Effect of Tai Chi on Single-leg Balance in a Sedentary

doi:10.21203/rs.3.rs-4620850/v1

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Effect of Tai Chi on Single-leg Balance in a Sedentary

https://doi.org/10.21203/rs.3.rs-4620850/v1

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Objective: This study examines the effects of 16 weeks of taichi exercises on single-leg balance and attentional network in a sedentary population. The effect of the attention network factor in the improved balance ability was investigated. Methods: A randomized two-group parallel controlled trial. 43 sedentary people (23 tai chi group and 20 control group) participated in this study. Each subject was required to meet the criteria of sitting and lying down for an average of at least 7 hours per day for the past 1 month, with no exercise habits. Tai chi was used as the primary exercise intervention. The training was administered three times a week for 16 weeks. The control group would be required to submit the Sedentary Behavior Questionnaire weekly and ensure similar lifestyle habits as before. We measured subjects' dual-task single-leg balance using the Tecnobody-PK252 balance apparatus before and after 16 weeks, and their attentional ability using the attention network test.

Results: Tai chi significantly improved dual-task single-leg balance and attention in the sedentary group (p < 0.05). There was a significant difference compared to the control group. A correlation was found between improved attentional ability and sway path scores. There was no significant difference in the control group before and after the experiment (p > 0.05).

Conclusion: Tai chi can improve dual-task single-leg balance in sedentary people. Tai chi can improve the attentional network ability of sedentary people. Improvements in dual-task balance in the tai chi group correlated with improvements in the attentional network with Orienting and Executive control network.

Exercise intervention

sedentary people

attention network

tai chi

dual-task balance

After the Influenza virus outbreak, many countries and regions have imposed restrictions on the scope of human activities (Alomari et al., 2020). These restrictions may lead to changes in people's lifestyles. Sedentary adults and home-based workers have been more physically inactive and sedentary (Loef et al., 2022). Similarly, because of school closures and area closures, adolescents may form unhealthy eating habits and increase sedentary behavior at home (Mazzolani et al., 2021). Sedentary behavior has certain effects on human health. Sedentary behavior can cause cardiovascular disease and affect sleep (German et al., 2021). Studies have pointed out that sedentary behavior and lack of physical exercise are some of the major modifiable risk factors for cardiovascular disease and all-cause mortality worldwide (Lavie et al., 2019). Sedentary behavior also affects adolescents' quality of life (Lucena et al., 2022). However, reducing sedentary time and increasing physical activity can significantly improve cardiovascular and obesity problems in adolescents (Verswijveren et al., 2022). Sedentary behavior can also exacerbate the loss of muscle mass and function (Hamer & Stamatakis, 2013). These include abdominal muscles (Vella et al., 2018), grip strength (Hamer & Stamatakis, 2013), lower limb muscles (Loprinzi et al., 2017), etc. Sedentary behavior can reduce people's balance and increase the risk of falls (Du et al., 2022; Ren et al., 2022).The research points out that sedentary young people perform worse on bipedal versus unipedal static balance tasks (Do Nascimento et al., 2017). Decreased balance is an important cause of falls (Ercan et al., 2020). If they continue to maintain sedentary habits in the future will increase the risk of falls, as well as the risk of other diseases.

The decline in balance is also closely related to people's cognitive resources (Yu et al., 2021). In actual cases of falls, normal young people often fall in relation to their unfocused attention resources (Uiga et al., 2018). One of the reasons for falls is that people direct their attention resources to other distracting tasks while performing gait or balance tasks (Wollesen et al., 2019). In life, people usually fall because they are unable to direct their attention to balance tasks, such as walking while playing with a cell phone or bumping into a telephone pole while greeting others. Therefore, Monitoring a young person's ability to pay attention is an important factor in determining a person's ability to balance. There are limitations to single-task balancing tests, and cognitive tasks need to be considered in the balancing task.Compared with single-task balance tests, dual-task balance tests can combine human cognitive resources more effectively and simulate the real situation where people achieve balance.

Attention is a unique conscious activity, a higher cognitive function, which is the pointing and focusing on certain things (Mayer, 2000). Attention permeates almost all of our mental activity, helping us to become aware of information (Petersen & Posner, 2012), select it (Wang et al., 2001), and accelerate the processing of external and internal information (Raz & Buhle, 2006);. When we walk while playing with our phones, we can be aware of the phone's screen, the road outside the phone, the people walking around us, and other information. From time to time we focus our attention on the game screen of the phone, making our body walk more automatically. This concentration of attentional resources improves our game score, but may affect our walking speed. Posner et al. proposed Attention Network Theory through neuropsychological studies of brain function, which views attention as a network system under which three sub-networks of alerting, orienting and executive control are included (Petersen & Posner, 2012). Alerting refers to a state in which individuals remain highly sensitive and is usually divided into exogenous and endogenous alertness (Wang et al., 2001). Orienting refers to orienting attention to selective attentional information, which includes endogenous and exogenous attentional orienting (Raz & Buhle, 2006). Executive control refers to the ability to monitor irrelevant information and resolve conflicts (Fan et al., 2005). Fan et al. designed the attention network test (ANT) based on Posner's attention network theory (Fan et al., 2002). The attention network test can effectively respond to the efficiency of the three networks of alerting, orienting and executive control in the attention network, and is widely used in normal, attention-deficit, and motor populations (Stener-Victorin et al., 2000).

