Efficacy of Ba Duan Jin in Improving

Balance
A Study in Chinese Community-Dwelling Older Adults
ABSTRACT Exercise programs emphasizing
The current quasiexperimental study was intended to determine the efficacy of balance training have been shown
Ba Duan Jin (translation: eight-section brocade) in improving balance ability of Chi-
to reduce the rate of falls and risk
of falling among older adults (Gil-
nese community-dwelling older adults. The trial group (n = 47) engaged in a Ba Duan
lespie et al., 2012; Sherrington et al.,
Jin exercise program for 12 weeks, whereas the control group (n = 48) participated in a 2008). Therefore, exercises that con-
12-week walking exercise program. After the intervention, participants’ balance ability centrate on balance training may be
was evaluated using the Timed Up and Go Test (TUGT), One Leg Standing Test (OLST), effective in preventing falls in older
Berg Balance Scale (BBS), and Modified Falls Efficacy Scale (MFES). Ba Duan Jin was associ- adults.
ated with increased TUGT and OLST scores at Week 6 with continuous increases reported
Qigong is a combination of pos-
tures, meditation, and movements
through Week 12. Ba Duan Jin was also associated with increased BBS and MFES scores at
designed to improve holistic health
Week 12. Ba Duan Jin may be an effective means for improving balance ability in Chinese and facilitate mind–body integration
community-dwelling older adults. [Journal of Gerontological Nursing, 42(5), 38-46.] (Jones, 2001; McCaffrey & Fowler,
2003). In traditional Chinese medi-
cine, “Qi” is the most basic ele-

F
alls are defined as unexpected
events in which individuals
come to rest on the ground,
floor, or a lower level (Lamb, Jørstad-
Stein, Hauer, & Becker, 2005). Risk
factors vary and are both intrinsic
and extrinsic. Aging affects the cen-
tral nervous system (i.e., changes in
brain volume) and neuromuscular
system properties (i.e., loss of sen-
sory and motor neurons), leading
to reductions in balance and gait
performance (Granacher, Muehl-
bauer, & Gruber, 2012). Balance re-
fers to the body’s coordination ca-
pacity from the vestibular organs,
somatosensory and visual stimuli,
and proprioception, as well as the
skin and joints (Howe, Rochester,
Neil, Skelton, & Ballinger, 2011).
Balance is both dynamic and static
(Pollock, Durward, Rowe, & Paul,
2000; Yan & Dou, 1999). Static bal-
ance is a relatively quiescent state
of controlling the center of grav-
ity, whereas dynamic balance is the
ability to control the body’s center
gravity and adjust posture dur-
ing movement. Reduction in bal-
ance ability leads to increased risk
of falls in older adults. A system-
atic review by Balzer, Bremer, Sch-
ramm, Lühmann, and Raspe (2012)
showed that multidimensional and
long-term exercise programs can
be effective for fall prevention.
ment, constituting the human body
and maintaining life activities. The
movement of Qi throughout the
entire body regulates physiological
function (Chi, 2012). Qigong Ba
Duan Jin (Ba Duan Jin, transla-
tion: eight-section brocade) is an
ancient Chinese health gymnastics
technique. Ba Duan Jin has eight
combinations of different body
movements, therefore named Ba
Duan Jin. Ba means eight, Duan
means section, and Jin means bro-
cade (i.e., symbolic of something
luxurious). Historical records show
Ba Duan Jin has been practiced
for more than 800 years. Ba Duan
Jin is designed in accordance with

Xiao-yun Liu, RN; Jing Gao, RN; Bing-xiang Yin, MS; Xiang-yu Yang, RN; and Ding-xi Bai, RN

© 2016 Liu, Gao, Yin, et al.; licensee SLACK Incorporated. This is an Open Access article distributed under the terms of the
Creative Commons Attribution-NonCommercial 4.0 International (http://creativecommons.org/licenses/by-nc/4.0). This
license allows users to copy and distribute, to remix, transform, and build upon the article non-commercially, provided the
author is attributed and the new work is non-commercial.

