 to -1.00; P < 0.001) and was insignificant (WMD, -0.19; 95% CI, -1.74 to 1.35; P = 0.81) when compared with active treatment. Tai Chi significantly reduced falls incidence in Parkinson's disease (odds ratio (OR), 0.47; 95% CI, 0.29 to 0.77; P = 0.003) and stroke (OR, 0.21; 95% CI, 0.09 to 0.48; P < 0.001). Balance measured with the Timed Up and Go Test comparing Tai Chi and active treatment was insignificant (WMD, 0.45; 95% CI, -3.43 to 2.54; P = 0.77) in stroke. CONCLUSION: Tai Chi is effective in reducing falls incidence in Parkinson's disease and stroke. This systematic review did not find high-quality studies among other neurological disorders.