Tai chi is a soft and easy-to-learn form of exercise, and the process of exercise focuses on the harmony of body and consciousness (Gyllensten et al., 2010). It is suitable for people who do not exercise for a long time. Tai chi can improve balance (Chen et al., 2021), as well as dual-task balance (Song et al., 2018). Some studies suggest that the improvement of dual-task balance in tai chi is due to improved physiological indicators (skeletal muscles and joints) (Zou et al., 2019). Tai chi improves one's cognitive resources (Solianik et al., 2022; Yue, Zhang, et al., 2020), attention (Yue, Zou, et al., 2020), mood (Liu et al., 2018), and memory (Yue, Yu, et al., 2020). The improvement of dual-task balance ability in people by tai chi may be simultaneous, and there is a correlation between them. There are few studies on tai chi for sedentary people. This study focuses on the improvement of tai chi for sedentary people in dual-task balance test with the improvement of attentional resources, and tries to investigate the correlation between balance ability and attentional resources. Some studies suggest that the improvement of dual-task balance in tai chi is due to improved physiological indicators (skeletal muscles and joints) (Zou et al., 2019). Tai chi improves one's cognitive resources (Solianik et al., 2022; Yue, Zhang, et al., 2020), attention (Yue, Zou, et al., 2020), mood (Liu et al., 2018), and memory (Yue, Yu, et al., 2020). The improvement of dual-task balance and attention in people by tai chi may be simultaneous, and there is a correlation between them. This correlation may be a simple correlation or it may be a factor from multiple attentional dimensions. There are few studies on tai chi for sedentary people. This study focuses on the improvement of tai chi for sedentary people in dual-task balance test with the improvement of attentional resources, and tries to investigate the correlation between balance ability and attentional resources.

2.1. Participants

The sample size was estimated by G*Power3.1 for the experimental sample. The parameters effect size f = 0.40, Class I error α err prob = 0.05, and test effectiveness Power(1-βerr prob) = 0.80 were set, and the minimum sample size was calculated to be 34. The final experimental subjects were recruited by posting recruitment information in Soochow University. 47 sedentary people were recruited and randomly grouped, 24 in the tai chi group (M = 24.3; SD = 3.2; ages 19–28; 45.8% Male) and 23 in the control group ( M = 25.2; SD = 2.4; ages 20–29; 47.8% Male). Inclusion criteria: (1) age between 20 and 30; (2) passed the Sedentary Behavior Questionnaire (SBQ) screening, the average daily sedentary time in the past month was more than 7 hours; (3) no history of alcohol and tobacco dependence; (4) no history of psychiatric disorders; (5) no exercise habits in the past year (less than once per week and less than 4 times per month); (6) normal corrected visual acuity; (7) right-handedness. All subjects were tested after signing an informed consent form. All subjects completed recruitment and assessment one week prior to the intervention session. The experiment was approved by the Ethics Committee of the School of Physical Education, Soochow University.

2.2. Procedure

All subjects were asked to complete the attention network test and Dual-task single-leg balance test. They would get enough rest before the attention network test. After understanding the instructions and completing the pre-test, the subjects were asked to complete three sub-networks (alerting, orienting and executive control) and their accuracy and response time would be recorded. Each sub-network had 60 trials. The subjects warmed up and acquainted themselves with the test equipment before the Dual-task single-leg balance test, which consisted of an open-eye dual-task balance test and a closed-eye dual-task balance test. Each test task had to be successfully completed three times. The dual-task balance test required the completion of successive subtraction calculations of minus 7 as a distraction task, and the values obtained were averaged over the three completions. After each group of subjects completed the full pre-test, the tai chi group would receive 16 weeks of tai chi intervention and the control group would be required to submit the Sedentary Behavior Questionnaire weekly and ensure similar lifestyle habits as before. The post-test would be performed on all subjects at the 17th week.

Table 1

Characteristics of Participants **(n = 43).**
Variables		TC Group (n = 23)		C Group (n = 20)		P value
		mean	SD	mean	SD
Age (years)		24.2	2.9	26.2	2.3
Gender	Male,n	10		9
	Female,n	13		11
Body weight (kg)		70.48	7.21	68.50	6.82	0.362
Height		166.46	7.99	165.72	6.58	0.746
EL (years)		17.15	1.72	17.18	1.95	0.954
SBQ	Weekday (hours/day)	9.24	3.32	8.24	2.48	0.273
	Weekend (hours/day)	8.91	3.38	9.82	3.28	0.381
	Total (hours/day)	9.15	2.46	8.69	2.21	0.524

^{BMI = Body Mass Index; EL = education level; SBQ = Sedentary Behavior Questionnaire; SD = Standard Deviation}.

2.3. Dual-task balance test

The Tecnobody-PK252 balance apparatus was used to measure the subject's balance. The subject stood barefoot on the Freeman plate with one foot, and the center of the arch of the supporting foot in the starting position was aligned with the center of the Freeman plate, with the knee joint upright. Freeman plate’s sampling frequency is 20Hz. The subject lifted the knee with the non-supporting foot and bent the hip and the knee at the angle of 90°. The ankle joint was relaxed to present a natural state. The subject kept the upper body straight and crossed the arms. The test would start after the subject kept steady. The test subjects were required to complete two tasks, a postural task and a cognitive task. The postural task was to stand on one leg while balance was maintained during the test, and the cognitive task was to calculate the result of successive subtractions of 7 within 1000 while maintaining body balance. The test consisted of a Dual-task of single-leg open-eye and closed-eye static balance. Each task was completed in 3 sets, and each set was 30s. Each set of tasks was performed with a continuous subtraction calculation of minus 7 as a distraction task, with 12 sets completed for each of the left and right feet. The PROKIN system recorded the sway path (mm), sway area (mm2), forward and backward motion speed (mm/s), left and right movement speed (mm/s), X-axis central of pressure (mm), Y-axis central of pressure (mm). The smaller the sway path, the better the balance and postural stability. The smaller the X-axis central of pressure, the smaller the displacement change of the swing path in the left and right. The smaller the Y-axis central of pressure, the smaller the displacement change of the swing path in the front and back.

