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      Can Tai Chi training impact fractal stride time dynamics, an index of gait health, in older adults? Cross-sectional and randomized trial studies

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          Abstract

          Purpose

          To determine if Tai Chi (TC) has an impact on long-range correlations and fractal-like scaling in gait stride time dynamics, previously shown to be associated with aging, neurodegenerative disease, and fall risk.

          Methods

          Using Detrended Fluctuation Analysis (DFA), this study evaluated the impact of TC mind-body exercise training on stride time dynamics assessed during 10 minute bouts of overground walking. A hybrid study design investigated long-term effects of TC via a cross-sectional comparison of 27 TC experts (24.5 ± 11.8 yrs experience) and 60 age- and gender matched TC-naïve older adults (50–70 yrs). Shorter-term effects of TC were assessed by randomly allocating TC-naïve participants to either 6 months of TC training or to a waitlist control. The alpha (α) long-range scaling coefficient derived from DFA and gait speed were evaluated as outcomes.

          Results

          Cross-sectional comparisons using confounder adjusted linear models suggest that TC experts exhibited significantly greater long-range scaling of gait stride time dynamics compared with TC-naïve adults. Longitudinal random-slopes with shared baseline models accounting for multiple confounders suggest that the effects of shorter-term TC training on gait dynamics were not statistically significant, but trended in the same direction as longer-term effects although effect sizes were very small. In contrast, gait speed was unaffected in both cross-sectional and longitudinal comparisons.

          Conclusion

          These preliminary findings suggest that fractal-like measures of gait health may be sufficiently precise to capture the positive effects of exercise in the form of Tai Chi, thus warranting further investigation. These results motivate larger and longer-duration trials, in both healthy and health-challenged populations, to further evaluate the potential of Tai Chi to restore age-related declines in gait dynamics.

          Trial registration

          The randomized trial component of this study was registered at ClinicalTrials.gov ( NCT01340365).

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          Most cited references44

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          Interventions for preventing falls in older people living in the community

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            Gait and cognition: a complementary approach to understanding brain function and the risk of falling.

            Until recently, clinicians and researchers have performed gait assessments and cognitive assessments separately when evaluating older adults, but increasing evidence from clinical practice, epidemiological studies, and clinical trials shows that gait and cognition are interrelated in older adults. Quantifiable alterations in gait in older adults are associated with falls, dementia, and disability. At the same time, emerging evidence indicates that early disturbances in cognitive processes such as attention, executive function, and working memory are associated with slower gait and gait instability during single- and dual-task testing and that these cognitive disturbances assist in the prediction of future mobility loss, falls, and progression to dementia. This article reviews the importance of the interrelationship between gait and cognition in aging and presents evidence that gait assessments can provide a window into the understanding of cognitive function and dysfunction and fall risk in older people in clinical practice. To this end, the benefits of dual-task gait assessments (e.g., walking while performing an attention-demanding task) as a marker of fall risk are summarized. A potential complementary approach for reducing the risk of falls by improving certain aspects of cognition through nonpharmacological and pharmacological treatments is also presented. Untangling the relationship between early gait disturbances and early cognitive changes may be helpful in identifying older adults at risk of experiencing mobility decline, falls, and progression to dementia. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
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              Dual tasking, gait rhythmicity, and Parkinson's disease: which aspects of gait are attention demanding?

              Cognitive function and the performance of a secondary, dual task may affect certain aspects of gait, but the relationships between cognitive function and gait are not well understood. To better understand the motor control of gait and the relationship between cognitive function and gait, we studied cognitive function and the effects of different types of dual tasking on the gait of patients with Parkinson's disease (PD) and controls, contrasting measures of gait automaticity and rhythmicity with other features. Patients with idiopathic PD (n=30; mean age 71.8 year) with moderate disease severity (Hoehn and Yahr Stage 2--3) were compared to age and gender-matched healthy controls (n=28). Memory and executive function were also assessed. In both groups, gait speed decreased in response to dual tasking, in a parallel fashion. For the PD group only, gait variability increased compared to usual walking. Executive function was significantly worse in the PD group, while memory was not different in the two groups. Executive function measures were significantly correlated with gait variability during dual tasking, but not during usual walking. These findings demonstrate that regulation of gait variability and rhythmicity is apparently an automatic process that does not demand attention in healthy adults. In patients with PD, however, this ability becomes attention-demanding and worsens when subjects perform secondary tasks. Moreover, the associations between executive function and gait variability suggest that a decline in executive function in PD may exacerbate the effects of dual tasking on gait, potentially increasing fall risk.
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                Author and article information

