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Complexity-based measures inform tai chi’s impact on standing postural control in older adults with peripheral neuropathy

Brad Manor123*, Lewis A Lipsitz1234, Peter M Wayne235, C-K Peng236 and Li Li7

Author Affiliations

1 Department of Gerontology, Beth Israel Deaconess Medical Center, 110 Francis Street Suite 1B, Boston, MA, USA

2 Harvard Medical School, Boston, MA, USA

3 Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan

4 Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA

5 Osher Center for Integrative Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

6 Division of Interdisciplinary Medicine and Biotechnology and Margret and H. A. Rey Institute for Nonlinear Dynamics in Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

7 Department of Health & Kinesiology, Georgia Southern University, Statesboro, GA, USA

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BMC Complementary and Alternative Medicine 2013, 13:87  doi:10.1186/1472-6882-13-87

Published: 16 April 2013



Tai Chi training enhances physical function and may reduce falls in older adults with and without balance disorders, yet its effect on postural control as quantified by the magnitude or speed of center-of-pressure (COP) excursions beneath the feet is less clear. We hypothesized that COP metrics derived from complex systems theory may better capture the multi-component stimulus that Tai Chi has on the postural control system, as compared with traditional COP measures.


We performed a secondary analysis of a pilot, non-controlled intervention study that examined the effects of Tai Chi on standing COP dynamics, plantar sensation, and physical function in 25 older adults with peripheral neuropathy. Tai Chi training was based on the Yang style and consisted of three, one-hour group sessions per week for 24 weeks. Standing postural control was assessed with a force platform at baseline, 6, 12, 18, and 24 weeks. The degree of COP complexity, as defined by the presence of fluctuations existing over multiple timescales, was calculated using multiscale entropy analysis. Traditional measures of COP speed and area were also calculated. Foot sole sensation, six-minute walk (6MW) and timed up-and-go (TUG) were also measured at each assessment.


Traditional measures of postural control did not change from baseline. The COP complexity index (mean±SD) increased from baseline (4.1±0.5) to week 6 (4.5±0.4), and from week 6 to week 24 (4.7±0.4) (p=0.02). Increases in COP complexity—from baseline to week 24—correlated with improvements in foot sole sensation (p=0.01), the 6MW (p=0.001) and TUG (p=0.01).


Subjects of the Tai Chi program exhibited increased complexity of standing COP dynamics. These increases were associated with improved plantar sensation and physical function. Although more research is needed, results of this non-controlled pilot study suggest that complexity-based COP measures may inform the study of complex mind-body interventions, like Tai Chi, on postural control in those with peripheral neuropathy or other age-related balance disorders.

Tai Chi; Posture; Sway; Balance; Complexity; Intervention; Neuropathy