2.4. Attention network test

The ANT test was based on MATLAB software with the Psychtoolbox toolkit installed, and completed by keyboard on the computer. The subject sat 45 cm away from the computer screen, and the jaw of the subject was fixed with a bracket so that the subject stared horizontally at the midpoint "+". Before the experiment, the subject would understand the requirements and purpose of the experiment through the instruction and complete the relevant test experiment as required. The attention point "+" was displayed in the middle of the screen and the display time was 400-1600ms at random. Then there would be four conditions of cues, "+" remain unchanged no cue, central cue "*" appeared in the "+" position instead of the attention point, the double clue "*" appeared above and below the attention point "+", the spatial cue "* " appeared in the position of the upcoming target of which the accuracy was 75%. All cues were presented for 100ms and then disappeared, after which the attention point "+" was re-presented for 400ms. After the attention point "+ " disappeared for the second time, the target stimulus with the arrow pointing to the left or right was presented at the top or bottom of the screen. On the left and right sides of the target stimulus were those that pointed in the same direction as its arrow (congruent condition), those that did not (incongruent condition), and the neutral condition without arrow pointing. The subjects were required to judge the direction of the stimulus arrow after observing the cue (Fig. 1). The results of Alerting, Orienting, and Executive control in the Attention network test are obtained by equations.

Alerting (ms) = RT (no cue) - RT (double cue)

Orienting (ms) = RT (center cue) - RT (spatial cue)

Executive control (ms) = RT (incongruent conditions) - RT (congruent conditions)

The meaning of RT (no cue) is reaction time in the no-cue condition task. The meaning of RT (double cue) is reaction time in the double-cue condition task. The meaning of RT (center cue) is reaction time in the central cue condition task. The meaning of RT (spatial cue) is reaction time in the spatial cue condition task. The meaning of RT (incongruent conditions) is reaction time under incongruent conditions. The meaning of RT (congruent conditions) is reaction time under congruent conditions. The larger the alerting and orienting network effect, the better the effect and the better the individual's alertness and attention pointing ability. Larger values of the enforcement control network effect indicate poorer effectiveness and less ability to resolve conflict problems.

2.5. Intervention

Yang style tai chi was used as the primary exercise intervention. It was a 16-week program, three times a week and 60 minutes each time. Each tai chi session included the preparation activities stage, the movement skill acquisition stage, the movement skill practice stage and the cool-down campaign stage. The intervention site was chosen at the indoor gymnasium of Soochow University. There were 3 lead testers for each session, one of whom was primarily responsible for teaching the movements and the other two were assistant teachers. A total of 7 lead testers conducted the course interventions. To avoid subjects being unable to participate due to time issues, we set up 2 sessions per week at different times for each session. Subjects could choose the appropriate time to participate according to their availability. Subjects could only participate in one time per day with each courses requiring them to complete a sign-in. Subjects will be paid an honorarium after completing the full trial. Week 17th is the assessment. The intervention is described below. (Table 2).

Table 2

The content of tai chi interventions.
Week	warm-up	Skill Acquisition	Skill practice	cool-down Campaign
1	Joint exercises	Pile kungfu, Pile kungfu, tai chi step	Pile kungfu, Pile kungfu, tai chi step	pile kung fu
2	Joint exercises	Pile kungfu, tai chi step	Pile kungfu, Pile kungfu, tai chi step	Pile kungfu, stretching exercises
3	Pile kungfu, Pile kungfu, tai chi step	Five steps of tai chi	Five steps of tai chi	Pile kungfu, stretching exercises
4	Pile kungfu, Pile kungfu, tai chi step	Five steps of tai chi	Five steps of tai chi	Pile kungfu, stretching exercises
5	Pile kungfu, Five steps of tai chi	Eight techniques of tai chi	Five steps of tai chi, Eight techniques of Tai Chi	Pile kungfu, stretching exercises
6	Pile kungfu, Five steps of tai chi	Eight techniques of tai chi	Five steps of tai chi, Eight techniques of Tai Chi	Pile kungfu, stretching exercises
7	Pile kungfu, five steps and eight techniques of tai chi,	Progressive movements (holding knee and twist step)	holding knee and twist step, tai chi step	Pile kungfu, stretching exercises
8	Pile kungfu, five steps and eight techniques of tai chi,	Progressive movements (part the wild gorse's mane)	Holding knee and twist step, part the wild horse's mane	Pile kungfu, stretching exercises
9	Pile kungfu, five steps and eight techniques of tai chi,	Progressive movements (grasp the bird's tail)	Holding knee and twist step, part the wild horse's mane, grasp the bird's tail	Pile kungfu, stretching exercises
10	Pile kungfu, five steps and eight techniques of tai chi,	False step movement (high pat on horse, white crane spreads its wings, needle at sea bottom)	Holding knee and twist step, part the wild horse's mane, grasp the bird's tail, High pat on horse, white crane spreads its wings, needle at sea bottom	Pile kungfu, stretching exercises
11	Pile kungfu, five steps and eight techniques of tai chi,	Reverse movement (play pipa, repulse monkey)	Holding knee and twist step, grasp the bird's tail, play pipa, repulse monkey	Pile kungfu, stretching exercises
12	Pile kungfu, five steps and eight techniques of tai chi,	Bow stance, left and right step movement (Single whip, wave hands like clouds, apparent close up)	Holding knee and twist step, part the wild horse's mane, Single whip, wave hands like clouds, apparent close up	Pile kungfu, stretching exercises
13	Pile kungfu, five steps and eight techniques of tai chi,	Mid-definition independent step movement (turn and kick, snake creeps down)	Part the wild horse's mane, white crane spreads its wings, needle at sea bottom, turn and kick, snake creeps down	Pile kungfu, stretching exercises
14	Pile kungfu, five steps and eight techniques of tai chi,		Holding knee and twist step, part the wild horse's mane, grasp the bird's tail, High pat on horse, white crane spreads its wings, needle at sea bottom	Pile kungfu, stretching exercises
15	Pile kungfu, five steps and eight techniques of tai chi,		Holding knee and twist step, grasp the bird's tail, Play Pipa, play pipa, repulse monkey	Pile kungfu, stretching exercises
16	Pile kungfu, five steps and eight techniques of tai chi,		Part the wild horse's mane, white crane spreads its wings, needle at seabottom, turn and kick, snake creeps down	Pile kungfu, stretching exercises
17	Test

