Vol.5, No.12A, 117-121 (2013) Health
Gait, posture and transfer assessment among
elderly practitioners and non-practitioners of Tai Chi
Miguel Antonio Rahal, Félix Ricardo Andrusaitis, Thuan Silva Rodrigues,
Angelica Castilho Alonso*, Julia Maria D’ Andrea Greve, Luiz Eugênio Garcez Leme
Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil; *Corresponding Author: angelicacastilho@msn.com
Received 24 October 2013; revised 25 November 2013; accepted 15 December 2013
Copyright © 2013 Miguel Antonio Rahal et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Falls may be devastating events among elderly
people. Tai Chi Chuan is a type of moderate
sports exercise that demonstrates improve-
ment s in balance, gait and postu re. The aim here
was to assess the influence of this method on
the balance, gait and posture of healthy active
elderly people. A controlled cross-sectional stu-
dy was conducted on 76 volunteers, divided into
two groups: 51 volunteers Tai Chi Chuan group
mean age 76.8 years and 25 volunteers control
group mean age 70.3 years. Both groups un-
derwent the Modified Clinical Test on Sensory
Interaction for Balance (mCTSIB), Walking Test
(WT), Sit-to-Stand Transfer Test (SSTT) and
Unipedal Assessment Test (UT), using the Neu-
rocom Balance Master system. Result: In condi-
tions Static balance tests: the mCTSIB-Tai-Chi
Group had a lower sway velocity (°/s) on a firm
surface with eyes open and medio-lateral direc-
tion, Foam Surface w ith eyes open medio-lateral
and anteroposterior direction. Unilateral Stance
Tai-Chi Group had a lower mean sway velocity
(°/s) with open eyes (right and left), but with
eyes closed. The Control Group showed a lower
sway velocity. Under Dynamic Balance: Walk
Across Test Tai-Chi Group presented a w alking
speed greater than the Control Group. In Sit to
Stand Transfer Test, Tai-Chi Group showed a
better index rising to lift up and lower oscilla-
tion in the final standing position. Conclusion:
The Tai Chi Group was shown to be a protec-
tion factor for preserving and maintaining the
static and dynamic positions of posture and
Keywords: Elderly P eo pl e; Tai Chi Chuan;
Assessment; Balance; Gait
One of the main recommendations for improving
quality of life and maintaining autonomy and independ-
ence is to remain active, keep up cognitive abilities and
preserve locomotor skills.
It has been estimated that balance complaints affect
85% of the population over the age of 65 years [1,2]
thereby leading to the loss of independence and auton-
omy. These complaints may result from health problems
[1-3] such as falls, which form the main cause of frac-
tures, particularly those of the femur [4]. Prevention of
such problems is a major challenge for individuals, their
families, healthcare professionals and public policy.
Rubenstein [5] advocated programs that placed value
on physical fitness through increased cardiovascular re-
sistance, strength and flexibility and improved body
composition, thereby reducing the risks of instability and
falls. Gait and balance analysis may contribute to this
and indicate new preventive programs for this age group
of the population [6,7].
All programs involving posture and balance training
have shown reductions in the frequency of falls up to
48% over the first 16 weeks of training. The best ex-
ample of this was found using Tai Chi Chuan: in the Fit-
ness, Arthritis and Seniors Trial (FAST) [8], and this
technique demonstrated the best results relating to de-
creased risk of falls, among all the comparison groups.
Gomes et al. [9] conducted a wide-ranging review of
studies in Medline covering Tai Chi Chuan for elderly
people and how this activity might prevent falls. In a
review of papers in the Cochrane database, Verguese et
al. [10] stated that Tai Chi Chuan is a method that re-
duces the risk of falls by 47%.
Copyright © 2013 SciRes. OPEN ACCES S
M. A. Rahal et al. / Health 5 (2013) 117-1 21
The aim of this project was to evaluate balance, gait
and transfers postural among elderly practitioners and
non-practitioners of Tai Chi Chuan.
This was a controlled cross-sectional observational
study (practice of Tai Chi Chuan versus controls). Bal-
ance and gait were analyzed at the Movement Laboratory
of the Institute of Orthopedics and Traumatology, Hospi-
tal das Clínicas, School of Medicine of the University of
São Paulo (LEM-IOT-HCFMUSP). Written consent was
mandatory for study participation. The study was per-
formed through approval granted by the Ethics Commit-
tee number nº 401/06.
Out of the 76 patients evaluated, 56 were female
(73.7%) and 20 were male (26.3%) (Ta ble 1). The mean
age of the Tai Chi Chuan practitioners (N = 51) was 76.8
years, with a maximum of 88 and minimum of 67 years.
The mean age of the non-practitioners (N = 25) was 70.3
years, with a maximum of 85 years and minimum of 60
years, The Tai Chi Chuan practitioners were significant
older than non-practitioners (P < 0.0001) and no signifi-
cant difference between the distribution of genders be-
tween groups (χ²-0.621; p = 0.431).