38

the theory of the laws of motion
and holism (i.e., the human body
is regarded as an organic whole) to
facilitate integrated Qi movements,
and it reflects the theory of tradi-
tional Chinese medicine and health
concepts.
Ba Duan Jin is a low-intensity
aerobic exercise. A complete set
comprises eight postures (Figure)
in addition to beginning and
ending movements. Ba Duan Jin
protocol for the current study fol-
lows the General Administration
of Sport of China (2003), which is
the most popular style. A Ba Duan
Jin exercise program typically in-
cludes three phases: (a) warm-up
preparation (1 minute); (b) set of
eight movements performed three
times (approximately 30 min-
utes); and (c) relaxation and cool
Journal of Gerontological Nursing • Vol. 42, No. 5, 2016
down (2 minutes). The practice
methods of Ba Duan Jin include
three regulations: (a) body focus,
(b) mind focus, and (c) breath focus.
The slow, gentle, graceful move-
ments of Ba Duan Jin, combined
with meditation, deep breathing,
and relaxation, move Qi through-
out the body. Current studies have
suggested that Ba Duan Jin training
appears to have substantive benefits
for older adults with physical and
mental disorders, such as anxiety,
depression, hyperlipidemia, spi-
nal problems, osteoarthrosis, and
type 2 diabetes (An et al., 2013;
Hsu, Wang, Liu, & Liu, 2008; Mei,
Chen, Ge, Zheng, & Chen, 2012).
Ba Duan Jin has several health ef-
fects, and the levels of exercise
intensity and simplicity of move-
ments make it suitable for practice
© 2016 Shutterstock.com/KPG Payless2
among older adults. The purpose of
the current study was to assess the
efficacy of Ba Duan Jin in improv-
ing the balance ability of Chinese
community-dwelling older adults.
METHOD
Design
A quasiexperimental, untreated
control group design was used.
The study was conducted from
February through June 2013. One
hundred eight voluntary partici-
pants were screened in one com-
munity of the Long Quan Yi Dis-
trict, Chengdu City, China. To
avoid contamination between the
trial and control groups, 54 par-
ticipants in the trial group were
selected from east of the commu-
nity and were assigned to practice
Ba Duan Jin. The control group
39
Figure. Ba Duan Jin exercise program. (A) Prop up the sky with hands to regulate the triple energizer. (B) Draw a bow on both sides,
like shooting a vulture. (C) Raise single arm to regulate spleen (Pi) and stomach (Wei). (D) Look back to treat five strains and seven
impairments. (E) Sway head and buttocks to expel heart (Xin)-fire. (F) Pull toes with both hands to reinforce the kidney (Shen) and
waist. (G) Clench fists and look with eyes wide open to enhance strength and stamina. (H) Rise and fall on tip toes to prevent all
diseases.

comprised 54 participants from
west of the community and were
assigned to practice walking. Both
groups practiced for 12 weeks. The
same health education was given to
both groups at Weeks 1, 4, 8, and
12. Data were collected at baseline
and Weeks 6 and 12.
Participants
Sample size was determined
based on an alpha level of 0.05, with
a type I error of 5% (alpha = 0.05)
and 90% power (alpha = 0.10).
The required minimum sample
for the current study was 48 par-
ticipants for each group. Assuming
an attrition rate of 10%, 54 par-
ticipants were recruited for each
group, thus a total of 108 partici-
pants were included. Participant
inclusion criteria were: age 60 or
older; ability to participate in phys-
ical exercise; and chronic disease in
a stable state (e.g., diabetes, hyper-
tension stabilized by medication).
Exclusion criteria were participa-
tion in other sports (e.g., Tai Chi,
Wu Qin Xi, ballroom dancing) and
illness/disease that cannot tolerate
physical activity.
After screening, selected par-
ticipants gave their agreement to
take part in the study by signing
appropriate consent forms. In the
trial group, during the interven-
tion, three participants dropped
out due to travel out of Chengdu
City and four withdrew due to
hospitalization. Therefore, a total
of 47 trial group participants com-
pleted the study. In the control
group, two participants withdrew
because of leg pain and four par-
ticipants switched to other physical
activities, thus 48 participants com-
pleted the study. The final sample
comprised 95 participants.
Intervention
The intervention team included
a coach, community director, re-
searcher, and graduate students.
The coach, a professional teacher
for the traditional health move-
ment, gave a lecture about Ba Duan
Jin to the trial group prior to the in-
tervention. Results were collected
and evaluated by the researcher
and four graduate students at the
completion of the study.
Trial group participants (Ba
Duan Jin) were given four les-

