Tai Chi Intervention for Geriatric Pain Syndrome - Project Summary Chronic multisite pain is a recently identified geriatric syndrome that contributes to serious impairments in cognition and cognitive-motor function and a higher fall risk in older adults. Tai Chi, a multi-component mind- body exercise, offers the possibility not only for alleviating pain symptoms, but also enhancing cognition-related function and decreasing fall risk among older adults with multisite pain, Our research program on Tai Chi and multisite pain has been funded through two pilot projects (R21AG043883 and R56AG062737), and the proposed full-scale, randomized controlled Tai Chi trial is a direct extension of our previous work examining chronic pain, attentional demands, mobility and falls in the older population. The goal of this single-blind randomized controlled trial is to examine the effects of a 6-month Tai Chi intervention, compared to light physical exercise, on chronic pain, cognition, cognitive-motor function, fear of falling, and rate of falls in older adults with multisite pain and fall risk. We will measure pain severity, pain interference, and fear of falling at baseline, mid-point (3-month), and post-intervention (6-month), as well as rate of falls during the intervention (0- to 6-month) and the 6-month follow-up period (month 6 to month 12) in 266 older adults (Tai Chi: N=133, and light physical exercise control: N=133). In addition, we will measure pain-related biomarkers, cognition, single-task and dual-task gait function, free-living physical activity, and sleep at baseline, mid-point, and post- intervention. We have 2 primary specific aims: Aim 1 is to examine the effects of Tai Chi on pain symptoms in older adults with multisite pain. We hypothesize that older adults in the Tai Chi intervention will have less pain, measured as pain severity and interference, than those in the control group. Aim 2 is to examine the effects of Tai Chi on fear of falling and rate of falls in older adults with multisite pain. We hypothesize that older adults in the Tai Chi intervention will have less fear of falling and fewer falls than those in the control group. We have 3 discovery aims: Aim 3 is to examine the effects of Tai Chi on pain-related biomarkers in older adults with multisite pain. We hypothesize that older adults in the Tai Chi intervention will have greater reductions in levels of inflammatory markers and beta endorphin, than those in the control group. Aim 4 is to examine the role of changes in pain symptoms in the change of fall rate by Tai Chi in older adults with multisite pain. We hypothesize that the effect of Tai Chi on the reduced fall rate will be explained in part by improvements in pain symptoms in older adults with multisite pain. Aim 5 is to examine the roles of changes in cognition and cognitive-motor function in the change of fall rate by Tai Chi in older adults with multisite pain. We hypothesize that the reduced fall rate in the Tai Chi group will be mediated by changes in cognition and cognitive-motor function in older adults with multisite pain. The results of this study will provide a foundation to establish the clinical significance of Tai Chi in the management of multisite pain syndrome and to explore the mechanisms through which Tai Chi alleviates pain and lowers rate of falls in vulnerable older adults.
