The Effect Of Tai Chi on

Mild Alzheimers patients

For qualifying examination (QE)

Miss Chomlak Kongart

Student ID: 5779051153

Background and Rational

In Thailand, the percentage of young and
working age population will continue to
decline from 2010 to 2040, while the number
of elderly population continues to increase, fro
m 13.2 percent in 2010 and is estimated to be
32.1 percent in 2040 (Knodel et al., 2015).
The characteristic of elderly had many
underlying disease : diabetes, hypertension
and dementia.
In Thailand, the prevalence of dementia is
229,000 in 2005 and it is expected 452,000 in
2020 and 1,233,000 in 2060 (ADI Asia Pasific
and non-ADI Asia Pacific).

Background and
Rational

Increasing prevalence of dementia has a bad

potential impact for status and the public health
system of a country. This is because dementia d
isease can be possible side effects, such as soci
al and economic burden for the family.
Up to now, medications have not yet been
shown effective in stopping this particular
disease, and some have problematic side effect
s. But some practices, like regular exercise, hav
e shown progress in delaying the advance of Alz
heimer's disease.
3

Background and Rational

According to Yancheva et al. (2009)
that up to 70 percent of people with
Alzheimers also have symptoms of
depression and anxiety. Due to dem
entia people may eventually withdra
w from all activities and difficulty to b
alance themself in all activities.

Background and Rational

The physical activity such as Tai Chi could improve
the balance and prevent elderly on the frail proble
m such as risk to fall.
Many studies have suggested that tai chi can help
boost older adults immunity to viruses and
improve their balance, thereby helping to prevent f
alls (Li, F., Harmer, P., Fitzgerald, K. et al, 2005).
Tai chi can help improve physical condition, muscle
strength, coordination, and flexibility; ease pain
and stiffness; reduce depression and anxiety, impro
ve sleep and balance (Li, Harmer, & Fisher, 2005).
5

Gap of Knowledge
Many studies have shown that Tai Chi has beneficial
effects on balance, falls, and non-vertebral
fractures, depression and anxiety but in Thailand do
esn't have study yet.
Many studies have investigated methods to prevent
dementia symptoms, but few have investigated the
effect of Tai Chi on dementia patient.
Importantly the evaluation of the health status of
dementia in this study implemented three methods,
namely Ham-D, Ham-A and berg Balance slcae (BBS
) which are still rare to be used simultaneously to e
valuate the effect of Tai-chi toward the cognitive im
provement of the mild Alzheimer patients.
6

Research Question
Does Tai Chi intervention treatment is able to
reduce Anxiety, Depression and improve
Balance for Mild AD.?

Research Objectives
General Objective
To study effectiveness of Tai Chi practice model on
anxiety, depression and balance in mild Alzheimers
patients
Specific Objectives
To measure Anxiety, Depression and Balance before
and after experiment of control and trial groups.
To compare Anxiety, Depression and Balance
between control and trial groups before and after
experiment.

Research Hypothesis
The Tai-chi practice significantly affects to
ameliorate the Anxiety, Depression and
Balance after experiment.
There is significant different anxiety score ,
Depression score ,Balance score between
intervention and control group after Tai chi pr
actice. (t-test)
Tai-chi practice affects significantly to
ameliorate the Anxiety, Depression and
Balance on trail group after Tai chi program.
(pair t-test)

Conceptual Framework

10

Literature Review

11

Literature Review
Alzheimers disease can be divided in to
three phases
Mild-Stage Alzheimers disease
Moderate
Moderate servere

Diagnose

physical examination
mental and behavior examinations

12

Literature Review
AD detection
Positron emission tomography (PET),
Computed tomography (CT) and
Magnetic resonance imaging (MRI)
scans

Alzheimers disease affects on

A loss of cognitive functioning

Depression, anxiety and
balance

13

Literature Review
Tai chi

Tai-Chi is derived from traditional

Chinese martial arts.
Tai-Chi practice breathing and relaxing
body movement slow and smooth
rhythm of movement. Its practice is ass
ociated with a low metabolic load and si
gnificant psychological benefit and qual
ity of life (Chen, 2012).

14

Tai Chi and Al Zheimer

Snowden et al., 20
11

physical activity or exercise (tai-chi)

improved cognition in older adults

C. Wang, Collet, &

Lau, 2004)

Regular tai chi exercise may help with

preservation of global ability in elders at
risk of cognitive decline

Frye, Scheinthal,
Kemarskaya, &
Pruchno, 2007

tai chi are safe, cost-effective ways to

improve both physical and psychological
functioning of older people

Wolf, Barnhart, Elli

son,
Coogler
, & Atlanta FICSIT,
1997
Kasai
et al., 2010
)

Tai Chi has been characterized as mindbody interventions and as meditative

movements
After six months of intervention, the TCC Group
showed significant improvement on the
Behavioral Memory Test and Memory
Complaint Scale
15

Measuring health status

for mild Alzeimer case
Hamilton Rating Scale for
Depression (Ham-D)
Hamilton Anxiety Rating
Scale (HAM-A)
Bergs Balance Scale (BBS)

16

Research Methodology

17

Research Design
This is an pre-experimental research study, two groups,
pre-test - post-test design.
X
E

Q1

Q2

Follow up 12 weeks

Follow up 24 weeks

E = Experimental
group
C = Control group

Q1

Q2

Follow up 12 weeks

Follow up 24 weeks

Q1 = Pre-study
measurement
Q2 = Post study
measurement
X = Tai - chi

18

Population and sample size

The target population of this study was a participant
who had been formally diagnosed with mild Alzheimer
stage and treated in King Chulalongkorn Hospital.
Inclusion criteria

Patients who diagnosed of mild Alzheimer stage 60 years old

and over
Voluntariness to participate in this study.
Able to speak and understand Thai with no severe hearing
impairment.

