| Summary: | Purpose: To investigate the effectiveness of a modified Tai Chi programme compared with a low-level exercise programme to reduce falls in community dwelling older adults with a falls risk. Relevance: About a third of adults over the age of 65 years will experience a fall in any one year. Preventing falls in older adults is recognized as important in public policy documents such as the National Falls Strategy and the Health of Older People Strategy. Although Tai Chi seems to be a promising intervention to prevent falls there are inconsistent results and unknown factors, including whether Tai Chi compared to an active control has a beneficial effect. Participants: A total of 684 community dwelling women and men aged 65 years or older (or >55 years if Maori or Pacific Islander) with an identified falls risk factor. Methods: The study was a single-blinded, pragmatic, randomized controlled trial with three arms. One group received Tai Chi once a week, the second received Tai Chi twice a week and the third received a low-level exercise class programme once a week. The intervention length was 20 weeks. Falls were recorded monthly during the 20 week intervention period and for a further 12 months follow-up. Semi-structured interviews were conducted immediately post-intervention with questions relating to participant experience and opinion of the exercise programmes. Analysis: Multilevel mixed-effects analyses that adjusted for important covariates were used for the primary analysis of falls data. In addition descriptive analysis was undertaken of the semi-structured interviews. Results: Participants in the once a week Tai Chi programme reduced their falls by 64.3% (95% CI: 48.3%, 75.3%), twice a week Tai Chi programme participants reduced their falls by 62.6% (95% CI: 42.9%, 75.5%), and the low level exercise programme participants reduced their falls by 49.3% (95% CI: 25.4%, 65.5%). The Tai Chi once a week and twice a week groups had the largest number of participants who indicated improved balance as a benefit (Tai Chi X1 44%, Tai Chi X2 45%) whilst the low level exercise group had the largest number of participants who social contact as a benefit (29%). Social contact was the second greatest benefit both Tai Chi groups gained from their programme (Tai Chi X1 28%, Tai Chi X2 30%). Conclusions: Both the modified Tai Chi programme and the low level exercise programme were effective in reducing falls in community dwelling older adults who had an identified falls risk. This study demonstrated that there were no statistically significant differences in the reduction of falls in the Tai Chi groups (delivered once or twice a week) compared with the control group. Implication: The act of participating in a group based exercise programme affords important social influences that may help to explain the falls reduction seen in all groups. It may also be that merely going out of the house has beneficial long-term health benefits for older adults. The exact components of falls prevention programmes may be less important than the act of performing regular physical activity in terms of falls prevented
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