40
sons by the researcher on how to
prevent falls, diabetes mellitus,
and hypertension, and keeping a
healthy diet, each lesson lasting
40 minutes. The actual intervention
itself was divided into two phases,
preintervention (2 weeks) and in-
tervention. In the first preinterven-
tion session, the coach explained
the theory of Ba Duan Jin and
provided participants with printed
materials on principles and tech-
niques. In the subsequent sessions,
the coach instructed Ba Duan Jin
movement two times per week for
Ba Duan Jin has several health effects, and the
levels of exercise intensity and simplicity of
movements make it suitable for practice among
older adults.
2 weeks with a practice time of 30
to 40 minutes, and the remaining
time was self-practice for 30 to 40
minutes daily at home following an
instructional DVD. The coach was
later responsible for correcting the
movement in class.
In the intervention phase
(12 weeks), participants practiced
together for 30 to 40 minutes each
day in teams. Participants were re-
quired to master Ba Duan Jin move-
ments and strive to master breath-
ing techniques while, at the same
time, develop or strengthen styles
to improve balance. Examples of
these techniques would be the sec-
ond pose (B), “Draw a bow on both
sides, like shooting a vulture”; the
fifth pose (E), “Sway head and but-
tocks to expel heart (Xin)-fire”;
and eighth pose (H), “Rise and fall
on tip toes to prevent all diseases”
(Figure). Safety instructions were
given prior to the intervention,
such as wearing loose clothing and
soft shoes. Each session of Ba Duan
Jin included a warm-up at the be-
ginning and self-relaxation at the
end of movement to reduce risks
Journal of Gerontological Nursing • Vol. 42, No. 5, 2016
of injury. After completion of the
12-week intervention phase, partic-
ipants were encouraged to maintain
their Ba Duan Jin group practice.
The intervention for the control/
walking group included the same
wellness education as the trial/Ba
Duan Jin group. The control group
walked for 40 to 60 minutes per day
for 12 weeks. Participants were in-
structed not to participate in other
forms of physical activity to ensure
the comparability of results. Spe-
cific requirements were: daily 40 to
60 minutes of medium-speed walk-
ing, twice per week team sessions,
and self-practice at other times; ap-
propriate speed was 80 to 90 steps
per minute, or the ability to talk
while walking. Participants were
instructed to dress in loose cloth-
ing, wear soft flat shoes, and walk
in open areas without barriers.
Outcome Measures and Follow Up
Participant characteristics and
socioeconomic data were collected.
Timed Up and Go Test (TUGT;
Podsiadlo & Richardson, 1991), One
Leg Standing Test (OLST; Vellas et
al., 1997), Berg Balance Scale (BBS;
Bogle, Thorbahn, & Newton, 1996),
and Modified Falls Efficacy Scale
(MFES; Yardley et al., 2005) were
performed before the intervention.
Timed Up and Go Test. The
TUGT is a simple, practical, and
reliable potential balance ability
test, which takes 1 to 2 minutes to
complete. This test has shown ex-
cellent test/retest reliability (intra-
class correlation coefficient [ICC]
= 0.99) in older adults (Okumiya et
al., 1998; Podsiadlo & Richardson,
1991). A completion time ranging
between 20 and 29 seconds indi-
cates a need for additional testing
to assess functional activity level.
A time >14 seconds to complete
the test indicates high risk for falls
(Shumway-Cook, Brauer, & Wool-
lacott, 2000). Reports have shown
that the TUGT and BBS have a
good correlation (r = –0.72) (Man-
cini & Horak, 2010).
One Leg Standing Test. The
OLST (with eyes closed) is com-
monly used for balance assessment
of postural stability. The OLST can
be used as a predictor of injurious
falls (Vellas et al., 1997). The OLST
may also prove to be valuable in
the assessment of hip fracture risk
(Lundin et al., 2014). Participants
are instructed to put their hands
on their hips, close their eyes,
and stand on their dominant foot,
with the other foot off the ground.
Times are recorded for the duration
that the position is held. The OLST
is considered to be potentially use-
ful in predicting functional decline
and is a marker of frailty (Drusini
et al., 2002; Hiroyuki, Uchiyama,
& Kakurai, 2003).
Berg Balance Scale. The BBS is
used mainly to determine risk fac-
tors for loss of independence and
