Falls by older people cost the health system more than road trauma. They are a significant public health priority that is expected to triple in coming decades. Despite high levels of understanding of risk factors for falling, there are few evidence-based population-wide interventions to prevent falls. The Central Sydney Tai Chi trial tested the effectiveness of a community-based introductory Tai Chi program in reducing falls among older people.

The study recruited over 700 participants over a two and a half year period, making this the largest trial of its type. Results clearly indicate that Tai Chi reduced falls by 35%, and reduced multiple falls by 70%, making it a highly effective strategy. The design of this study makes these results highly generalisable to many community contexts. Tai Chi programs are an intervention that all Area Health Services can implement or endorse.

To implement a 16-week, introductory, community-based Tai Chi program for community-dwelling older people aged 60 years or older and test if it will reduce falls over a 6-month period by 35%.

The health cost of falls is twice that of road accidents and is predicted to triple within the next 50 years (Moller, 2003). Falls are the leading cause of injury related mortality and hospitalisations in older people (NSW Health, Population Health Division, 2004), and, on average, 33% of older people will fall at least once in a 12-month period (Stel et al, 2001).

While there have been several interventions developed to address falls risk factors, the evidence base for effective falls prevention interventions is limited (Gillespie et al, 2004). There is some evidence that Tai Chi may be effective in limited contexts (Wolf et al, 1996; Li et al, 2004), but there have been no studies investigating the effectiveness of Tai Chi in preventing falls in a community setting.

Initially, two pilot studies were conducted to examine social marketing models for engaging older people and Tai Chi leaders, to identify barriers to taking physical activity classes, and identify appropriate programs for older people (Health Promotion Unit CSAHS, 1998; Health Promotion Unit, 2000). The Central Sydney Tai Chi trial, a randomised controlled trial, was then designed to test the effectiveness of Tai Chi in reducing falls. The trial also investigated whether Tai Chi improved balance, the performance of daily activities and confidence in avoiding a fall.

People recruited into the trial were aged 60 years or over, living independently in the community and new to Tai Chi. They were randomly allocated to either the Tai Chi intervention or a control group. The Intervention group participated in a community-based, 16-week introductory Tai Chi program. Recruitment was staggered between June 2001 and March 2003, with 38 new Tai Chi programs implemented.

All participants (treatment & control) recorded on a falls calendar, daily for a six-month period, if they had fallen. Each participant, at baseline and at the end of the 16-week intervention, had the following assessed: balance (using several tests), performance of daily activities (Activities of Daily Living Scale), and confidence in avoiding a fall (Falls Efficiency Scale). All measures used had been validated in previous research and were acceptable to participants.

Tai Chi classes were conducted at a variety of community venues. Each venue was selected according to the local area being targeted in the advertising and recruitment period, and for ease of access to the venue. Research from our pilot studies indicated that a major barrier for older people in joining physical activity classes was when the classes were held (Health Promotion Unit, 2000). Most older people prefer classes that are held before noon, and so venues available at these times were also a factor in venue choice.

To increase the chances of the classes being sustained beyond the study period, the Tai Chi trial worked in partnership with SHARE, a non-profit organisation providing physical activity classes for older people, to help implement the classes for this study. At the end of this study, SHARE took over the ongoing administration of all classes.

More than 1000 older people were enrolled in the Tai Chi classes, with 702 of those participating in the study. As of July 2005, one and a half years after the end of the study, 18 out of a possible 33 classes have been sustained independently with three additional Tai Chi classes commencing.

Analysis of the falls data reveals that the Tai Chi program did reduce the overall rate of falls during the study period by 35%. Tai Chi also reduced multiple falls (twice or more) during the study period by 70%.

Results also indicate that Tai Chi improved aspects of balance compared to the control group but did not affect the performance of daily activities or confidence in avoiding a fall.

The significance of this study, the largest of its type ever conducted, is that it shows that with a modest investment of one 1-hour Tai Chi class per week, the rate of older people falling can be substantially reduced. The development and implementation of these classes using existing service providers and infrastructure increased the transferability of the results to other community settings. No previous rigorous Tai Chi studies have been conducted in community settings, making the results highly generalisable.

This study complements the NSW Health Falls Prevention Policy which recommends "Identify[ing] and improve[ing] the evidence on which falls … reduction strategies are based …". It also recommends the "Maintenance of a healthy balanced lifestyle including load bearing exercise" as a central recommendation (NSW Health, 2003). Tai Chi programs are an intervention that all Area Health Services can implement or endorse.

• Central Sydney Health Promotion Unit. Tai Chi and Older People Project: a qualitative study. Project report. Sydney: Health Promotion Unit, Central Sydney Area Health Service, 1998.
• Central Sydney Health Promotion Unit. Tai Chi and Older People: a pilot Tai Chi program. Project report. Sydney: Health Promotion Unit, Central Sydney Area Health Service, 2000.
• Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions Preventing Falls in Older People. Cochrane Database of Systematic Reviews 2004; 2.
• Li F, Harmer P, Fisher KJ, McAuley E. Tai Chi: improving functional balance and predicting subsequent falls in older persons. Med Sci Sports Exerc 2004; 36:2046-52.
• Moller J. Projected costs of fall related injury to older persons due to demographic change in Australia. Report to the Commonwealth Department of Health and Ageing under the National Falls Prevention for Older People Initiative. Canberra: Department of Communications, Information Technology and the Arts, 2003.
• NSW Health. Management Policy to Reduce Fall Injury Among Older People: Detailed Strategies and Performance Requirements 2003-2007: p. 31. Sydney: NSW Department of Health, 2003.
• NSW Health, Population Health Division. The Health of the people of NSW: Report of the Chief Health Officer, 2004. Sydney: NSW Department of health, 2004.
• Stel VS, Smit JH, Pluijm SMF, Lips P. Consequence of falling in older men and women and risk factors for health service use and functional decline. Age Ageing 2001; 33: 58-65.
• Wolf SL, Barnhart HX, Kutner NG, et al, the Atlanta FICSIT Group. Reducing Frailty and Falls in Older Persons: An Investigation of Tai Chi and Computerized Balance Training.

Co-Director, Health Promotion
Sydney South West Area Health Service
Phone: 02 9828 5907