                Contributors
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                11 October 2017
                2017
                : 12
                : 10
                : e0186212
                Affiliations
                [1 ] Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
                [2 ] Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
                [3 ] Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
                [4 ] Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
                [5 ] Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts, United States of America
                [6 ] Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
                [7 ] Motion Analysis Laboratory, Spaulding Rehabilitation Hospital, and the Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, United States of America
                [8 ] Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, United States of America
                [9 ] Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
                [10 ] Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
                Midwestern University, UNITED STATES
                Author notes

                Competing Interests: Peter M Wayne is the founder and sole owner of the Tree of Life Tai Chi Center. Peter M Wayne’s interests were reviewed and are managed by the Brigham and Women’s Hospital and Partners HealthCare in accordance with their conflict of interest policies. Remaining authors declare that they have no competing interests. We confirm that this does not alter our adherence to the PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0002-7682-1943
                Article
                PONE-D-16-45445
                10.1371/journal.pone.0186212
                5636131
                29020106
                93e17b1f-5f76-41ca-94b5-a3d75015f78d
                © 2017 Gow et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 November 2016
                : 19 September 2017
                Page count
                Figures: 2, Tables: 4, Pages: 17
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100008460, National Center for Complementary and Integrative Health;
                Award ID: R21 AT005501-01A1
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100008460, National Center for Complementary and Integrative Health;
                Award ID: K24 AT009282
                Award Recipient :
                This work was supported by grant R21 AT005501-01A1 and K24 AT009282 from the National Center for Complementary and Integrative Health (NCCIH: https://nccih.nih.gov/), National Institutes of Health (NIH: http://www.nih.gov/) awarded to PW. Dr. LL was supported by grant R03-AG025037 from the National Institute on Aging (NIA: http://www.nia.nih.gov/) and the Irving and Edyth S. Usen and Family Chair in Geriatric Medicine at Hebrew SeniorLife. Dr. CP was supported by a grant (NSC 102-2911-I-008-001) from Ministry of Science and Technology of Taiwan ( https://www.most.gov.tw/en/public). Dr. BM was supported by grant 5 KL2 RR025757-04 from the Harvard Catalyst ( http://catalyst.harvard.edu/) and grant 1K01 AG044543-01A1 from the National Institute on Aging (NIA: http://www.nia.nih.gov/). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCCAM, NIA, or NIH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Physiology
                Biological Locomotion
                Walking
                Medicine and Health Sciences
                Physiology
                Biological Locomotion
                Walking
                Biology and Life Sciences
                Physiology
                Biological Locomotion
                Gait Analysis
                Medicine and Health Sciences
                Physiology
                Biological Locomotion
                Gait Analysis
                Medicine and Health Sciences
                Public and Occupational Health
                Physical Activity
                Medicine and Health Sciences
                Public and Occupational Health
                Physical Activity
                Physical Fitness
                Exercise
                Medicine and Health Sciences
                Sports and Exercise Medicine
                Exercise
                Biology and Life Sciences
                Sports Science
                Sports and Exercise Medicine
                Exercise
                People and Places
                Population Groupings
                Age Groups
                Elderly
                Physical Sciences
                Mathematics
                Geometry
                Fractals
                Research and Analysis Methods
                Computational Techniques
                Fluctuation Analysis
                Biology and Life Sciences
                Anatomy
                Nervous System
                Central Nervous System
                Medicine and Health Sciences
                Anatomy
                Nervous System
                Central Nervous System
                Custom metadata
                The authors confirm that all data underlying the findings are fully available without restriction. We have released the data analyzed in this manuscript to the public through the Physionet archives ( https://physionet.org/physiobank/database/taichidb/). Physionet provides free tools for working with these waveforms in an efficient manner ( https://physionet.org/physiotools/wfdb.shtml). Our release complies with the strict Physionet guidelines which require a detailed description of what is contained in the release. The DOI for this release is: 10.13026/C2W01J.

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