falls by older adults. The scale as-
sesses balance in 14 activities of
daily living (ADLs). Each item
is graded on a Likert scale, rang-
ing from 0 to 4 points, with higher
scores indicating higher risk for falls
(maximum score = 56 points). The
BBS takes approximately 10 to 15
minutes to complete. Bogle Thor-
bahn and Newton (1996) reported
that the BBS has strong interrater
reliability (rs= 0.88), with a cutoff
score of 45 indicating high fall risk.
The BBS was tested in a Chinese
population, resulting in Cronbach’s
alpha of 0.864 and a split-half reli-
ability coefficient of 0.915 (Weng,
Wang, & Wang, 2007).
Modified Falls Efficacy Scale. The
MFES is modified from the Falls Ef-
ficacy Scale (FES), which includes
14 items plus four outdoor activ-
41
 t tests were used to compare differ-
TABLE 1 ences in participant characteristics
STUDY PARTICIPANT DEMOGRAPHICS (N = 95) and socioeconomic status between
the two groups. A group t test
Control Trial was used to compare data between
Group Group t Test/ groups. For data collected at differ-
(n = 48) (n = 47) Chi-Square ent time points, repeated measures
Variable n (%) n (%) Test p Value analysis of variance (ANOVA) was
Gender 0.203a 0.802 used to compare between-group
Female 37 (77.1) 38 (80.9) and within-group differences. The
significance level was alpha = 0.05.
Male 11 (22.9) 9 (19.1)
Education 0.386a 0.575 RESULTS
Middle school or less 42 (87.5) 39 (83) Preliminary analysis was con-
ducted to assess the equivalence be-
High school 6 (12.5) 8 (17) tween the trial and control groups
Employment 0.674a 0.425 in regard to all participant charac-
teristics and socioeconomic status.
Military factory worker 40 (83.3) 36 (76.6)
No significant differences were
Teacher/technician 8 (16.7) 11 (23.4) found between groups (Table 1).
Marital status 1.036a 0.486c Differences were noted between
the trial and control groups in
Married 42 (87.5) 44 (93.6) regard to the TUGT and OLST
Single 6 (12.5) 3 (6.4) (Table 2). The average time of the
Monthly income (RMB Yuan) 9.000a 0.061c
TUGT among trial group partici-
pants was significantly lower than
<1,000 3 (6.25) 2 (4.3) that of the control group at Weeks
1,000 to 3,000 42 (87.5) 41 (87.2) 6 and 12. The average time of the
OLST among trial group par-
>3,000 3 (6.3) 4 (8.5)
ticipants was significantly higher
Age (mean, SD) (years) 66.63 (5.98) 67.1 (6.18) 0.916b 0.362 than that of the control group at
Weeks 6 and 12. Repeated mea-
a
sures ANOVA showed statistically
Chi-square test.
b
t test. significant group and time effects
c
Fisher’s exact test. (Table 3).
TUGT and OLST times were
also compared between baseline and
Week 6 and baseline and Week 12
ity items. Internal validity (Cron- Data Collection Procedures within both groups (Table 2). In the
bach’s alpha = 0.96) and test–retest Baseline data for the trial group trial group, TUGT times at Weeks 6
reliability (ICC = 0.96) have been were collected before commence- and 12 were both significantly lower
shown to be excellent (Yardley et al., ment of the Ba Duan Jin exercise. than those at baseline. OLST times
2005). The MFES is used to measure Baseline data for the control group at Weeks 6 and 12 were both signifi-
the capacity of older adults to com- were collected before initiation of cantly higher than those at baseline.
plete assigned activities without loss the walking regimen. Participants In the control group, TUGT time at
of balance confidence. Each item performed the TUGT and OLST Week 6 was only slightly lower than
is graded on a Likert scale, ranging at baseline and Weeks 6 and 12 af- baseline (p = 0.046), but significantly
from 0 (no confidence) to 10 (full ter the intervention. The BBS and lower than times at baseline and
confidence) points. The MFES has MFES were performed at baseline Week 12 (p < 0.001). OLST times be-
been translated into Chinese and and Week 12 after the intervention. tween baseline and Week 6 showed
its reliability and validity have been no significant difference. However,
tested in hospitals and communities Data Analysis the OLST time at Week 12 was sig-
(Cronbach’s alpha = 0.9774; content Study data were analyzed using nificantly lower than baseline.
validity ICC = 0.637 to 0.926 [Hao SPSS (version 19). Chi-square tests, After the intervention, between-
& Liu, 2007]). Fisher’s exact tests, and independent group comparison showed that the

