This is a report on my first classes in falls prevention for Merton Sutton and Wandsworth PCGroup (NHS) back in 2000. Yes that's nearly 20 years ago! I was asked to create a full time Falls Prevention program funded by the NHS and local council by Piers Simey. It is only the summary but interesting reading for my students and anyone interested in the field. The project ran about a year in total with exit strategies. When I moved to the West Country I handed most classes to a local teacher Joseph ? and Paul Cromton. I now run similar classes here.
Tai Chi Falls Prevention and Exercise Project
7th February to 12th May 2000
Based primarily on research by Wolf et al. 1993 a project was set in motion to offer Tai Chi opportunities to over 50’s and evaluate the effectiveness of this system of exercise. Funded jointly by MSW HA and Wandsworth Social Services and based within the Wandsworth HA area.
Tai Chi in its full form is a martial art, however as it has developed over the centuries, specific slow and gentle exercises and ‘forms’ have evolved with the goal of health improvement. It is this aspect that has been taught.
The original plan was to provide ten ‘taster’ sessions to groups of older people hopefully leading to six long term and viable opportunities.
Viable opportunities were defined as classes of 15 to 25 clients, willing to pay a minimal amount
( about £1 ) supplemented by the PCG.
13 sessions were offered across the three PCGs (Battersea, BTW, Putney and Roehampton).
Approximately 220 plus people attended and had an opportunity to have an insight into Tai Chi and think about exercise in general.
This led to nine ongoing classes which ran for the length of the project.
The tasters had three parts, a demonstration and explanation of Tai Chi, a chance to try some simple exercises and open discussion at the end.
Many people were sceptical of any exercise system but were pleasantly surprised that they could take part and enjoyed doing so. More tasters could be offered if more time and funding became available. The tutor’s time was slowly taken up more by the ongoing classes.
There are definite opportunities in the Khasla Centre and the Black Elderly Project in Tooting. There are also opportunities in Nursing homes and sheltered accommodation.
Ongoing Tai Chi Opportunities
Nine classes ran for the length of the project. Of these, seven continue to run.
One amalgamated with a viable class and one falls outside the PCGs concerned but will continue initially funded by the centre concerned.
Two meet the original criteria for viability, both in B’sea.
Two continue as the venues will match any shortfall in funding, hopefully.
Three do not meet funding criteria. One is in an area of mild deprivation (Lennox estate) and has low numbers. It is a new group, formed only one month before the start of the project. This group is willing to pay contributions. The other two groups are unlikely to pay contributions and fall short of the numbers needed. One is in the Asian Voluntary Support Centre and the other is in the Tooting Neighbourhood Centre (attended by predominately Black clients).
14 February 2000 to 5 May 20 00
Total number on registers- 171
Total attendance - 733
Total number of classes- 66
Average class attendance- 11
(some members attend more than one class)
What the classes are like
Each class is geared to the needs of the group and individuals concerned. Exercises are done both sitting and standing and most classes contain an element of both. They last for between half and a full hour. Many classes were considerably shorter in the first weeks matching client ability.
The classes are light and friendly. There are several rest and relaxation periods (an intrinsic aspect of Tai Chi). There is also ample time for social talk and discussion about exercise and fall prevention before, during and after the class.
All classes are followed by light refreshment or a lunch club.
What was taught
The original research above was run using Yang style Tai Chi. The tutor uses Lam style, however all styles conform to the same basic principles. The ‘Form’ movements taught (Peng, Li, Chi, An) are common to both (and most!) styles. Lam style has been developed by a practising Traditional Chinese Doctor with a very strong emphasis on health improvement and avoiding injury. Tai Chi works in three dimensions through the natural reach and movements of the body.
Chair exercises revolved mostly around relaxation, improving strength and flexibility of the upper body and leg work.
Standing exercises were similar but also included leg strengthening, weight shifting, turning and
balance/stability awareness. Some classes were also able to start to learn the Forms mentioned above.
All classes had repeated advice regarding safety and not ‘over doing it’.
All clients filled out a Physical Activity Readiness Questionnaire (PAR-Q). The client’s GP was contacted regarding client’s ability to take part if relevant medical conditions raised any concern. This method is under review and may change to a more informative and accurate method using individual interviewing followed by a form letter to the GP highlighting any concerns. This may remove some of the paper work involved and improve the process, allowing more time for the tutor and client to explore possible problems.
So far all doctors have agreed to client participation with or without additional comments except one practice which said that as they did not know anything of Tai Chi, the best people to ask about eligibility were the clients themselves.
The three-month period is a very short time to evaluate in depth the effectiveness of the system and this section does not claim more than a basic review of the project.
Three methods were used to evaluate the project, ongoing evaluation by all concerned, functional reach tests and a questionnaire.
1. The tutor constantly evaluated the progress of clients by their participation and ability.
Progress was evident from the increased stamina of clients, one group tripled their length of class in a month, and the ability to perform the exercises. Tai Chi is based on the idea that change takes time.
Retaining ability is better than losing it, a small and stable increase is better than a large unstable one and the exercises themselves should never over work or put the student at risk.