2.6. Statistical Analysis

All data were analyzed by SPSS 25.0, and the results obtained were expressed as mean ± standard deviation. Paired comparison t-test was used to analyze the changes in the balance ability of each group before and after the experiment. Independent samples t-test was used to analyze the differences between groups after the experiment. P-value less than 0.05 was considered to be statistically significant.

The results showed differences between the two groups in the Dual-task single-leg balance test and attention network test. Correlation analysis was performed for the experimental group. Pearson product difference correlation was used to analyze Alerting, Orienting, and Executive control in the Sway path and attention network test. The correlation between the improvement of balance and the improvement of attention factors was further demonstrated.

If the study showed that Sway path was correlated with attention network test, the possible influencing factors were further discussed. Sway path, Alerting, Orienting, and Executive control were normalized, and Sway path was used as the outcome variable. multiple linear regression analysis was performed with Alerting, Orienting, and Executive control as factors. The correlation coefficients before and after normalization were used to investigate whether the change in Sway path was influenced by the attention network.

3.1. Baseline Assessment

Excluding those who dropped out during the period, a total of 43 sedentary people participated in both the pre-test and post-test, and 23 of them completed the 16-week tai chi exercise program. The basal characteristics of the two groups are similar in terms of age, BMI, sex, education level, and SBQ (p > 0.05) (Table 1). In the first evaluation, there are no statistically significant differences in static balance parameters between the two groups (p > 0.05), including sway path (SP), sway area (SA), forward and backward motion speed (FBMS), left and right movement speed (LRMS), X-axis central of pressure (COP), Y-axis central of pressure under the balance test with eyes open and eyes closed. Similarly, there are no statistically significant differences between the groups in terms of attention network test (ANT) (p > 0.05), including accuracy, alerting, orienting and executive control.

3.2. Dual-task single-leg balance test and attention network test to change after tai chi intervention

Paired-samples t-test was used to compare the change in each value of Dual-task single-leg balance test and the change in each value of ANT before and after the intervention in each group. The change in the amount of difference between the two groups before and after the intervention was compared by independent samples t-test.

After the tai chi interventions, significant improvements in Dual-task single-leg balance test and ANT are found. With regard to changes in sway area and sway path scores, the tai chi group shows significant decreases in both the opened and closed eyes dual balance test. In the opened eyes, The 16-week intervention significantly reduced the values of SA (t = 2.698, p < 0.05, Cohen's d = 0.398, 95% CI 66.66323, 459.31938) and SP scores (t = 3.975, p < 0.05, Cohen's d = 0.586, 95% CI 161.49846, 493.20589). A specific comparison of the differences shows that the mean value of the SA before the intervention (988), would be significantly higher than the mean value of the SA after the intervention (725). The mean value of SP before the intervention (1542), would be significantly higher than the mean value of SP after the intervention (1214). In the closed eyes, The 16-week intervention significantly reduced the values of SA (t = 4.866, p < 0.05, Cohen's d = 0.733, 95% CI 1626.64604, 3928.92214) and SP scores (t = 7.589, p < 0.05, Cohen's d = 1.144, 95% CI 1234.63849, 2128.23879). A specific comparison of the differences shows that the mean value of the SA before the intervention (3720), would be significantly higher than the mean value of the SA after the intervention (942). The mean value of SP before the intervention (2993), would be significantly higher than the mean value of SP after the intervention (1311). But the control group only shows decrease of SP scores in the closed eyes dual balance test (t = 2.146, p < 0.05, Cohen's d = 0.586, 95% CI 27.42494, 2181.12506). A specific comparison of the differences shows that the mean of the sway area before 16 weeks (3636), would be significantly higher than the mean of the sway area after 16 weeks (2532). There was no significant difference between SP (p > 0.05) and SA (p > 0.05) in the control group before and after 16 weeks in the opened eyes condition, and no significant difference in SA in the closed eyes condition (p > 0.05) (Table 3). In the opened eye condition, there were significant decreases between the two groups after the experiment in SA (t = 2.16, p < 0.05, Cohen's d = 0.686, 95% CI 104.608, 847.314) and SP scores (t = 2.735, p < 0.05, Cohen's d = 0.989, 95% CI 292.161, 981.233). A specific comparison of the differences shows that the mean value of the amount of change in the tai chi group (-329) is significantly lower than the mean value of the control group (309) (Table 4). In the closed eye condition, there were significant decreases between the two groups after the experiment in SA (t = -17.16, p < 0.05, Cohen's d = 0.573, 95% CI 122.924,, 3801.396) and SP scores (t = -6.91 p < 0.05, Cohen's d = 0.527, 95% CI -17.123, 1863.419). A specific comparison of the differences shows that the mean value of the amount of change in the tai chi group (-1606) is significantly lower than the mean value of the control group (-142) (Table 4).