42
 TABLE 2
TIMED UP AND GO TEST (TUGT) AND ONE LEG STANDING TEST (OLST) COMPARISON (N = 95)
Week 6 vs. Week 12 vs.
Baseline Baseline
Test/Group Baseline Week 6 Week 12 (p Value) (p Value)
TUGT
Trial 9.15 (1.876) 7.91 (1.641) 7.127 (1.261) 0.561 (<0.001*) 0.877 (<0.001*)
Control 9.48 (1.902) 8.92 (1.456) 8.625 (1.393) 0.830 (0.046*) 2.043 (<0.001*)
t test (p value) 0.852 (0.397) 3.015 (0.003*) 5.487(<0.001*)
OLST
Trial 4 (2.313) 4.89 (2.672) 6.17 (2.995) 0.634 (<0.001*) 1.314 (<0.001*)
Control 3.5 (1.786) 3.88 (1.77) 3.958 (1.867) 0.809 (0.085) 2.479 (<0.001*)
t test (p value) –1.181 (0.241) –2.195 (0.031*) –4.329 (<0.001*)

*p < 0.05.

trial group scores for the BBS and

MFES were significantly higher than
the control group scores (Table 4).
DISCUSSION
With an increasingly growing ag-
ing society, falls in older adults have
become a serious public health prob-
lem. It was reported that more than
one third of older adults fall at least
once per year and more than one half
of those falls lead to injury (Rose &
Hernandez, 2010). Falls may lead to
serious injuries, such as fractures,
brain damage, and even death, with
approximately 95% of hip fractures
in older adults due to falls and more
than 20% of cases leading to death
(Ioannidi et al., 2009; Wolinsky et
al., 2009). In the United States, falls
are the leading cause of traumatic
brain injury in individuals older than
65 and are associated with the rise
of Medicare costs (Murphy, Baker,
Leo-Summers, & Tinetti, 2014;
Thompson, McCormick, & Kagan,
2006). Exercise or physical therapy
is recommended by the U.S. Preven-
tive Services Task Force to prevent
falls in community-dwelling adults
65 or older who are at increased risk
of falls (Croswell & Shin, 2012).
TABLE 3
REPEATED MEASURES ANALYSIS OF VARIANCE OF THE TIMED UP
AND GO TEST (TUGT) AND ONE LEG STANDING TEST (OLST) (N = 95)
Time Effects
Variable F P
TUGT 85.218 <0.001 *
OLST 43.432 <0.001*
*
p < 0.05.
Ba Duan Jin is a traditional Chi-
nese exercise. It is a highly popular
practice, particularly in China, for
health maintenance, healing, and
increasing vitality (Chen, 2007).
Ba Duan Jin exercise is thought to
comprise a state that activates the
natural self-regulation capacity and
stimulates the balanced release of
endogenous neurohormones and
a wide array of natural health re-
covery mechanisms (Jahnke, Lar-
key, Rogers, Etnier, & Lin, 2010).
Several studies have shown that Ba
Duan Jin exercise can prevent bone
loss and improve the quality of life
for middle-aged women (Chen,
Group Effects Cross Effects
F P F P
9.355 0.003 *
13.844 <0.001*
8.051 0.003* 19.363 <0.001*
Yeh, & Lee, 2006; Hsu et al., 2008).
Ba Duan Jin has been shown to en-
hance sleep quality in older adults
(Chen, Liu, Huang, & Chiou,
2012), as well as alleviate symp-
toms of knee osteoarthritis (An et
al., 2008). Systematic reviews have
shown Ba Duan Jin can decrease
plasma total cholesterol, triglycer-
ides, and low-density lipoprotein-
C levels and increase plasma high-
density lipoprotein-C levels (Mei
et al., 2012). However, there is cur-
rently insufficient evidence to sup-
port Ba Duan Jin as an exercise to
improve the balance ability of older
adults.

Journal of Gerontological Nursing • Vol. 42, No. 5, 2016 43

 TABLE 4
COMPARISON OF THE BERG BALANCE SCALE (BBS) AND MODIFIED FALLS EFFICACY SCALE (MFES)
SCORES BETWEEN GROUPS (N = 95)
BBS MFES
Time Group (Mean, SD) t Test p Value (Mean, SD) t Test p Value
Baseline Trial 51.19 (4.2) 0.642 0.522 126.32 –1.079 0.283
(15.679)
Control 51.77 (4.581) 122.96
(14.665)
Week 12 Trial 53.57 (2.676) –2.456 0.016* 132.26 –3.215 0.022*
(12.761)
Control 51.81 (4.144) 123.38 (14.11)

*
p < 0.05.