Clients repeatedly expressed their appreciation of the class and their frequent laughter demonstrated their enjoyment (especially when working hard!) In my experience of teaching over the last six years I have rarely come across such large numbers of enthusiastic and determined people and feel privileged to have been able to teach them.
In discussion with Piers Simey, the HA received very positive feedback for the project notably by the Nurses and community workers attached to the groups concerned.
2. The functional reach test was taken during the first class and during the weeks 1-10 may 2000. The time difference between tests was two to three months. I would stress that this is a very short time and is for project evaluation purposes only.
A functional reach of less than 25cms is generally considered to be an indication of higher risk of fall.
Mean original reach; 22.8cms
Mean second test reach; 27.5cms
Mean improvement; +4.7 cms
Total number in sample- 30
Total number going from below to above 25 cms; 11
(37% of total survey, 52% of those below 25cms reach)
The lowest score was a loss of 10 cms, however this person was ill for the preceding three weeks and missed those classes.
The highest improvement was a gain of 18 cms
56% showed an increase of 3 cms or more,
13% showed an increase of 10 cms or more.
It is interesting to note that the mean improvement brought the group from below to above the ‘at risk’ level.
3. The questionnaire is still in progress and 51 replies have been returned so far.
Of these, there have been only four requests for improvement.
The first is for improved heating in one of the venues (it can be cold and the venue needs addressing).
The second, three people requested either longer of more frequent classes.
The third was a request for music.
The fourth was requests for pictures/note for “homework.”
Everyone answered very positively to questions regarding the general running of the class and exercises.
Most were willing to pay 50p-£1 for the classes.
About ¾ of the replies with an opinion said that they practice between one and seven times a week at home.
Some comments from the forms;
“Having had to give up my regular exercise class and swimming, I was thrilled to join the class”
“ I would like to keep the class going helping with my breathing.”
“I would like to have another class during the week.”
“It’s easy- very relaxing, enjoyable- a good group of people”
“All elderly folk should do them- I certainly intend keeping up Tai Chi”
“Parts of my body more flexible”
“As I live on my own it’s somewhere to go for a couple of hours and I enjoy it”
“A good idea. If these classes are not around, we would sit in doors doing nothing”
“Such a benefit in every way”
“Some help with arthritic joints”
“I get out of my chair easier”
Difficulties on the way
The main problems encountered were from admin or access points of view.
The PAR-Q form underwent several changes and is still under re-view. S. Dinan has suggested a different system, interviewing each prospective member to fill in a standard Dr’s letter and registration form. The Dr’s letter would then be sent, placing the responsibility with the Dr to inform of any contra-indications. The interview would also allow for the tutor and student to get to know each other, pass on specific needs and information of safe exercising. The present system is slightly clumsy and time consuming.
There is a shortfall in equal access to ethnic minorities and poorer members.
The classes at present are free. Many are willing to pay contributions, however, the smaller groups and those unable to pay would necessarily lose their Tai Chi opportunities when the initial funding ceases. (Planned June 12th 2000). It is interesting to note that two of the groups which fall short in numbers and willingness to pay are also from ethnic minority groups (one Asian, one Black).
Access has also been affected by a lack in translated advertising, there are now Punjabi leaflets but Urdu and Hindi translations would also be useful.
There has been some difficulty getting into certain groups, the Black Elderly Project in Tooting being a good example. They appear to be very busy and have not responded to any of various methods of communication. Generally though, most groups are more than willing to receive a taster.
The biggestproblems facing the consultant was lack of time and guaranteed funding of classes. As the number of classes increased the time taken by teaching and travelling increased so there was less time for
Unsure funding meant that adequate advertising could not happen. Classes take time to establish themselves, in the private sector I would suggest at least a year. Advertising needs to say where, when, cost and purpose of class, some of which is, at present, incomplete. Once the class is definite and funded, various methods should be adopted to build numbers to the required level of 15-25 regular attendees. The Lennox class is a good example. Advertising in the local shops, surgery and targeted leaflet distribution by the estate warder have produced little extra interest. The enthusiasm of the present students indicates that once involved, clients stay. The group itself was only one month old when the class joined as part of the social group.
Somevenues also fall short. The Peebody trust site may become too expensive to run the class and the hall is cold. Other sites run alongside lunch and social clubs. The advantage is bringing in new members from the sidelines, which happens slowly. The disadvantage is background noise and interruptions.
Classes have been enjoyed thoroughly which shows the possibility of using Tai Chi as an exercise system for older people. There are many other openings possible if funding can be found. There are also openings for possible free standing classes or those run in leisure and adult education centres. Classes in sheltered/nursing homes are also a possibility, though they would probably have fewer members and require funding from the private sector.
The Khasla centre has shown interest in creating a free-standing class as the contact Mr Ubhi suggested that attendance would probably run around the 25 mark.
Cost for a tutor for a class at £25 per session for 48 weeks per annum is £1,200. If met in part by
contributions then this can be reduced. For ten free classes to run full time £12,000 would be sufficient.