Physical Activity Engagement After Tai Ji Quan Intervention Among Older Adults With Mild Cognitive Impairment or Memory Concerns: A Secondary Analysis of a Randomized Clinical Trial

Importance The effect of exercise interventions on increasing and sustaining moderate to vigorous physical activity (MVPA) among older adults with mild cognitive impairment (MCI), who are at heightened risk of dementia, remains unclear. Objective To examine whether participation in a 6-month, supervised, home-based tai ji quan intervention increases MVPA among US community-dwelling older adults at 1 year. Design, Setting, and Participants This study was a secondary analysis of a parallel-group, outcome assessor-blinded, randomized clinical trial conducted virtually at participants' homes. Eligible participants were aged 65 years or older, lived independently, and had a baseline Clinical Dementia Rating (CDR) global score of 0.5 or less. Participants were enrolled between October 1, 2019, and June 30, 2022. Final follow-up occurred in May 2023. Interventions Participants were randomly assigned (1:1:1) to standard tai ji quan, cognitively enhanced tai ji quan, or stretching, and they exercised (via real-time videoconferencing) 1 hour semiweekly for 6 months. Main Outcomes and Measures The primary outcome was self-reported time engaged in MVPA (in minutes per week), assessed with the International Physical Activity Questionnaire at baseline and at 4, 6, and 12 months following randomization. The Physical Activity Guidelines for Americans recommend that older adults achieve at least 150 min/wk of MVPA, and the number of participants meeting this recommendation was also assessed. Analyses followed the intention-to-treat principle. Results Among the 318 participants enrolled, 107 were randomized to standard tai ji quan, 105 to cognitively enhanced tai ji quan, and 106 to stretching. Their mean (SD) age was 76 (5) years, 212 (66.7%) were women, and 247 (77.7%) had a CDR global score of 0.5. A total of 304 participants (95.6%) completed the trial, and 299 (94.0%) had complete data on the primary outcome at the 12-month follow-up. At 12 months, both tai ji quan groups had increased MVPA levels compared with the stretching control group, with mean differences from baseline of 66 min/wk (95% CI, 25-108 min/wk; P = .002) with standard tai ji quan and 65 min/wk (95% CI, 24-108 min/wk; P = .002) with cognitively enhanced tai ji quan. Odds ratios for meeting the recommended amount of MVPA (>= 150 min/wk) were 3.11 (95% CI, 1.75-5.53; P < .001) for the standard tai ji quan group and 3.67 (95% CI, 2.02-6.65; P < .001) for the cognitively enhanced tai ji quan group compared with the stretching group. Conclusion and Relevance In this secondary analysis of a randomized clinical trial involving older adults with MCI or self-reported memory concerns, home-based tai ji quan training (delivered via videoconferencing) increased MVPA 6 months following cessation of the intervention compared with stretching. These findings suggest that tai ji quan may be promoted as an avenue to achieve physical activity guidelines for older adults with MCI or subjective memory concerns.