The current study findings show
that after Ba Duan Jin intervention,
dynamic balance (TUGT) and stat-
ic balance (OLST) were improved
at Weeks 6 and 12, indicating par-
ticipants were experiencing con-
tinuously positive effects. BBS and
MFES scores significantly increased
after the 12-week intervention. BBS
scores reflected the balance abil-
ity and its changes in older adults,
whereas MFES scores involved con-
fidence of maintaining balance in
ADLs in older adults. The increases
of BBS and MFES scores suggest that
Ba Duan Jin exercise is better than
walking in improving balance abil-
ity and self-efficacy of older adults.
A Korean study showed that exer-
cise can prevent falls and appropri-
ate exercise can effectively improve
falls efficacy of older adults (Liu &
So, 2008); the current study’s results
support these findings. Ba Duan Jin
draws on natural forces to optimize
and balance energy within through
the purposeful coordination of
body, breath, and mind (Koh, 1982).
The effects of Ba Duan Jin on bal-
ance ability may be associated with
strengthening body postures, espe-
cially those used in postures B, E,
and H (Figure). Therefore, results of
the current study provide evidence
about the effectiveness of Ba Duan
Jin in improving balance ability of
older adults.
LIMITATIONS
Some limitations should be ac-
knowledged. Participants were
mostly young-old adults (age 60 to
75 years), with mean ages of 67.1
(SD = 6.18) and 66.63 (SD = 5.98) in
the trial and control groups, respec-
tively; thus, results may be preju-
diced by participants’ ages. The
incidence of falls in the older-old
population (age >75 years) is high,
with studies reporting that the rate
of falls and associated complications
is more than 45% in these individu-
als (Rubenstein, 2006). Thus, falls
prevention is a vital part of commu-
nity care. To understand the effects
of Ba Duan Jin on balance ability
in older-old adults, a repeat study
should be done in this population.
In the future, to support the cur-
rent study findings, the Ba Duan Jin
technique merits longer-term stud-
ies with expanded sample sizes and
increased balance function test tools
in different communities and dif-
ferent population age groups (e.g.,
Western older adult populations).
CONCLUSION
Ba Duan Jin was associated
with increased TUGT and OLST
times at Week 6 with continuous
increases through Week 12. Ba
Duan Jin was also associated with
improved BBS and MFES scores at
Week 12. Results indicate that Ba
Duan Jin, which may be a cultur-
ally preferable exercise for Chinese
community-dwelling older adults,
can be used to improve the bal-
ance ability of this population and
consequently prevent falls and
falls-induced injuries. Findings
from the current study provide a
basis for further development of
community-based exercise pro-
grams for prevention of falls in
older adults.
REFERENCES
An, B., Dai, K., Zhu, Z., Wang, Y., Hao,
Y., Tang, T., & Yan, H. (2008). Baduan-
jin alleviates the symptoms of knee os-
teoarthritis. Journal of Alternative and
Complementary Medicine, 14, 167-174.
doi:10.1089/acm.2007.0600
An, B.C., Wang, Y., Jiang, X., Lu, H.S.,
Fang, Z.Y., Wang, Y., & Dai, K.R.
(2013). Effects of Ba Duan Jin exer-
cise on knee osteoarthritis: A one-year
study. Chinese Journal of Integrative
Medicine, 19, 143-148.
Balzer, K., Bremer, M., Schramm, S., Lüh-
mann, D., & Raspe, H. (2012). Falls
prevention for the elderly. GMS Health
Technology Assessment, 8, Doc01.
doi:10.3205/hta000099
Bogle Thorbahn, L.D., & Newton, R.A.
(1996). Use of the Berg Balance Test to

44
 predict falls in elderly persons. Physical
Therapy, 76, 576-583.
Chen, H.H., Yeh, M.L., & Lee, F.Y. (2006).
The effects of Baduanjin qigong in the
prevention of bone loss for middle-aged
women. American Journal of Chinese
Keypoints
Liu, X.-Y., Gao, J., Yin, B.-X., Yang, X.-Y., & Bai, D.-X. (2016). Efficacy of Ba Duan Jin in Improving
Balance: A Study in Chinese Community-Dwelling Older Adults. Journal of Gerontological
Nursing, 42(5), 38-46.

1
Medicine, 34, 741-747.
Chen, K. (2007). Qigong therapy for stress Qigong Ba Duan Jin is an ancient Chinese health gymnastics
management. In P.M. Lehrer, R.L. Wool- technique that is simple and low in exercise intensity and has several
folk, & W.E. Sine (Eds.), Principles and
proven health effects.
practice of stress management (pp. 428-

2
448). New York, NY: Guilford Press.
Chen, M.C., Liu, H.E., Huang, H.Y., & Ba Duan Jin was used in a sample of Chinese community-dwelling
Chiou, A.F. (2012). The effect of a older adults to assess its efficacy in improving balance ability in this
simple traditional exercise program population.
(Baduanjin exercise) on sleep quality of
older adults: A randomized controlled
trial. International Journal of Nurs-
ing Studies, 49, 265-273. doi:10.1016/j.
ijnurstu.2011.09.009
3 Participants were divided into two groups, with the trial group
performing Ba Duan Jin and the control group performing walking
exercise for 12 weeks.

