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Effects of Tai Chi on Lower Limb Proprioception in Adults Aged Over 55: A Systematic Review and Meta-Analysis

Published:August 17, 2018DOI:https://doi.org/10.1016/j.apmr.2018.07.425

      Abstract

      Objective

      To summarize and critically evaluate the effects of Tai Chi on lower limb proprioception in adults older than 55.

      Data Sources

      Seven databases (Scopus, PubMed, Web of Science, SPORTDiscus, Cochrane Library, Wanfang, CNKI) were searched from inception until April 14, 2018.

      Study Selection

      Eleven randomized controlled trials were included for meta-analysis.

      Data Extraction

      Two independent reviewers screened potentially relevant studies based on the inclusion criteria, extracted data, and assessed methodological quality of the eligible studies using the Physiotherapy Evidence Database (PEDro).

      Data Synthesis

      The pooled effect size (standardized mean difference [SMD]) was calculated while the random-effects model was selected. Physiotherapy Evidence Database scores ranged from 5 to 8 points (mean=6.7). The study results showed that Tai Chi had significantly positive effects on lower limb joint proprioception. Effect sizes were moderate to large, including ankle plantar flexion (SMD=−0.55; 95% confidence interval [95% CI], −0.9 to −0.2; P=.002; I2=0%; n=162), dorsiflexion (SMD=−0.75; 95% CI, −1.11 to −0.39; P<.001; I2=0%; n=162), nondominant or left knee flexion (SMD=−0.71; 95% CI, −1.10 to −0.41; P<.001; I2=25.1%; n=266), dominant or right knee flexion (SMD=−0.82; 95% CI, −1.06 to −0.58; P<.001; I2=33.8%; n=464).

      Conclusions

      There is moderate to strong evidence that suggests that Tai Chi is an effective intervention to maintain and improve lower limb proprioception in adults older than 55. More robust multicenter studies including oldest-old participants, with longer follow-ups and validated outcome measures, are needed before a definitive conclusion is drawn.

      Keywords

      List of abbreviations:

      95% CI (95% confidence interval), DF (dorsiflexion), PF (plantar flexion), RCT (randomized controlled trial), SMD (standardized mean difference), TTDPM (threshold to detection of passive motion)
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      References

