Disease-matched clinical exercise programs are very important strategies for treating patients with Parkinson disease (PD) (Burini et al., 2006). Traditional rehabilitation interventions have focused on physical and occupational therapy to help maintain a higher functional status (De Goede et al., 2001). Only a few such studies have shown that exercise programs are effective for improving the impaired functions of PDs (Goodwin et al., 2008). Tai chi is a traditional Chinese martial art that involves slow and graceful movements that can improve postural balance, flexibility, and mood (Choi et al., 2013; Fong and Ng, 2006). Recently, Tai chi has been found to exert a positive influence on the clinical treatment of the physical activity, fatigue, and the quality of life of patients with advanced cancer and neurodegenerative disease, as well as elderly people with chronic pain (Lan et al., 1996; Xu et al., 2005; Zhang et al., 2006). Exercise interventions for PDs should include physical and psychological intervention, because most PDs have limited function, general fatigue, depression, and a negative quality of life. The prevalence of depression among PDs ranges from 20% to 70% (Ehrt et al., 2006). A study noted improvement of rigidity and motor function with the use of behavioral therapy for anxiety, and the subjects showed improved emotional states (Carlson, 2005).

The current study is focused on therapeutic Tai chi (TTC) for PDs, which combines deep breathing, meditation, and slow movement with postural stability. The purpose of this study is to investigate the effects of TTC training on improving the functional fitness status and activities of daily living (ADL) of PDs for their health-related quality of life.

In the present study, we investigated the functional fitness and ADL of PDs after they underwent TTC exercise intervention. Physical fitness in our study was evaluated by arm-curl, stand-up and sit-down from a chair, timed up and go, functional reach, sit and reach, stand on foot with eyes opened, and 6-min walk. Arm-curl test results showed that the upper muscle strength was considerably increased after 12 weeks of exercise training. Generally, Tai chi exercise training has been shown to increase upper and lower body muscular strength and improved knee joint proprioception (Tsang and Huichan, 2004). The results of the standing-up and sitting-down test of the lower muscle strength in the CON worsened during the 12-week intervention. TTC training has benefits for lower body strength and postural stability in PDs by acting on a number of knee joint proprioception sensorimotor systems that contribute to postural control (Xu et al., 2005). The timed up and go test showed that the TTC was much faster than the CON, but there was no significant change after the training. It has been reported that PDs have shown increased muscular fatigue and decreased muscular strength, both of which could affect the muscular action required by the timed up and go test. It may be that our version of Tai chi does not improve lower extremity power substantially. The experiments presented here show that the functional forward reach ability in the control group worsened significantly during intervention in comparison with those of the TTC exercise. This result confirms the separate observations of previous investigators (Hong et al., 2000; Lan et al., 2002). Palmer et al. (1986) compared the effects of upper body karate training with those of a United Parkinson’s Foundation stretching program. They reported that the improvements in both groups were similar. Functional improvement occurred in gait, arm tremor, and coordination, but the function of complex arm-trunk movements was decreased. In the present study, whole body stretching was included in the training protocol. The balance ability was assessed by a single leg stance with eyes opened. The present study showed significantly improved balance ability in the TTC. Balance ability is related to the control of the center of gravity within the base of support. Many persons with PD reported impaired balance and falls (Johnell et al., 1992). Koller and Huber (1989) found that the balance impairment in older adults with a longer duration PD does not usually respond to levodopa, a common treatment drug for PD; 38% of the persons with PD experience falls; 13% fall more than once per week; and some studies have reported that PDs fall repeatedly throughout the day. PDs are 5 times more likely than healthy older adults to suffer fall-related injuries, such as hip fractures. Balance capacity and muscle strength are strong risk factors for falling. The present study showed that the PDs who underwent TTC exercise improved their muscle strength and balance capacity, and this will have a positive effect of fall prevention. This improvement, which confirms the separate observations of previous studies, shows that TTC exercise results in better balance capacity, proprioception function, and muscle strength (Canning et al., 1997).

The results of the 6-min walk test did not changed after 12 weeks of TTC exercise. Many of the PDs had poor cardiorespiratory fitness, as evidenced by a lower VO_2max, but there were several subjects with a normal and even an above-normal fitness level. This study has encouraged increasing interest in cardiorespiratory and gait improvement.

ADL problems are common and debilitating symptoms in PDs. It may increase the burden of living with the disease and also negatively affect all occupational and social activities. The ADL is probably the most appropriate health-related quality of life measure and these dimensions have significant and high correlations with the UPDRS. The present study showed improvement of the TCC group. Herlofson and Larsen’s (2003) study showed that the ADL is more related than others with quality of life for PDs. Liu et al. (2005) also showed that Tai chi exercise produce statistically significant improvements in well-being, including significant reductions in mood disturbance, anxiety, stress, tension, depression, anger, fatigue, confusion, and state anxiety.

In conclusion, this study showed that TTC training had good effects on the functional fitness and ADL of PDs. The results suggest that further study of the effects of TTC intervention must be developed in the future.