4
Chi, J.H. (2012). Basic theory of TCM. In
Q. Sun (Ed.), TCM nursing (3rd ed., p. At Week 12, Ba Duan Jin was shown to be an effective means for
35). Beijing, China: People’s Medical improving balance ability in Chinese community-dwelling older
Publishing House. adults, with increased times and scores in the Timed Up and Go
Croswell, J., & Shin, Y.R. (2012). Preven-
Test, One Leg Standing Test, Berg Balance Scale, and Modified Falls
tion of falls in community-dwelling
older adults: Recommendation state- Efficacy Scale.
ment. American Family Physician, 86,
1135-1136.
older people. Cochrane Database Liu, M., & So, H. (2008). Effects of Tai Chi
Drusini, A.G., Eleazer, G.P., Caiazzo, M.,
of Systematic Reviews, CD004963. exercise program on physical fitness, fall
Veronese, E., Carrara, N., Ranzato,
doi:10.1002/14651858.CD004963.pub3 related perception and health status in
C.,…Wieland, D. (2002). One-leg stand-
Hsu, M.C., Wang, T.S., Liu, Y.P., & Liu, C.F. institutionalized elders [article in Ko-
ing balance and functional status in an
(2008). Effects of Baduanjin exercise on rean]. Taehan Kanho Hakhoe Chi, 38,
elderly community-dwelling population
oxidative stress and antioxidant status 620-628.
in northeast Italy. Aging Clinical and
and improving quality of life among Lundin, H., Sääf, M., Strender, L.E., Nyren,
Experimental Research, 14, 42-46.
middle-aged women. American Journal S., Johansson, S.E., & Salminen, H.
General Administration of Sport of Chi-
of Chinese Medicine, 36, 815-826. (2014). One-leg standing time and hip-
na. (2003). Qigong–Baduanjin. Bei-
Ioannidis, G., Papaioannou, A., Hop- fracture prediction. Osteoporosis Inter-
jing, China: People’s Sports Publishing
man, W.M., Akhtar-Danesh, N., Anas- national, 25, 1305-1311. doi:10.1007/
House of China.
tassiades, T., Pickard, L.,…Adachi, J.D. s00198-013-2593-1
Gillespie, L.D., Robertson, M.C., Gillespie,
(2009). Relation between fractures and Mancini, M., & Horak, F.B. (2010). The
W.J., Sherrington, C., Gates, S., Clem-
mortality: Results from the Canadian relevance of clinical balance assessment
son, L.M., & Lamb, S.E. (2012). Inter-
Multicentre Osteoporosis Study. Cana- tools to differentiate balance deficits.
ventions for preventing falls in older
dian Medical Association Journal, 181, European Journal of Physical and Reha-
people living in the community. Co-
265-271. doi:10.1503/cmaj.081720 bilitation Medicine, 46, 239-248.
chrane Database of Systematic Reviews,
Jahnke, R., Larkey, L., Rogers, C., Etnier, McCaffrey, R., & Fowler, N.L. (2003). Qi-
9, CD007146. doi:10.1002/14651858.
J., & Lin, F. (2010). A comprehensive gong practice: A pathway to health and
CD007146.pub3
review of health benefits of qigong and healing. Holistic Nursing Practice, 17,
Granacher, U., Muehlbauer, T., & Gru-
tai chi. American Journal of Health 110-116.
ber, M.A. (2012). Qualitative review of
Promotion, 24, e1-e25. doi:10.4278/ Mei, L., Chen, Q., Ge, L., Zheng, G., &
balance and strength performance in
ajhp.081013-LIT-248 Chen, J. (2012). Systematic review of
healthy older adults: Impact for testing
Jones, B.M. (2001). Changes in cytokine Chinese traditional exercise baduanjin
and training. Journal of Aging Research,
production in healthy subjects practic- modulating the blood lipid metabolism.
2012, 708905. doi:10.1155/2012/708905
ing Guolin Qigong: A pilot study. BMC Evidence-Based Complementary and
Hao, Y., & Liu, X. (2007). The test research
Complementary and Alternative Medi- Alternative Medicine, 2012, 282131.
of modified falls efficacy scale in Chi-
cine, 1, 8. doi:10.1155/2012/282131
nese elders. Journal of Chinese Nursing,
Koh, T.C. (1982). Baduanjin—An ancient Murphy, T.E., Baker, D.I., Leo-Summers,
42, 19-21.
Chinese exercise. American Journal of L.S., & Tinetti, M.E. (2014). Trends
Hiroyuki, S., Uchiyama, Y., & Kakurai,
Chinese Medicine, 10, 14-21. in fall-related traumatic brain injury
S. (2003). Specific effects of balance
Lamb, S.E., Jørstad-Stein, E.C., Hauer, K., among older persons in Connecticut
and gait exercises on physical function
& Becker, C. (2005). Development of a from 2000–2007. Journal of Gerontol-
among the frail elderly. Clinical Reha-
common outcome data set for fall injury ogy and Geriatric Research, 3, 1-11.
bilitation, 17, 472-479.
prevention trials: The Prevention of doi:10.4172/2167-7182.1000168
Howe, T.E., Rochester, L., Neil, F., Skel-
Falls Network Europe consensus. Jour- Okumiya, K., Matsubayashi, K., Naka-
ton, D.A., & Ballinger, C. (2011).
nal of the American Geriatrics Society, mura, T., Fujisawa, M., Osaki, Y., Doi,
Exercise for improving balance in
53, 1618-1622. Y., & Ozawa, T. (1998). The timed “up