        • Boisgontier P.
        • Swinnen P.
        Proprioception in the cerebellum.
        Front Neurosci. 2014; 8: 212
        • Goble J.
        Proprioceptive acuity assessment via joint position matching: from basic science to general practice.
        Phys Ther. 2010; 90: 1176-1184
        • Jo S.
        • Park S.-B.
        • Kim J.
        • et al.
        Comparison of balance, proprioception and skeletal muscle mass in total hip replacement patients with and without fracture: a pilot study.
        Ann Rehabil Med. 2016; 40: 1064-1070
        • Han J.
        • Waddington G.
        • Adams R.
        • et al.
        Assessing proprioception: a critical review of methods.
        J Sport Health Sci. 2016; 5: 80-90
        • Ko U.
        • Simonsick E.
        • Deshpande N.
        • et al.
        Sex-specific age associations of ankle proprioception test performance in older adults: results from the Baltimore Longitudinal Study of Aging.
        Age Ageing. 2015; 44: 485-490
        • Ko U.
        • Simonsick M.
        • Despande N.
        • et al.
        Ankle proprioception associated gait patterns in older adults: results from the Baltimore longitudinal study of aging.
        Med Sci Sports Exerc. 2016; 48: 2190-2194
        • Arvin M.
        • Hoozemans M.
        • Burger J.
        • et al.
        Reproducibility of a knee and hip proprioception test in healthy older adults.
        Aging Clin Exp Res. 2015; 27: 171-177
        • Colledge N.
        • Cantley O.
        • Peaston I.
        • et al.
        Aging and balance: the measurement of spontaneous sway by posturography.
        Gerontology. 1994; 40: 273-278
        • Deshpande N.
        • Simonsick E.
        • Metter J.
        • et al.
        Ankle proprioceptive acuity is associated with objective as well as self-report measures of balance, mobility, and physical function.
        Age (Dordr). 2016; 38: 53
        • Alamgir H.
        • Muazzam S.
        • Nasrullah M.
        Unintentional falls mortality among elderly in the United States: time for action.
        Injury. 2012; 43: 2065-2071
        • McCarthy M.
        Falls are leading cause of injury deaths among older people, US study finds.
        BMJ. 2016; 354: i5190
        • Ribeiro F.
        • Oliveira J.
        Aging effects on joint proprioception: the role of physical activity in proprioception preservation.
        Eur Rev Aging Phys Act. 2007; 4: 71-76
        • Xu D.
        • Li J.
        • Hong Y.
        Tai Chi movement and proprioceptive training: a kinematics and EMG analysis.
        Res Sports Med. 2003; 11: 129-142
        • Zhou M.
        • Peng N.
        • Dai Q.
        • et al.
        Effect of Tai Chi on muscle strength of the lower extremities in the elderly.
        Chin J Integr Med. 2016; 22: 861-866
        • Huang Y.
        • Liu X.
        Improvement of balance control ability and flexibility in the elderly Tai Chi Chuan (TCC) practitioners: a systematic review and meta-analysis.
        Arch Gerontol Geriatr. 2015; 60: 233-238
        • Liu H.
        • Frank A.
        Tai Chi as a balance improvement exercise for older adults: a systematic review.
        J Geriatr Phys Ther. 2010; 33: 103-109
        • Zheng G.
        • Li S.
        • Huang M.
        • et al.
        The effect of Tai Chi training on cardiorespiratory fitness in healthy adults: a systematic review and meta-analysis.
        PLoS One. 2015; 10: e0117360
        • Xu D.
        • Hong Y.
        • Chan K.
        Effect of Tai Chi exercise on proprioception of ankle and knee joints in old people.
        Br J Sports Med. 2004; 38: 50-54
        • Tsang W.
        • Hui-Chan C.
        Effects of Tai Chi on joint proprioception and stability limits in elderly subjects.
        Med Sci Sports Exerc. 2003; 35: 1962-1971
        • Fong S.
        • Ng G.
        The effects of sensorimotor performance and balance with Tai Chi training.
        Arch Phys Med Rehabil. 2006; 87: 82-87
        • Guo Y.
        • Yang P.
        • You L.
        • et al.
        Underlying mechanisms of Tai-Chi-Chuan training for improving balance ability in the elders.
        Chin J Integr Med. 2014; 20: 409-415
        • Cavegn I.
        • Riskowski L.
        The effects of Tai Chi on peripheral somatosensation, balance, and fitness in Hispanic older adults with type 2 diabetes: a pilot and feasibility study.
        Evid Based Complement Alternat Med. 2015; 2015: 767213
        • Tsang W.
        • Hui-Chan C.
        Effects of exercise on joint sense and balance in elderly men: Tai Chi versus golf.
        Med Sci Sports Exerc. 2003; 36: 658-667
        • Li X.
        • Xu Q.
        • Hong Y.
        Effects of 16-week Tai Chi intervention on postural stability and proprioception of knee and ankle in older people.
        Age Ageing. 2008; 37: 575-578
        • Chang S.
        • Zhou J.
        • Hong Y.
        • et al.
        Effects of 24-week Tai Chi exercise on the knee and ankle proprioception of older women.
        Res Sports Med. 2016; 24: 84-93
        • Liu J.
        • Wang Q.
        • Zheng J.
        • et al.
        Effects of Tai Chi versus proprioception exercise program on neuromuscular function of the ankle in elderly people: a randomized controlled trial.