Exclusion criteria

Regular practice of Tai-Chi.

Patients who were unwilling or unable to participate.
Emergence of newer symptom.
older people with blindness;

19

Population and sample size

Sampel size was calculating by implementing
G-Power application. The result as follow:
Effect design (d) : 80% (Lee,et.al 2009)
Alpha error : 0.05
Power (1-) : 0.95
Experimental group : 42
Control group
: 42
Total sample : 84

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Sample selection
the 84 participants were randomly by
using the excel program from all ad
patient.
Subjects are allocated a set a
number from 1 to 84. Those who get
odds number will be assigned as
intervention group and other as contr
ol group.
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Research tool
Hamilton anxiety ratting scale
(HAM-A)
Hamilton depression scale
(HAM-D)
Berg balance scale (BBS)
Tai chi practice program
22

Hamilton depression scale

(HAM-A)
The scale designed to assess the
severity of a patients anxiety. Each
of the items contains a number of sy
mptoms and each group of symptom
s is rated on a scale of zero to four, w
ith four being the most severe
a. Scores of less than 6 = no anxiety.
b. Score 7-14
= mild anxiety.
c. Score 15-27
= moderate anxiety.
d. Score more than 27 = severe anxiety.
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Hamilton anxiety ratting scale (HAM-D)

The questionnaire is designed for adults and
is used to rate the severity of their
depression by: Probing mood, Feelings of gui
lt, Suicide ideation, Insomnia.
For the assessment scores are:
Less than 17
: no depression
18-24
: mild depression
25-34
: moderate depression
35-51
: severe depression
52-68
: very severe depression

24

The Berg Balance Scale (BBS)

A clinical test of a person's static and dynamic balance
abilities.
The test takes 1520 minutes and comprises a set of 14
simple balance related tasks, ranging from standing up
from a sitting position, to standing on one foot.
The degree of success in achieving each task is given a
score of zero (unable) to four (independent), and the
final measure is the sum of all of the scores.
Level of balance scale;
0-20 score mean requires a wheelchair
21-40 score mean needed assistance in walking
41-56 score mean can be independently
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Validate of research tools

Questionnaires will examine in the part of
reliability and validity in all of by nurse and
questionnaires test before use in the project.
An alternative (meditation) therapy manuals will
examine for reliability and validity by expert
and trial out before use in the project.

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Tai-chi Intervention
The intervention group undertook a Tai-Chi
practice protocol, while a control group
received usual care.
The TC sessions will involve group practice
with instruction given in both verbal and
visual form to demonstrate both the movem
ents and the basic theory behind each actio
n.
Each TC session will consist of 5 minutes of
warm up, 25 minutes of TC practice and 10
minutes of cooling down. The TC will be led
by a skilled instructor who has been practici
ng TC and have TC instructor certificate.

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Tai chi Intervention

TC sessions will take place during 24 weeks
which contact with instructor.
Two time per week and 40 min per time
(warm-up, tai-chi practice and cool down)

28

Data Collection
Baseline data for all participants was
collected by the researcher and the
research assistant employ:
the Hamilton rating scale for anxiety
(HAM-A),
Hamilton rating scale for depression
(HAM-D),
Berg balance scale (BBS) instrument.
Outcome assessment data was
collected at week before 12week, after
12 week and after 24 week.

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Data Analysis
Personal data , HamA, HamD and BBS score
were analysis by descriptive statistics in
frequency, percentage, mean and standard devi
ation
Compare personal data and symptom of
anxiety, depression and balance score will be
analyzed by Chi-square test, fishers exact test.
To compare the different between experimentcontrol and before and after, the student t-test
will be applied

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Data Analysis
To compare the different between
before and after apply tai-chi
program in experiment group by
using pair t-test

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Ethical Consideration
For ethical consideration, the proposal will
be submitted for approval from Golden
Jubilee Medical Center, Mahidol University.
Participants will receive both written and
verbal information before they agreed to
participate.
Informed signed consent
They have to right to refuse to participate in
the study.
Have freedom to withdrawal
Their information will be kept confidentially,
and not used for other purpose.

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Limitation

Due to the limitation of the research

coverage, this study potential to produce
a selection biases because this selection f
ocused on only patient who treated at the
King Chulalongkorn Hospital.

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Expected Benefit & Application

Firstly, the result of this study may help
increasing the well-being those who has a
problem to the Alzheimers. This study ende
avor to benefit elderly persons and elders f
amilies, community, and anyone who has in
terested in the topic.
Secondly, this study may give benefit to the
medical practice, particularly to maintain
the cognitive and physical condition of elde
rly.

34

Research schedule
Months
Activities

from

Trial out technique and intervention

Data collection

Data analysis

Writing research paper and publication

Elaborate

proposal

and

literature

review
Explore site visit for Alzheimer
Tool development
Ethical committee

and

approval

study in mild Alzheimers patients

35

Budget
Description
1

Data Collection and processing

Communication (Telephone, Fax, Internet)

10,000

Stationary (paper, toner,)

10,000

Local Transportation Costs (Taxi, car rent,

messenger)
Sub-total

10,000

Instrument and Equipment

30,000

Fuel and other expenses

3,000
23,000

Expertise Consultation
Questionnaires validity and reliability
Sub-total

30,000

Field survey and Questionnaires Launching

Sub-total

Total Amount (Baht)

15,000
15,000

Productions
Report (Proposal, Progress and Complete paper)

1000

Art work, cover page

3,000

Sub-total

4,000

THANK YOU
FOR YOUR ATTENTION