title: A 1-year randomized controlled trial comparing mind body exercise (Tai Chi) with stretching and toning exercise on cognitive function in older Chinese adults at risk of cognitive decline.
abstract: OBJECTIVE
  To compare the effectiveness of Chinese-style mind-body exercise (24 forms simplified Tai Chi) versus stretching and toning exercise in the maintenance of cognitive abilities in Chinese elders at risk of cognitive decline.
  
  
  METHODS
  A 1-year single-blind cluster randomized controlled trial.
  
  
  METHODS
  Community centers and residential homes for elders in Hong Kong.
  
  
  METHODS
  A total of 389 subjects at risk of cognitive decline (Clinical Dementia Rating, CDR 0.5 or amnestic-MCI) participated in an exercise intervention program.
  
  
  METHODS
  A total of 171 subjects were trained with Tai Chi (Intervention [I]) and 218 were trained with stretching and toning exercise (Control [C]).
  
  
  METHODS
  Cognitive and functional performance were assessed at the baseline, and at 5, 9, and 12 months. Data were analyzed using multilevel mixed models. Primary outcomes included progression to clinical dementia as diagnosed by DSM-IV criteria, and change of cognitive and functional scores. Secondary outcomes included postural balance measured by the Berg Balance Scale neuropsychiatric and mood symptoms measured by the Neuropsychiatric Inventory, and Cornell Scale for Depression in Dementia.
  
  
  RESULTS
  At 1 year, 92 (54%) and 169 (78%) participants of the I and C groups completed the intervention. Multilevel logistic regression with completers-only analyses controlled for baseline differences in education revealed that the I group had a trend for lower risk of developing dementia at 1 year (odds ratio 0.21, 95% CI 0.05-0.92, P = .04). The I group had better preservation of CDR sum of boxes scores than the C group in both intention-to-treat (P = .04) and completers-only analyses (P = .004). In completers-only analyses, the I group had greater improvement in delay recall (P = .05) and Cornell Scale for Depression in Dementia scores (P = .02).
  
  
  CONCLUSIONS
  Regular exercise, especially mind-body exercise with integrated cognitive and motor coordination, may help with preservation of global ability in elders at risk of cognitive decline; however, logistics to promote long-term practice and optimize adherence needs to be revisited.
authors.affiliation: Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong. cwlam@cuhk.edu.hk
authors.forename: Linda C W
authors.initials: LC
authors.lastname: Lam
authors.forename: Rachel C M
authors.initials: RC
authors.lastname: Chau
authors.forename: Billy M L
authors.initials: BM
authors.lastname: Wong
authors.forename: Ada W T
authors.initials: AW
authors.lastname: Fung
authors.forename: Cindy W C
authors.initials: CW
authors.lastname: Tam
authors.forename: Grace T Y
authors.initials: GT
authors.lastname: Leung
authors.forename: Timothy C Y
authors.initials: TC
authors.lastname: Kwok
authors.forename: Tony Y S
authors.initials: TY
authors.lastname: Leung
authors.forename: Sammy P
authors.initials: SP
authors.lastname: Ng
authors.forename: Wai M
authors.initials: WM
authors.lastname: Chan
mesh_terms: D000368:Aged; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000503:physiopathology* / Q000517:prevention & control*; D018450:Disease Progression; D005260:Female; D015577:Geriatric Assessment; D006723:Hong Kong; D006801:Humans; D008297:Male; D052580:Muscle Stretching Exercises; D016012:Poisson Distribution; D018570:Risk Assessment; D016037:Single-Blind Method; D026302:Tai Ji; D016896:Treatment Outcome