        Evid Based Complement Alternat Med. 2012; 2012: 265486
        • Zhang C.
        • Sun W.
        • Yu B.
        • et al.
        Effects of exercise on ankle proprioception in adult women during 16 weeks of training and eight weeks of detraining.
        Res Sports Med. 2015; 23: 102-113
        • Moher D.
        • Shamseer L.
        • Clarke M.
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.
        Syst Rev. 2015; 4: 1
        • Petry M.
        A comparison of young, middle-aged, and older adult treatment-seeking pathological gamblers.
        Gerontologist. 2002; 42: 92-99
        • Zou L.
        • Yeung A.
        • Zeng N.
        • et al.
        Effects of mind-body exercises for mood and functional capabilities in patients with stroke: an analytical review of randomized controlled trials.
        Int J Environ Res Public Health. 2018; 15: 721
        • Zou L.
        • Yeung A.
        • Quan X.
        • et al.
        Mindfulness-based Baduanjin exercise for depression and anxiety in people with physical or mental illnesses: a systematic review and meta-analysis.
        Int J Environ Res Public Health. 2018; 15: 321
        • Zou L.
        • Yeung A.
        • Quan X.
        • et al.
        A systematic review and meta-analysis of mindfulness-based (Baduanjin) exercise for alleviating musculoskeletal pain and improving sleep quality in people with chronic diseases.
        Int J Environ Res Public Health. 2018; 15: 206
        • Maher G.
        • Sherrington C.
        • Herbert D.
        • et al.
        Reliability of the PEDro scale for rating quality of randomized controlled trials.
        Phys Ther. 2003; 83: 713-721
        • Da Costa R.
        • Hilfiker R.
        • Egger M.
        PEDro’s bias: summary quality scores should not be used in meta-analysis.
        J Clin Epidemiol. 2013; 66: 75-77
        • Borenstein M.
        • Hedges V.
        • Higgins T.
        • et al.
        Introduction to meta-analysis.
        Wiley, West Sussex, UK2009
        • Schmid A.
        • McAlindon T.
        • Schmid C.
        • et al.
        The influence of Tai Chi exercise on proprioception in patients with knee osteoarthritis: results from a pilot randomized controlled trail.
        Chin J Integr Med. 2013; 1: 1-9
        • Sungkarat S.
        • Boripuntakul S.
        • Chattipakorn N.
        • et al.
        Effects of Tai Chi on cognition and fall risk in older adults with mild cognitive impairment: a randomized controlled trial.
        J Am Geriatr Soc. 2017; 65: 721-727
        • Wang R.
        • Li Y.
        16-week Tai Chi Chuan for improving low-limb proprioception in old adults: a randomized controlled trial.
        J Henan Normal University. 2016; 44: 172-177
        • Yan Y.
        Effects of Tai Chi on proprioception of knee joints in older people.
        Chin J Gerontol. 2014; 34: 6174-6175
        • Liu J.
        • Wang X.
        • Lu Z.
        • et al.
        Effect of Tai Chi on proprioception of knee in older people.
        Chin J Rehab Med. 2012; 27: 962-964
        • Chen W.
        • Fu S.
        • Chan M.
        • et al.
        The effects of Tai Chi on the balance control of elderly persons with visual impairment: a randomized clinical trial.
        Age Ageing. 2012; 41: 254-259
        • Zhu Q.
        • Huang L.
        • Li J.
        • et al.
        Effect of Taijiquan practice versus wellness education on knee proprioception in patients with knee osteoarthritis: a randomized controlled trial.
        J Tradit Chin Med. 2017; 37: 774-781
        • Hu Y.
        • Chung Y.
        • Yu H.
        • et al.
        Effect of Tai Chi Exercise on fall prevention in older adults: systematic review and meta-analysis of randomized controlled trials.
        Int J Gerontol. 2016; 10: 131-136
        • Han J.
        • Waddington G.
        • Anson J.
        • et al.
        Level of competitive success achieved by elite athletes and multi-joint proprioceptive ability.
        J Sci Med Sport. 2015; 18: 77-81
        • Han J.
        • Anson J.
        • Waddington G.
        • et al.
        Sport attainment and proprioception.
        Int J Sports Sci Coach. 2014; 9: 159-170
        • Han J.
        • Anson J.
        • Waddington G.
        • et al.
        The role of ankle proprioception for balance control in relation to sports performance and injury.
        Biomed Res Int. 2015; 2015: 842804
        • Forge R.
        Mind-body (mindful) exercise in practice.
        ACSM’s Health Fit J. 2016; 20: 6-8
        • Han J.
        • Anson J.
        • Waddington G.
        • et al.
        Proprioceptive performance of bilateral upper and lower limb joints: side-general and site-specific effects.
        Exp Brain Res. 2013; 226: 313-323
        • Seel T.
        • Raisch J.
        • Schauer T.
        IMU-based joint angle measurement for gait analysis.
        Sensors. 2014; 14: 6891-6909
        • Theodoropoulou E.
        • Nektarios M.
        • Stavrou
        • Konstantinos K.
        Neighborhood environment, physical activity, and quality of life in adults: intermediary effects of personal and psychosocial factors.
        J Sport Health Sci. 2017; 6: 96-102