Adult above 65 years of age, ambulating without assistive device, both genders, willingness and ability to come for regular exercise sessions and follow up for 6 weeks

Any known neurological problems( stroke, parkinsonism, motor neuron disease, paraplegia) sensory loss, known orthopedic problems (amputation, symptomatic lower limb arthritis, lower limb deformities, total hip and knee replacement), symptomatic coronary artery diseases ,inability to follow commands, regular exercises for more than 2hrs/ week.

The participants were assessed on,Forward Reach Test (FRT), Timed Up and Go Test (TUG), Berg Balance Score (BBS), SF-36 health related Quality of life questionnaire before and after completion of exercise protocols.

Table-1: Participant selection and analysis flow chart:

Table-2: Base line characteristics comparison (Yoga Vs Yang Tai Chi) for scores before starting exercise intervention

(SD-standard deviation, FRT-forward reach test, TUG-Timed up and go test, BBS-Berg balance scale, SF36-quatity of life questionnaire)

Table-3: Comparison of score before and after exercise intervention (Yoga and Taichi Groups)

Table-4: Comparison of difference in scores before and after exercise intervention (Yoga and Taichi Groups)

It was seen that, both interventions were effective to enhance balance and quality of life in healthy elderly with a significant improvement in FRT, TUG, BBS, SF-36 scores after completion of 6 weeks of intervention (P<0.0001) (as shown in table 3). Both the intervention are known for their positive effect on strength, proprioception and movement control which ultimately leads to enhanced balance control, thus reducing fear of fall and improving quality of life. Many of the previous researchers have found similar results of these programs individually [9-19].

Yoga and Tai-Chi have many similarities. Health and longevity are primary goals of both and many people cross-train in both disciplines. Both emphasize on stretching, breath work and inner energy called as “prana/chi”. They seek to integrate the body, energy, and mind. Their approaches to physicality are significantly more subtle than ordinary exercise methods and sports. Both help calm mind and deal with stress. There is a very subtle difference in type of muscle contractions required to maintain postures and range in which both forms are practiced. Yoga emphasises on maintaining particular posture in end range whereas Tai-Chi promotes a fluid like movement instead of a static posture. The practitioner stretches to relax in Yoga and relaxes to stretch in Tai chi. Yoga tends to use more extreme stretches and some postures lock the joints and arch the back and Tai-Chi emphasizes stretching through sophisticated dynamic fluid motions rather than by holding static postures. The Effect of these dissimilarities on their efficacy to improve balance remains unexplored. Need for comparing Yoga and Tai-Chi with other interventions has been expressed for a long time [21]. Hence, we planned this study to find the most effective exercise program among these two to enhance balance in healthy elderly. Yang Tai-Chi is the most basic type. It consist of eight forms, that are easy to learn and can be practiced independently. We choose Yang Tai Chi as our exercise intervention as most of the participants were beginners. The results revealed that, Yang Tai-Chi is more effective to augment balance and thus Quality of life in elderly (as shown in Table 4)

In this study, the chosen Tai-Chi forms were multi component, featuring constant swinging, shifting, and turning in all directions (left, right, forward, and backward). Such activities require a high degree of concentration and coordination between mind and different body parts. It stimulates Motor, nervous and the proprioceptive systems [22]. Chosen Yoga postures lacked this constant variability .Thus, rotational movements performed in a flow in a slow and controlled manner throughout a full range may be the main reason for efficacy of Yang Tai Chi.

Yoga emphasizes on posture maintenance whereas Yang Tai-Chi concentrates on slow, fluid movements throughout the range .It requires conscious awareness of body position and extremity movements, which may improve joint proprioception. Since all chosen forms required slow, fluid and coordinated motion of upper limb, lower limb and trunk, the effect might be more pronounced in Tai-Chi group than Yoga group. A previous study on elderly assessing effect of Tai-Chi on knee proprioception has found similar results [23].

Another reason can be stimulation of vestibular system by repeated slow head movement which helps to enhance the balance control. They were a key feature of Tai-Chi forms selected. This reasoning can be supported by a previous study where Tai-Chi has proved to be beneficial for vestibular system improvement [24].This effect seems to be less in Yoga as no similar movements are associated in Yoga postures.

Inefficient quadriceps strength, low knee and ankle proprioception are found to be the main cause of balance affection in elderly.Most of the forms included in our Tai-Chi program composed of performing movements in a semi-squatting posture, which puts more stress on the knee joint and gives a great range of motion to control the height of centre of gravity during the smooth and slow movement [25].Yoga program did not include such postures. Thus, the effect of quadriceps training and proprioception might be more in Tai-Chi group as compared to Yoga group .It might have lead to enhanced balance in Tai-Chi participants.

All the above mentioned factors might have given the additional benefit to the participants of Tai-Chi group over Yoga participants, leading to superior balance. This in turn, might have been the cause of reduced falls, augmented confidence while performing activities and hence greater Quality of life in Tai-Chi participants. Along with the strengths like carefully matched participants on the basis of age, number of falls and baseline scores before start of intervention in both groups ,the study also has some weaknesses. Our sample was small and consisted unequal number of male and female participants .Studies have shown that ,women have worse balance than men and their balance is less likely to improve with exercise interventions [26].It remains to be seen whether gender bias within this age group would also show any changes in results. Secondly, the number of exercise sessions was only 30. Most of the studies have documented at least 40 sessions to show significant improvements in balance. Only one study showed a significant reduction in the risk of falls after 30 sessions.[27]So, we recommend long term effect of these interventions to be explored in future.