Journal of Gerontological Nursing • Vol. 42, No. 5, 2016 45

 & go” test is a useful predictor of falls
in community-dwelling older people.
Journal of the American Geriatrics Soci-
ety, 46, 928-930.
Podsiadlo, D., & Richardson, S. (1991). The
Timed Up and Go: A test of basic func-
tional mobility for frail elderly persons.
Journal of the American Geriatrics Soci-
ety, 39, 142-148.
Pollock, A.S., Durward, B.R., Rowe, P.J., &
Paul, J.P. (2000). What is balance? Clini-
cal Rehabilitation, 14, 402-406.
Rose, D.J., & Hernandez, D. (2010).
The role of exercise in fall prevention
for older adults. Clinics in Geriatric
Medicine, 26, 607-631. doi:10.1016/j.
cger.2010.07.003
Rubenstein, L.Z. (2006). Falls in older
people: Epidemiology, risk factors and
strategies for prevention. Age and Age-
ing, 35(Suppl. 2), ii37-ii41.
Sherrington, C., Whitney, J.C., Lord, S.R.,
Herbert, R.D., Cumming, R.G., & Close,
J.C. (2008) Effective exercise for the
prevention of falls: A systematic review
and meta-analysis. Journal of the Amer-
ican Geriatrics Society, 56, 2234-2243.
doi:10.1111/j.1532-5415.2008.02014.x
Shumway-Cook, A., Brauer, S., & Wool-
lacott, M. (2000). Predicting the prob-
ability for falls in community-dwelling
older adults using the Timed Up & Go
Test. Physical Therapy, 80, 896-903.
Thompson, H.J., McCormick, W.C., &
Kagan, S.H. (2006). Traumatic brain in-
jury in older adults: Epidemiology, out-
comes, and future implications. Journal
46
of the American Geriatrics Society, 54,
1590-1595.
Vellas, B.J., Wayne, S.J., Romero, L.,
Baumgartner, R.N., Rubenstein, L.Z., &
Garry, P.J. (1997). One-leg balance is an
important predictor of injurious falls in
older persons. Journal of the American
Geriatrics Society, 45, 735-738.
Weng, C., Wang, J., & Wang, G. (2007). The
internal reliability and concurrent valid-
ity of Berg Balance Scale in stroke pa-
tients. Chinese Journal of Rehabilitation
Medicine, 22, 688-717.
Wolinsky, F.D., Bentler, S.E., Liu, L., Ob-
rizan, M., Cook, E.A., Wright, K.B.,…
Wallace, R.B. (2009). Recent hospi-
talization and the risk of hip fracture
among older Americans. Journals of
Gerontology. Series A, Biological Sci-
ences and Medical Sciences, 64, 249-255.
doi:10.1093/gerona/gln027
Yan, T., & Dou, Z. (1999). Practical paraly-
sis rehabilitation. Beijing, China: Peo-
ple’s Health Publishing House.
Yardley, L., Beyer, N., Hauer, K., Kempen,
G., Piot-Ziegler, C., & Todd, C. (2005).
Development and initial validation of
the Falls Efficacy Scale-International
(FES-I). Age and Ageing, 34, 614-619.
ABOUT THE AUTHORS
Ms. Liu is Lecturer, College of
Medicine (Nursing), Chengdu Uni-
versity; Ms. Gao is Professor, Ms. Yang
is Associate Professor, and Ms. Bai is
Teaching Assistant, College of Nurs-
ing, Chengdu University of Tradition-
al Chinese Medicine; and Mr. Yin is
Resident Physician, Hospital affiliated
with Chengdu University of Tradi-
tional Chinese Medicine, Chengdu,
China.
The authors have disclosed no
potential conflicts of interest, finan-
cial or otherwise. The authors thank
Juan Du for her help with Ba Duan
Jin exercise instruction and Hong-yun
Zhang from Chengdu University for
her encouragement and support in
various aspects.
Address correspondence to Jing
Gao, RN, Professor, College of Nurs-
ing, Chengdu University of Tradition-
al Chinese Medicine, No. 166, West
of Liu Tai Road, WenJiang District,
Chengdu City, Sichuan Province,
China, 610000; e-mail: 729012934@
qq.com.
© 2016 Liu, Gao, Yin, et al.;
licensee SLACK Incorporated. This
is an Open Access article distributed
under the terms of the Creative Com-
mons Attribution-NonCommercial
4.0 International (http://creativecom-
mons.org/licenses/by-nc/4.0). This
license allows users to copy and dis-
tribute, to remix, transform, and build
upon the article non-commercially,
provided the author is attributed and
the new work is non-commercial.
Received: May 4, 2015
Accepted: December 10, 2015
doi:10.3928/00989134-20160201-03