Fear of Falling: Taijiquan as a Form of Graded in Vivo Exposure Therapy

Shane Kachur, R. Nicholas Carleton, Gordon Asmundson


Falls in the elderly can cause injuries that lead to loss of independence. Loss of postural sway, balance, and slower reaction times are strong predictors of falling (Lajoie & Gallagher, 2004). Traditional exercise programs focus on studying and treating these factors (Tideiksaar, 1997); however, fear of falling – another strong predictor of falls – has received relatively little attention in the treatment literature (Maki et al., 1991). There are indications of a direct link between fear of falling, and actual falls (Myers et al., 1996), and a relationship between fear-related avoidance of activities and falling (Delbaere et al., 2004). Taijiquan, an ancient Chinese martial art turned exercise regimen (Wolf et al., 2001), has been shown to be effective ameliorating fear of falling and traditional antecedents of falling (Tsang et al., 2004). Like graded exposure therapies, Taijiquan practitioners slowly and progressively achieve increasingly difficult postures that simulate potentially fearful situations in a calming environment. Relative to other exercise treatments, such as computerized balance training, education, and graded exercise, Taijiquan has produced significant reductions in fear of falling and in actual falls (McGibbon et al., 2005). Herein the available research on Taijiquan and falls is reviewed to advocate for Taijiquan as a form of graded exposure therapy to reduce fear of falling and falls in seniors. Implications and future research directions will be discussed.


ASMUNDSON, G., NORTON, P., & VLAEYEN, J. (2004). Fear-avoidance models of chronic pain: an overview. En G. Asmundson, J. Vlaeyen, & G. Crombez (Eds.), Understanding and treating fear of pain. New York: Oxford University Press.

BOERSMA, K., LINTON, S., OVERMEER, T., JANSSON, M., VLAEYEN, J., & DE JONG, J. (2002). Lowering fear-avoidance and enhancing function through exposure in vivo: A multiple baseline study across six patients with back pain. Pain, 108, 8-16.

CHAMBERLIN, M., FULWIDER, B., SANDERS, S., & MEDEIROS, J. (2005). Does fear of falling influence spatial and temporal gait parameters in elderly persons. The Journals of Gerontology. Series A, Biological sciences and medical sciences, 60, 1163-1167.

DELBAERE, K., CROMBEZ, G., VANDERSTRAETEN, G., WILLEMS, T., & CAMBIER, D. (2004). Fear-related avoidance of activities, falls, and physical frailty. A prospective community-based cohort study. Age and Ageing, 33, 368-373.

HAAS, C., GREGOR, R., WADDELL, D., OLIVER, A. SMITH, D., FLEMMING, R., & WOLF, S. (2004). The influence of Tai Chi training on the centre of pressure trajectory during gait initiation in older adults. Archives of Physical Medicine and Rehabilitation, 85, 1593-1598.

HADJISTAVROPOLOUS, T., & CARPENTER, M. (2006). Fear of pain and fear of falling in the elderly. Presentación en la Canadian Pain Society 2006 Annual Conference, Edmonton, 14 y 15 de junio. Edmonton, AB.

HONG, J. (2006). Chen style Taijiquan practical method (Z. H. Chen, Trad.). Edmonton, Canada: Hunyuantaiji press.

LAJOIE, Y., & GALAGHER, S. (2003). Predicting falls within the elderly community: of postural sway, reaction time, the Berg balance scale, and the Activities-specific Balance Confidence Scale for comparing fallers and non-fallers. Archives of Physical Medicine and Rehabilitation, 85, 1593-1598.

MAKI, B., HOLLIDAY, P., & TOPPER, A. (1991). Fear of falling and postural performance in the elderly. Journal of Gerontology, 46, 123-131.

MCGIBBON, C., KREBS, D., PARKER, S., SCARBOROUGH, D., WAYNE, P., & WOLF, S. (2005). Tai Chi and vestibular rehabilitation improve vestibulopathic gait via different neuromuscular mechanisms: preliminary report. BMC Neurology, 5, 1471-1483.

MEYERS, A., POWELL, L., MAKI, B., HOLLIDAY, P., BRAWLEY, L., & SHERK, W. (1996). Psychological indicators of balance confidence: Relationship to actual and perceived abilities. Journal of Gerontology, 51, 37-43.

POWELL, L., & MYERS, A. (1995). The activities-specific balance confidence (ABC) scale. Journal of Gerontology, 50, 28-34.

SHUMWAY-COOK, A., GRUBER, W., BALDWIN M., & LIAO, S. (1997). The effect of multidimensional exercises and balance, mobility and fall risk in community-welling older adults. Physical Therapy, 77, 46-57.

TAGGERT, H. (2002). Effects of Tai Chi exercise on balance, functional mobility, and fear of falling among older women. Applied Nursing Research, 15, 235-242.

TIDEIKSAAR, R. (1997). Falling in the old age: Its prevention and management (2nd Ed). New York: Springer.

TINETTI, M., MEDES DE LEON, C., DOUCETTE, J., & BAKER, D. (1994). Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. Journal of Gerontological Medical Science, 49, 140-147.

TINETTI, M., RICHMAN, D., & POWELL, L. (1990). Falls efficacy as a measure of fear of falling. Journal of Gerontological Psychologial Science, 48, 239-243.

TINETTI, M. & WILLIAMS, C. (1997). Falls, injuries due to falls, and the risk of admission to a nursing home. The New England Journal of Medicine, 337, 1279- 1284.

TSANG, W. W., WONG, V. S., FU, S. N., HUI-CHAN, C. W. (2004). Tai Chi improves standing balance control under reduced or conflicting sensory conditions. Archives of Physical Medicine, 85, 129-137.

VLAEYEN, J., DE JONG, J., LEEUW, M., & CROMBEZ, G. (2004). Fear reduction in chronic pain: graded exposure in vivo with behavioral experiments. En G. Asmundson, J. Vlaeyen, & G. Crombez (Eds.), Understanding and treating fear of pain. New York: Oxford University Press.

WAYNE, P., KREBS, D., WOLF, S., GILL-BODY, K., SCARBOROUGH, D., MCGIBBON, C., & KAPTCHUK, T. (2004). Can Tai Chi improve vestibular postural control? Archives of Physical Medicine and Rehabilitation, 85, 142- 152.

WOLF, S., BARNHART, H., KUTNER, N., MCNEELY, E., COOGLER, C., & XU, T. (1996). Reducing frailty and falls in older persons: An investigation of Tai Chi and computerized balance training. Journal of the American Geriatric Society, 44, 889-903.

WOLF, S., COOGLER, C., & XU, T. (1997). Exploring the basis for Tai Chi Chuan as a therapeutic exercise approach. Archives of Physical Medicine and Rehabilitation, 85, 886-892

DOI: http://dx.doi.org/10.18002/rama.v2i2.299


  • There are currently no refbacks.

Copyright (c) 2012 Shane Kachur, R. Nicholas Carleton, Gordon Asmundson

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.


Revista de Artes Marciales Asiáticas - RAMA

I.S.S.N. 2174-0747

Attached to the Department of Physical Education and Sports, University of León (Spain)

Edited by the Publications Office, University of León

Creative Commons License