Culture-specific exercise sparks interest of older women


American Heart Association meeting report

ORLANDO, Feb. 18 Getting older Americans to exercise isn't always easy, but exercise programs in tune with a culture create interest and increase adherence, researchers in a pilot study reported at the Second International Conference on Women, Heart Disease and Stroke.

University of California San Francisco School of Nursing researchers provided a 12-week Tai Chi exercise program to older Chinese women who had one major risk factor for coronary heart disease.

Most exercise programs for women with coronary heart disease have high dropout rates, but 96 percent of participants completed the Tai Chi program, and there was a waiting list to join.

"Tai Chi has been widely practiced in China for centuries, and is a popular form of exercise there," said Ruth E. Taylor-Piliae, a doctoral candidate in the School of Nursing at UCSF. "The exercise program was provided at a community center where a large number of Cantonese-speaking senior citizens gather daily. They readily embraced this form of exercise and were excited. Activities within various cultures that are the equivalent of brisk walking, most likely will spark interest and be readily acceptable."

The researchers, as a part of a pilot study to determine feasibility and acceptability, set up a Yang Style Tai Chi program for Chinese women at a community center where senior citizens already gather daily for lunch, activities or health talks. The 27 Chinese women in the study, average age 64, participated in one-hour Tai Chi sessions three times a week for three months.

All the women had at least one coronary heart disease risk factor, 56 percent had arthritis. The most surprising factor was that 90 percent of the women either were diagnosed with high blood pressure or were on medications for high blood pressure, researchers said. Also, 44 percent of the women had high cholesterol levels and 26 percent had been diagnosed with diabetes.

"The amount of high blood pressure was surprising," said Taylor-Piliae. "We had never encountered this before."

The Tai Chi program includes weight shifting between right and left legs, knee flexion, straight and extended head and trunk, rotation, and arm and leg movements with bent knees.

Subjects were asked to replicate the motions, postures and movement speed of the instructor. The entire sequence, which takes 8 to 10 minutes to perform, was repeated several times to provide an aerobic benefit. Participants were monitored for safety and were corrected by the instructors as needed.

By the end of 12 weeks, the women had learned the entire Yang Style 24-posture short form. There were no falls or injuries. One woman dropped out of the program at six weeks due to recurring health problems.

Following completion of the study, one-fourth of the women have continued the Tai Chi program at the community center. All participants were given a CD-ROM of a Tai Chi master performing this style, but researchers have not completed follow-up calls to determine how many women have continued the program at home.

"Tai Chi is a very successful exercise program for these women," said Taylor-Piliae. "The Yang style of Tai Chi tends to have slower and more gentle movements compared to other styles and works well for older adults. And other studies have shown it produces an aerobic effect."

The success of the project was enhanced by the researchers being culturally in tune with the group. Taylor-Piliae had spent 15 years in Hong Kong, speaks Cantonese and is familiar with the culture. "Language was not a barrier to understanding in this study," she said. "This is important."

The researchers looked at the effects of Tai Chi on blood pressure, balance, muscular strength and flexibility, and psychological measures, but the results have not been fully analyzed.

Given the success of this program, the California researchers are hoping to conduct a large randomized clinical trial, to examine the acceptability of a Tai Chi program among other ethnicities, and also examine health benefits.

"We did see that the program was acceptable to this group and appeared to produce some health benefits," she said. "Hopefully, with a larger study we will have more definitive information on the health indicators."

But what the researchers learned is that Tai Chi appears to be a form of exercise that is safe and acceptable to Chinese women. "We are seeing that it has worked in this community," she said. "Not only are Chinese women interested, but so are other Asian, Hispanic and African-American women."

Presently, treadmill walking is one of the most recommended forms of exercise for people with risk factors for coronary heart disease, she said.

"I think the key is to find out what already is a popular form of exercise within an ethnic group. If it is safe and is equivalent to brisk walking, then it not only may be effective, but more acceptable."

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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