Regarding changes in Forward and backward motion speed (FBMS) and left and right movement speed (LRMS). Under the opened eyes test, the tai chi group shows significant decrease in the FBMS (t = 2.146, p < 0.05, Cohen's d = 0.586, 95% CI 27.42494, 2181.12506) and LRMS (t = 2.146, p < 0.05, Cohen's d = 0.381, 95% CI 27.42494, 2181.12506). A specific comparison of the differences showed that the mean FBMS before the intervention (35.44), would be significantly higher than the mean FBMS after the intervention (32.5). A specific comparison of the differences showed that the mean LRMS before the intervention (31.14), would be significantly higher than the mean LRMS after the intervention (26). But the control group does not (p > 0.05) (Table 3). Regarding changes in LRMS, the tai chi group shows significant decrease in the closed eyes dual balance test (t = 9.133, p < 0.05, Cohen's d = 1.372, 95% CI 24.83448, 38.91116). A specific comparison of the differences showed that the mean LRMS before the intervention (55.41), would be significantly higher than the mean LRMS after the intervention (23.5). But the control group does not (p > 0.05). There was no significant change in the control group before and after 16 weeks (Table 3). There are significant differences between the two groups after the experiment in LRMS with closed eyes (t = -5.673, p < 0.05, Cohen's d = 1.267, 95% CI 16.306, 40.300). A specific comparison of the differences showed that the mean value of the amount of change in the tai chi group (-31.41) was significantly lower than the mean value of the control group (-2.1) (Table 4).

There were no significant changes in X-axis and Y-axis COP in the tai chi and control groups before and after 16 weeks under the opened and closed eyes test (p > 0.05).

Regarding changes in ANT, the tai chi group shows significant decreases in executive control (t = 5.295, p < 0.05, Cohen's d = 1.081, 95% CI 169.077, 385.872), and significant increase in accuracy (t = -5.209, p < 0.05, Cohen's d = 1.063, 95% CI -0.131, -0.057) and orienting (t = -2.254, p < 0.05, Cohen's d = 0.460, 95% CI -300.809, -12.867), but the control group does not (p > 0.05) (Table 3). A specific comparison of the differences showed that the mean executive control before the intervention (444), would be significantly lower than the mean FBMS after the intervention (410). A specific comparison of the differences showed that the mean accuracy before the intervention (0.85), would be significantly higher than the mean FBMS after the intervention (0.95).A specific comparison of the differences showed that the mean orienting before the intervention (445), would be significantly higher than the mean FBMS after the intervention (602). There is significant decrease between the two groups after the experiment in executive control (t = -2.432, p < 0.05, Cohen's d = 0.717, 95% CI -381.827, -35.751). A specific comparison of the differences showed that the mean value of the amount of change in the tai chi group (-194) was significantly lower than the mean value of the control group (15). There is significant increase between the two group after the experiment in Alerting (t = 3.347, p < 0.05, Cohen's d = 0.987, 95% CI 35.524, 134.061). A specific comparison of the differences showed that the mean value of the amount of change in the tai chi group (96) was significantly lower than the mean value of the control group (6.4). There is significant increase between the two group after the experiment in orienting (t = 2.351, p < 0.05, Cohen's d = 0.460, 95% CI 27.036, 351.874), A specific comparison of the differences showed that the mean value of the amount of change in the tai chi group (154) was significantly lower than the mean value of the control group (-35.1) (Table 4).

Table 3

Comparison of parameters before and after training between the tai chi and control groups.
	TC Group (n = 23)			C Group (n = 20)
	Baseline (mean ± SD)	Follow-up (mean ± SD)	P value	Baseline (mean ± SD)	Follow-up (mean ± SD)	P value
Dual-task single-leg balance test
Opened eyes
SP (mm)	1542 ± 517	1214 ± 446	< 0.001*	1178 ± 456	1487 ± 652	0.104
SA (mm²)	998 ± 494	725 ± 494	0.01*	816 ± 429	1029 ± 569	0.229
FBMS (mm/s)	35.44 ± 14.45	32.5 ± 17	< 0.001*	30.94 ± 10.12	28.41 ± 12.44	0.457
LRMS (mm/s)	31.14 ± 10.9	26 ± 10.19	0.013*	27.31 ± 11.57	31.74 ± 17.22	0.32
X-axis COP (mm)	10.78 ± 10.77	10.33 ± 7.01	0.799	13.33 ± 11.22	14.54 ± 11.12	0.672
Y-axis COP (mm)	27.80 ± 17.21	27.83 ± 16.59	0.993	26.8 ± 28.43	26.41 ± 14.89	0.240
Closed eyes
SP (mm)	2993 ± 1365	1311 ± 524	< 0.001*	3636 ± 2198	2532 ± 883	0.045*
SA (mm²)	3720 ± 3620	942 ± 485	< 0.001*	3760 ± 2470	3018 ± 356	0.191
FBMS (mm/s)	94 ± 149	59.7 ± 28.93	0.138	59.67 ± 20.61	61.66 ± 22.58	0.755
LRMS (mm/s)	55.41 ± 23.53	23.5 ± 13.21	< 0.001*	45.67 ± 12.4	43.57 ± 13.21	0.577
X-axis COP (mm)	9.53 ± 7.99	10.64 ± 7.56	0.503	11.72 ± 8.23	17.73 ± 10.48	0.06
Y-axis COP (mm)	20.46 ± 15.02	15.09 ± 15.42	0.116	17.04 ± 13.3	13.29 ± 10	0.437
Attention Network Test
Accuracy	0.85 ± 0.08	0.94 ± 0.02	0.000*	0.89 ± 0.06	0.88 ± 0.06	0.438
Alerting (ms)	47 ± 199	123 ± 116	0.159	42 ± 86	63 ± 54	0.264
Orienting (ms)	445 ± 179	602 ± 288	0.034*	444 ± 150	410 ± 124	0.360
Executive control (ms)	358 ± 231	80 ± 135	0.000*	231 ± 221	209 ± 138	0.659

