The ancient art of tai chi, plus a modern twist, may help older adults reverse mild declines in brain power, a new clinical trial reveals. 

Researchers found that tai chi classes helped older adults improve their subtle problems with cognition (memory and thinking skills). It also helped them with a fundamental multitasking skill: walking while your attention is elsewhere.

But while tai chi was effective, a “cognitively enhanced” version that added mental challenges to the mix worked even better, the study found.

Experts called the findings — published Oct. 31 in the Annals of Internal Medicine promising. They support the concept of stimulating seniors’ minds in multiple ways, rather than one.

Tai chi is a traditional Chinese practice that combines slow, graceful movement and physical postures with controlled breathing. It’s performed as a moving meditation, and studies over the years have found that it can help older people improve their balance and lower their risk of falls.

There is also evidence that tai chi can help seniors sharpen their cognition, said Peter Harmer, a researcher on the new trial.

His team wanted to test the effects of adding specific mental challenges to the tai chi practice — based on recent studies suggesting that physical and mental exercise together are better than either alone.

Conventional tai chi classes, like most physical exercise classes, are primarily about “instructor-student response,” said Harmer, a professor emeritus of exercise and health sciences at Willamette University in Salem, Ore.

That approach, he said, may not “maximize” the potential benefits of tai chi.

So his team recruited 318 older adults who were either noticing declines in their memory or had signs of mild cognitive impairment (MCI). MCI refers to problems with memory, judgment and other mental abilities that are not severe — but may, in some cases, progress to dementia.

The participants were randomly assigned to three groups: one that took a standard tai chi class; one that took the cognitively enhanced version; and one that took a class in stretching exercises. All three groups met twice a week for one hour, over six months.

Because the study launched shortly before the pandemic, most of the sessions were shifted from in-person to Zoom. 

People in the enhanced tai chi group were given extra mental challenges during their practice: They sometimes verbally repeated the instructor’s cues as they moved, spelled words as they practiced a particular form, or performed movements on their own, with no cues from the teacher, for instance.

In the end, Harmer’s team found, enhanced tai chi won out. On average, those older folks improved their scores on a standard test of overall cognition by 3.1 points — versus 1.7 points in the standard tai chi group. The stretching group showed no significant change.

Similarly, enhanced tai chi was better when it came to improving seniors’ performance on a “dual-task” walking test. That essentially gauges a person’s walking prowess while the mind is on other things, such as talking on the phone.

That kind of divided attention can become challenging for older adults — and, Harmer said, improving it might reduce their risk of falls.

Dr. Judith Heidebrink, a professor of neurology at the University of Michigan, said the three-point gain in the enhanced tai chi group was “pretty remarkable.”

That’s because the study participants were not substantially impaired to begin with, said Heidebrink, who was not involved in the research.

She said the findings align with the idea that stimulating older adults’ cognitive skills in multiple ways may beat any single route.

At the same time, Heidebrink said, it’s not clear how well the enhanced version could be replicated on a wide scale.

“Could this be standardized and packaged?” Heidebrink said.

In the meantime, she noted, standard tai chi is out there — and this study supports benefits from it.

Dr. Manuel Montero-Odasso is a geriatrician and director of the Gait & Brain Lab at St. Joseph’s Health Care London’s Parkwood Institute, in Ontario, Canada.

He said the improvement in study participants’ dual-task walking could be significant.

“Many activities of daily living that are important to maintaining independence involve doing two or more things at the same time,” said Montero-Odasso, who was not involved in the study.

“These results support the concept that if you improve dual-tasking, you may have better obstacle negotiation and reduce the risk of falls,” he said.

Not everyone, of course, has access to, or wants to do, tai chi.

That’s fine, according to Montero-Odasso.

“Do exercises that you like and enjoy, but that challenge your brain,” he recommended. “Do cognitive activities that challenge you.”

Just doing your usual crossword puzzle may not suffice, according to Montero-Odasso. He said it’s better to learn something new, like a language, or try brain-training exercises designed for boosting cognition.

As for cognitively enhanced tai chi, Harmer said his team plans to provide training in it in the future, to make it more widely available.

More information

The National Council on Aging has advice on getting started with tai chi. 

SOURCES: Peter Harmer, PhD, professor emeritus, exercise and health sciences, Willamette University, Salem, Ore.; Judith Heidebrink, MD, MS, professor, neurology, clinical core co-leader, Michigan Alzheimer’s Disease Research Center, University of Michigan, Ann Arbor; Manuel Montero-Odasso, MD, PhD, geriatrician, director, Gait & Brain Lab, Parkwood Institute, St. Joseph’s Health Care London, professor, medicine, Schulich School of Medicine and Dentistry at Western University, London, Ontario, Canada; Annals of Internal Medicine, Oct. 31, 2023, online