Virtual, cognitively enhanced tai chi improves cognition, executive function in older adults

Older adults with mild cognitive impairment may benefit from virtual tai ji quan, also known as tai chi, particularly a version that is cognitively enhanced, a recent trial found.

Researchers randomly assigned 318 adults ages 65 years and older with self-reported memory decline or concern and a Clinical Dementia Rating global score of 0.5 or lower at baseline to cognitively enhanced tai ji quan, standard tai ji quan, or stretching one hour twice weekly for 24 weeks, all done at home via videoconferencing. Cognitively enhanced tai ji quan included a set of cognitively demanding activities that involved interactive, reactive, and verbal and nonverbal instructional cueing. The goal of the trial was to compare the effectiveness of the interventions for improving global cognition as measured by Montreal Cognitive Assessment (MoCA) score and reducing dual-task walking costs, defined as the difference between gait speed while performing one or two tasks. Outcomes were assessed at 16 weeks, 24 weeks (the primary endpoint), and 48 weeks. The study results were published Oct. 31 by Annals of Internal Medicine.

One hundred five patients were randomly assigned to the cognitively enhanced tai ji quan group, 107 to standard tai ji quan, and 106 to stretching. Three hundred four patients (96%) completed the 24-week assessment, with an average adherence rate of 80% in all groups. Those in the cognitively enhanced tai ji quan group had more improvement in MoCA score (mean difference, 1.5 points [98.75% CI, 0.7 to 2.2 points] versus standard tai ji quan and 2.8 points [95% CI, 2.1 to 3.6 points] versus stretching) and in dual-task walking (mean difference, 9.9% [95% CI, 2.8% to 16.6%] and 22% [95% CI, 13% to 31%], respectively). No serious adverse events were reported, and effects of the intervention persisted at 48-week follow-up.

Most of the study participants were White and had relatively high cognitive function, which limits the generalizability of the results, the authors noted. In addition, they pointed out that they did not include a control group without exercise and that all study assessments were done online rather than in person. They concluded that twice-weekly moderate-intensity tai ji quan with cognitive enhancement was clinically superior to standard tai ji quan and stretching for improving global cognition and reducing task interference during walking at 24 weeks.

“The effects were sustained at 48 weeks, with participants in the cognitively enhanced tai ji quan group successfully maintaining improved cognitive function over time,” the authors wrote. “The virtual, home-based intervention also had high intervention fidelity and adherence, and could be a feasible, acceptable exercise-based therapy for older adults with [mild cognitive impairment].”