They were all capable of moving their body weight on
a single leg in the Biodelta leg press apparatus. The indi-
viduals were divided into two groups: Practitioners of Tai
Chi Chuan for more than two years, using the Lian-Gun
variant technique adapted for elderly people (Tai Chi
Chuan group). Independent volunteers living in the
community, over the age of 60 years. (Control group).
The inclusion criteria were as follows: 1) Falls over
the last three months; 2) Painful or insensitive feet; 3)
Neurological deficit with impairment of the lower limbs;
4) Inability to walk; 5) Amputations at any level on the
lower limbs; 6) Surgical interventions on the feet at the
time of the study; 7) Presence of amaurosis; 8) States of
dementia; 9) Use of any auxiliary means for gait, for any
reason; 10) Painful or incapacitating conditions in the
lower limbs; 11) Pathological processes in the feet, knees
and/or hips; 12) Any degree of dependence relating to
activities of daily living; m) Presence of hallux valgus
exceeding 30˚;13) Inability to go up a flight of stairs
consisting of eight steps.
2.1. Equipment
The platform used was the Balance Master System
(BMS), made by Neurocom International Inc®, Clacka-
mas, USA, accompanied by version 8.3 of the operating
software. It was 1.40 meters in length by 0.43 meters in
width and had four force sensors connected to the soft-
ware. The sensors enabled measurement of each indi-
vidual’s pressure center from the mean horizontal and
Table 1. Characterization of the sample according to sex and
Group Female% Male % Total%
Tai Chi Chuan group39 76.5 12 23.5 5167.1
Control group 17 68.0 8 32.0 2532.89
Total 56 73.68 20 26.3 76100.0
vertical forces exerted by the feet [11,12].
All tests were performed by the same evaluator and
standardized in respect of positioning and testing. The
NeuroCom Balance Master® has multiple testing proto-
cols designed to examine balance. This study used for
Static balance protocol: Modified Clinical Test of Sen-
sory Interaction on Balance (mCTSIB) and Unilateral
Stance. Dynamic balance protocol: Walk Test and Sit-to-
stand transfer test. The equipment has good reliability and
reproducibility by researchers (ICC 0.53 to 0.81) [13].
2.2. Statistical Analysis
The data were entered into the Excel software (Mi-
crosoft, 2007), within the Microsoft® Office package.
The results were calculated by means of the Sigma Stat
software (Jandel Corporation, 1995).
For the association between the sexes in the Balance
and Volunteers groups, the chi-square test (2) was used.
To compare ages between the two groups, the Mann-
Whitney test was used. This test was also used for all the
comparisons between the two groups regarding the
Modified Clinical Test on Sensory Interaction for Bal-
ance (MCTSIB), Walking Test (WT), Sit-to-Stand Trans-
fer Test (SSTT) and Unipedal Assessment Test (UT).
3.1. Static Balance
Modified Clinical Test of Sensory Interactionon Bal-
ance (mCTSIB)—Tai-chi Group had a lower sway veloc-
ity in degrees per second (°/s): on a firm surface in the
medio-lateral direction with eyes open and in surface
foam with eyes closed in the mediolateral and antero-
posterior direction, on a condition eyes closed only in
surface foam in the medio-lateral direction.
Unilateral Stance Tai-chi group had a lower sway ve-
locity in degrees per second (°/s) with open eyes (right
and left), but with eyes closed, the Control Group had
lower sway velocity (Table 2).
3.2. Dynamic Balance
In Walk Across Test Group Tai-Chi presented a walk-
ing speed while greater than the Control Group.
In Sit to Stand Transfer Test Tai-Chi Group showed a
better index rising to lift up and lower oscillation in the
final position standing (Table 3).
Copyright © 2013 SciRes. OPEN ACCESS
M. A. Rahal et al. / Health 5 (2013) 117-1 21
Copyright © 2013 SciRes. OPEN ACCES S
Tabl e 2. Comparison between Tai-Chi Group and Control Group by eyes, surface and side leg stance in terms of static balance pro-
Tai-Chi-Chuan Group Median No-Practicant Group Median p
mCTSIB test (°/s)
Open Eyes
Firm Surface mediolateral 0.100 0.400 0.02*
Firm Surface anteroposterior -0.300 0.600 0.55
Foam Surface mediolateral 0.100 0.600 0.05*
Foarm Surface anteroposterior 1.500 1.000 0.25
Closed Eyes
Firm Surface mediolateral 0.300 0.200 0.03*
Firm Surface anteroposterior 0.200 0.300 0.39
Foam Surface mediolateral 0.300 0.350 0.11
Foarm Surface anteroposterior 1.300 0.500 0.25
Unilateral Stance (˚/s)
Open Eyes
Mean Right Leg Stance 1.200 1.700 0.00*
Mean Left Leg Stance 1.150 1.800 0.00*
Closed Eyes
Mean Right Leg Stance 3.400 2.400 0.00*
Mean Left Leg Stance 3.400 1.900 0.00*
Test Mann Whitney *p < 0.005. Legend: mCTSIB—Modified Clinical Test of Sensory Interaction on Balance; M—mean.