^{*p < 0.05; TC = tai chi; C = control group;SP = Sway path; SA = Sway area; FBMS = Forward and backward motion speed;LRMS = Left and right movement speed; COP = central of pressure}.

Table 4

Comparison of the differences of the values before and after experiment between tai chi and control groups.
	TC Group (n = 23)	C Group (n = 20)
	After 16 weeks (mean ± SD)	After 16 weeks (mean ± SD)	P value
Dual-task single-leg balance test
Opened eyes
SP (mm)	-329 ± 564	309 ± 811	0.01*
SA (mm²)	-277 ± 661	212 ± 766	0.011*
FBMS (mm/s)	2.3 ± 19.6	2.5 ± 14.91	0.96
LRMS (mm/s)	5.01 ± 13.31	4.43 ± 19.42	0.026
X-axis COP (mm)	0.35 ± 11.92	-1.21 ± 12.82	0.634
Y-axis COP (mm)	0.62 ± 23.56	-6.38 ± 23.56	0.363
Closed eyes
SP (mm)	-1606 ± 1538	-142 ± 2053	0.002*
SA (mm²)	-2703 ± 3769	-741 ± 2446	0.037*
FBMS (mm/s)	-31.3 ± 49.1	2.1 ± 28.16	0.326
LRMS (mm/s)	-30.41 ± 24.41	-2.1 ± 16.59	< 0.001*
X-axis COP (mm)	-1.44 ± 11.11	6.01 ± 13.45	0.158
Y-axis COP (mm)	-9.71 ± 19.81	-3.27 ± 18.43	0.222
Attention Network Test
Accuracy	0.14 ± 0.20	0.07 ± 0.05	0.098
Alerting (ms)	96 ± 95.93	6.4 ± 84.6	0.002*
Orienting (ms)	154 ± 332	-35.1 ± 197	0.023*
Executive control (ms)	-194 ± 337	15 ± 236	0.019*

^{*p < 0.05; TC = tai chi; C = control group;SP = Sway path; SA = Sway area; FBMS = Forward and backward motion speed;LRMS = Left and right movement speed; COP = central of pressure}.

3.4. Correlation analysis of Dual-task single-leg balance test and attention network test for the tai chi group

Table 5

Correlation of sway path scores with attention networks in the TC Group.
Effect size	Attention Network Test	Alerting	Orienting	Executive control
Dual-task single-leg balance test
Opened eyes SP (mm)	Correlation coefficient	0.185	0.419*	-0.440*
	P value	0.398	0.047	0.036
Closed eyes SP (mm)	Correlation coefficient	0.231	0.491*	-0.493*
	P value	0.290	0.017	0.017

^{*p < 0.05; SP = Sway path}.

Correlation analysis was used to investigate the correlation between the amount of change in opened and closed eyes SP and the amount of change in alerting, orienting, and executive control, respectively, using Pearson correlation coefficients to indicate the strength of the correlations. The results show that the sway path scores of the subjects under the open-eye dual-task balance test are significantly related to orienting and executive control. The correlation coefficient value between sway path and alerting is 0.185, which is close to 0, and the P value is 0.398 > 0.05, thus indicating that there is no correlation between sway path and alerting. The correlation coefficient value between sway path and orienting is 0.419 and shows a 0.05 level of significance, thus indicating that there is a significant positive correlation between sway path and orienting. The correlation coefficient between sway path and executive control is -0.440 and shows a 0.05 level of significance, thus indicating a significant negative correlation between sway path and executive control.

The sway path scores of the subjects under the closed-eye dual-task balance test are significantly correlated with Orienting executive control. The correlation coefficient value between sway path and alerting is 0.231, which is close to 0, and the p-value is 0.290 > 0.05, thus indicating that there is no correlation between sway path and alerting. The correlation coefficient value between sway path and orienting was 0.491 and showed 0.05 level of significance, thus indicating that there is a significant positive relationship between sway path and orienting. The correlation coefficient value between sway path and Executive control was − 0.493 and showed a 0.05 level of significance, thus indicating a significant negative correlation between sway path and Executive control.

3.5. Multiple linear regression model for the tai chi group

Table 6

Multiple linear regression models for the results of the tai chi group sway path scores and attention network tests.
	β	SE	Beta’	t	P value	VIF	R²	Adjusted R	F value	P value
Opened eyes SP (mm)
Constants	-410.531	153.501	-	-2.674	0.015*	-	0.227	0.105	1.861	0.170
Alerting	0.090	1.208	0.016	0.075	0.941	1.148
Orienting	0.375	0.422	0.233	0.890	0.385	1.683
Executive control	-0.458	0.420	-0.288	-1.090	0.289	1.717
Closed eyes SP (mm)
Constants	-2295.741	455.588	-	-5.039	0.000**	-	0.299	0.188	2.70	0.075
Alerting	0.709	3.584	0.041	0.198	0.845	1.148
Orienting	1.469	1.253	0.292	1.172	0.256	1.683
Executive control	-1.467	1.247	-0.296	-1.176	0.254	1.717

^{*p < 0.05; β = Partial regression coefficient; SE = Standard error; Beta’ = Standardized bias regression Regression coefficient}.