Tabl e 3. Comparison between Tai-Chi Chuan Group and No Practicant Group in terms of dynamic balance protocol (gait and trans-
Tai-chi-chuan Group
Walk across
Mean Step width (cm)
Speed (cm/s)
End sway velocity(degrees/s)
Sit to Stand
Rising Index (%) 22.000 16.000 0.00*
COG Sway Velocity (degrees/sec) 3.600 5.200 0.01*
Test Mann-Whitney. *p < 0.005 Legend: COG = center of gravity.
With increasing life expectancy, increasing numbers of
elderly people in Brazil and improvements in quality of
life, studies on balance and gait abnormalities increas-
ingly involve analyses that attempt to create strategies
for recognizing and preventing incapacity and the onset
of frailness.
Activities that emphasize balance reduce the risk of
falls. They improve muscle strength in the lower limbs
and vertebral column and improve postural reaction
times. There are increases in locomotion velocity, flexi-
bility and stability when stopping a movement [14].
Regarding the tests applied, we observed that the eld-
erly people in the group undergoing balance training by
means of Tai Chi group presented a greater mean age
than that of the control group. The mean age in the bal-
ance training group was 76.8 years, versus 70.3 years in
the control group. Hence, one group was theoretically
characterized as presenting greater risk of falls and lower
capacity for balance and posture [1,14-16] However, the
battery of tests showed:
Modified Clinical Test on Sensory Interaction for
Balance (MCTSIB): This test had the aim of analyzing
posture under circumstances of suppression of visual
information and modification of somatosensory informa-
tion, separately or in association [10,17]. In our study, we
found that Thai Chi group presented quantitative advan-
tages, especially when the experimental conditions in-
volved vision and a stable surface. These Tai Chi Chuan
practitioners maintained increased reserves of balance, in
the same way as described by others authors [17-19].
The velocity of postural oscillation was lower on sta-
M. A. Rahal et al. / Health 5 (2013) 117-1 21
ble surfaces when vision was maintained. When vision
was suppressed, both groups were affected, but the Tai
Chi group had a greater adaptive capacity for keeping an
erect posture, in the same way reported in others studies
With wider oscillations and a capacity for recovery of
balance, better results were obtained on the unstable sur-
face. The Tai Chi group presented better performance,
but without any statistical difference.
Anteroposterior stability is lower than side-to-side sta-
bility in humans because of the support base formed by
the feet. This characteristic may explain the loss of sta-
bility at the time when movement is made in the antero-
posterior direction. The Tai Chi group showed better ad-
aptation because of its training in this situation.
Walking Test: This presented movement velocity data
consisting of the mean locomotion velocity of the center
of mass, going towards the target. In this, Tai Chi group
presented better scores than did the control group. This
was contrary to the findings from the studies of authors
like Quesada et al. [22] and Rejeski et al. [23], consider-
ing that all practitioners of physical activities should be
benefited equally, although the Tai Chi group was the
best. The movement velocity may translate anticipatory
or even compensatory adjustments in relation to the pos-
tural disorders that existed. Our study was concordant
with the findings of Thimoty [24] and Gomes et al. [9].
The final postural oscillation and the progression veloc-
ity can be explained by the greater difficulty in returning
to stability after locomotion. Thus, greater postural os-
cillation would be given by lower ability of the compen-
satory mechanisms. The Tai Chi group presented better
Unipedal Test: This demonstrated that when one
group was trained for balance exercises, it presented
scores greater than those of the volunteers, which was in
agreement with Gomes et al. [9]. The Tai Chi Group
presented smaller oscillations when in the unipedal posi-
tion, because of controls of greater efficiency in the body
adjustment mechanisms, as also observed by others study.
Sit-to-Stand Transfer Test: The Tai Chi Group pre-
sented favorable results regarding the mean rising index
(is the amount of force exerted by the legs during the
rising phase, expressed as a percent of body weight) to
perform the task, as also shown by Condron et al. [27]
There was no pain or fear while performing the task, and
all subjects in the Tai Chi Group presented better final
oscillation results. Once center of gravity has moved
forward enough to be over the feet (new base of support),
the upper body must decelerate to stop the forward mo-
tion. The legs must extend, pushing down against the
surface to produce counterforce sufficient to raise the
body to a standing position. Insufficient force will result
in a failure to rise to a upright position. Higher scores are
good, and low scores are worse [11].
In the light of the conditions presented in this study,
we conclude the following:
Tai Chi Chuan was shown to be a protection factor for
preserving and maintaining the static and dynamic posi-
tions of posture and gait.
The locomotion capacity of the Tai Chi Chuan group
was greater in the evaluation on movement velocity. The
oscillation of the center of gravity was smaller with steps
that were more secure.
The capacity for transferring from the sitting to the
standing position was greater among the Tai Chi Chuan
The Tai Chi Chuan practitioners were more secure in
the tests on locomotion of the center of mass. They re-
sumed their posture when there were oscillations of
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