The amount of change in alerting, orienting, and executive control were used as independent variables, while the amount of change in opened and closed eyes SP were used as dependent variables for linear regression analysis, respectively. The resulting multiple linear regression model is shown in Table 6. The model equation is opened eyes SP = -410.531 + 0.090*alerting + 0.375*orienting − 0.458*executive control, the model R-squared value is 0.227, implying that alerting, orienting, and executive control can explain 22.7% of the variation in opened eyes SP. When the F-test was performed on the model, it was found that the model did not pass the F-test (F = 1.861, P = 0.170 > 0.05), which means that alerting, orienting, executive control does not have an influential relationship on opened eyes SP, and thus the relationship between the independent variables on the dependent variable cannot be specifically analyzed.

The resulting multiple linear regression model is shown in Table 6. The model equation is: closed eyes SP = -2295.741 + 0.709*alerting + 0.1.469* orienting − 1.467*executive control, the model R-squared value is 0.299, implying that alerting, orienting, executive control can explain 29.9% of the variation in closed eyes SP. When the F-test was performed on the model, it was found that the model did not pass the F-test (F = 2.70, P = 0.075 > 0.05), which means that alerting, orienting, executive control does not have an influential relationship on closed eyes SP, and thus the relationship between the independent variables on the dependent variable cannot be specifically analyzed.

Tai chi is an excellent traditional Chinese culture, which focuses on physical and mental conditioning and internal and external training. It can improve sedentary group’s physical and mental health (Huang et al., 2014).

The present study shows that the tai chi group showed significant difference in the Dual-task single-leg balance test and attention network test before and after training. This indicates that physical activity can improve balance and increase motor control (Huynh et al., 2021). Tai chi improved participants' ability to perform the dual-task single-leg balance test with their eyes open and closed. Significant improvements in sway area and sway path scores were found, suggesting that participants' single-leg balance improved (Maniar et al., 2022). In the eyes-open condition, forward and backward motion speed and left and right movement speed were significantly improved, showing that subjects could better control their joint muscle changes (Marcori et al., 2022). Left and right movement speed changed significantly in the eyes-closed condition, but Forward and backward motion speed did not change significantly, which may be related to the state of the body when maintaining single-leg balance. During the single-leg balance task, the body posture is asymmetrical from left to right. In this posture, the body is more likely to lose its balance and swing to both sides. In order to avoid falling backwards (or other uncontrollable directions), subjects who are about to lose their balance are more likely to have forward and backward movement changes. No significant difference between X-axis and Y-axis central of pressure may be related to the threshold of the center of balance to be maintained. When the central of pressure is within a certain range of motion, the body can achieve balance, but beyond this range, the body will lose its balance.

The control group produced a significant decrease in sway path scores in the Closed eyes condition only before and after the test. This may be due to the practice effect of the subjects. The control group showed no significant changes in other aspects. The otherwise statistically insignificant changes in those who did not receive the intervention for 16 weeks may be related to their lifestyle habits, with almost all of them maintaining their previous sedentary habits on the sedentary behavior scale turned in each week, each averaging over 7 hours of sedentary time per day. This was facilitated by the epidemic, which kept the control group in a closed environment for long periods of time.

Tai chi improved subjects' performance of orienting and executive control in the attention network test, and significantly increased the accuracy in this test task. Sixteen weeks practice of tai chi can significantly improve people's executive function and accuracy. This is consistent with the findings of Ingold et al. (Ingold et al., 2020). The reason may be related to the overall movement style of tai chi, which can significantly improve people's anxiety and depression levels (Deng et al., 2018) and increase their patience during long tasks. Studies have shown that long-term tai chi improves the structure of human brain regions, including cerebral blood flow, brain-derived trophic factors (Zhang, 2009), gray matter white matter volume and density (Erickson et al., 2014; Gujral et al., 2017), and enhanced functional regional linkages (Clark & Williams, 2011).

The changes in sway path scores and attention network test before and after tai chi training are correlated. The correlation analysis that the changes in Dual-task single-leg balance test and attention network test have some moderate correlations, especially in executive control. The greater the executive control effect, the greater the ability of the tai chi group subjects to resolve the conflict task, and the smaller the sway path, the greater the dual-task balance ability. The smaller the Orienting effect, the better the attentional orienting ability and the smaller the sway path, the better the balance ability of the subjects in the tai chi group. The reasons may be related to their own physical conditioning during postural control (Yu et al., 2021), and also related to the corresponding functional brain regions of the brain (Goel et al., 2019). The practice of tai chi requires fine executive control to coordinate body posture and breathing, maintain concentration, suppress distracting thoughts, and improve the body's proprioception. Different movement demands, especially some balance tasks, require subjects to constantly change their body posture and their center of gravity to counteract the disturbances and maintain balance (Goel et al., 2019). Confronting these distractions strengthens people's ability to perceive and respond to inconsistent tasks, which further strengthens people's ability to solve conflict problems.

The findings of the correlation analysis indicate that the attention of Orienting and Executive control had an effect on subjects' balance ability. Further regression analyses indicated that the effect of attention on balance was derived from multiple attentional dimensions. During the Sixteen weeks practice of tai chi, most of the information received is verbal, visual and self-proprioceptive. The ultimate goal is movement skills, including the expression and posture. Tai chi movement emphasizes "harmony" and the "softness overcoming strength" approach. The subject is sensitive to external information and perceives the information carried by the outside world in a soft way. The emphasis on "peace of mind" in tai chi practice also inhibits the influence of irrelevant and effective information on the body and consciousness to some extent.

There is some theoretical basis for the effect of tai chi on orienting (Jha et al., 2007). In the process of practicing tai chi, the subjects are required to be constantly aware of themselves, their proprioception and its changes. They are also asked to try to communicate with the external environment to feel the unity of man and nature, the connection between man and himself, man and man, and man and the environment. In this process of perception, we need to constantly mobilize our attentional resources. We need to concentrate on a certain point. This kind of spontaneous attention from the inside out can effectively improve the directivity of our attentional resources. The testers' instructions and commands during the intervention can enhance the subjects' exogenous attention orienting ability. At the same time, the participants have to adjust their body state during the concentration process, in order to maintain balance and resist interference from the external environment. In this dynamic process, the subjects need to constantly mobilize attentional resources to keep themselves in the best position to perceive the physical changes.

No linear relationship between ANT and SP was found in the analysis of further linear regressions, which may be related to the characteristics of ANT. The three sub-networks are independent of each other (Fan et al., 2005; Fan et al., 2002). Similarly, it has been shown that there are shared attentional resources during visual and auditory perception (Haroush et al., 2011). There may also be shared attentional resources between proprioception and vision. Another possibility may also exist in relation to the sample size, which may lead to new findings if more subjects are recruited.

The present study has some limitations, and ANT cannot fully reflect the full range of human attentional resources. There are various ways to measure attentional resources from different dimensions, and this study only measures attentional resources from the perspective of attention network. This study initially investigates the effect of long-term practice of primary tai chi on single-leg static balance and attentional capacity. Future research will build on this study with a larger sample size and look for different groups of people. The tai chi intervention program in this study focused on the undergraduate and graduate student population on campus and did not consider other groups affected by the outbreak, such as families, and the community. Improving the tai chi curriculum is another important research component for future studies, such as conducting family-oriented tai chi exercise classes. The syllabus is not applicable to everyone in teaching. In addition, in the future experimentats and measurements, more balance tests and attention tests still need to be added. In addition to static balance, we will also try to incorporate dynamic balance tests, such as walking, jumping, climbing stairs, etc. The attention network test can not fully reflect a person's full attentional ability, nor can it reflect a person's full cognitive level. Therefore, more dimensions of human cognitive ability will be explored. In the future, we hope to incorporate more new techniques to further explore the brain area patterns of physical exercise affecting cognition, such as high temporal resolution electroencephalogram (ERP) and electromyogram (EMG).

Tai chi is a gentle and easy-to-learn sport, which is suitable for most physically inactive people. Sixteen weeks practice of tai chi can improve the single-leg dual-task static balance test and attention network test in young sedentary people. It is initially confirmed that tai chi improves the single-leg balance and attention ability in ypung sedentary people. Correlational analysis studies have shown a correlation between improvements in the attentional and executive control network and improvements in balance ability. Regression equations indicated that the attentional network did not have a significant effect with sedentary individuals' dual-task static balance ability in multiple dimensions.

Author Contributions:Conceptualization S.N.Z. and H.P.Y; intervention F.G.,and C.L.; methodology and formal analysis F.G. and C.L; writing—original draft preparation W.J.W. and J.C.; writing—review and editing H.P.Y., and C.L.; supervision, project administration, funding acquisition S.N.Z. and H.P.Y. All authors have read and agreed to the published version of the manuscript.

Funding: Not Funding.

Institutional Review Board Statement: Not applicable.

Data Availability Statement: Data sharing not applicable.

Conflicts of Interest:The authors declare no conflict of interest.

Acknowledgements:A heartfelt thank you goes out to each and every author who has dedicated their time, energy, and expertise to this research. Your diligent efforts and invaluable contributions have been integral to the success of this study. Your commitment to excellence and dedication to the pursuit of knowledge have been an inspiration to us all. We are grateful for your support and look forward to future collaborations.

Ethics approval and consent to participate:This study is still in the process of obtaining ethical approval.

Consent for publication:Confirmation has been obtained that all individuals or entities involved in the study have agreed to the publication of the research results.

Authors' information:Chao Lu ^1,4,†, Feng Gao ^1,†, Jie chen ^2,†, Weijian Wang ¹and Haoping Yang ^3,*,Shinian Zhang ^1,*

1 Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029,China.

2 Zhenjiang Hospital of Traditional Chinese and Western Medicine, Zhenjiang 212002,China.

3 Psychology school, Beijing Sport University; Beijing 100084, China.

4 Zhenjiang First People's Hospital,Zhenjiang 212002, China.

† The authors contributed equally to this work.

* Correspondence: [email protected];[email protected]

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No competing interests reported.

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Effect of Tai Chi on Single-leg Balance in a Sedentary

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Abstract

Figures

1. Introduction

2. Materials and Methods

2.1. Participants

2.2. Procedure

2.3. Dual-task balance test

2.4. Attention network test

2.5. Intervention

2.6. Statistical Analysis

3. RESULTS

3.1. Baseline Assessment

3.2. Dual-task single-leg balance test and attention network test to change after tai chi intervention

3.5. Multiple linear regression model for the tai chi group

4. Discussion

5. Conclusions

Declarations

References

Additional Declarations

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