EFFECTS OF TAI CHI ON MULTISITE PAIN AND BRAIN FUNCTIONS IN OLDER ADULTS

描述（由申请人提供）：越来越多的证据支持疼痛，无论是通过疼痛部位数量还是疼痛严重程度来衡量，都与老年人认知功能和活动能力较差以及跌倒风险有关。疼痛的注意力负担可能是患有慢性多部位疼痛的老年人中高福尔斯率的一个因素。太极拳整体整合了身体和认知功能，不仅可以缓解疼痛，还可以改善许多患有慢性多部位疼痛的老年人的注意力和流动性。这项在患有多部位疼痛的老年人中进行太极干预的试点研究是我们目前研究老年人慢性疼痛注意力需求的工作的直接延伸。这项随机对照试验的主要目的是评估12周太极计划对患有慢性多部位疼痛和跌倒史的老年人的可行性和可接受性。我们将研究太极拳对疼痛特征，认知功能，认知介导的移动性以及社区居住的多部位疼痛和过去至少一次跌倒的老年人的疼痛相关生物标志物水平的影响 年（65岁及以上，太极组N=30，轻度运动对照组N=30）。我们的R21发展补助金申请的具体目标是：1）评估12周随机对照太极计划的可行性和可接受性，为社区老年人的更大规模试验做准备。具体而言，我们将：1A）评估招募和参与12周太极干预中患有慢性多部位疼痛的老年人的可行性; 1B）确定最佳太极/运动方案和数据收集方案，以规划更大规模的试验; 1C）评估随机参与者对其分配治疗的依从性; 1D）获得关于结果测量的差异和变化的信息，用于更大试验中的功效分析。2)研究太极拳对疼痛特征、疼痛相关生物标志物、认知功能和认知介导的移动性的疗效。具体而言，我们将：2A）确定太极拳对疼痛严重程度和疼痛干扰的影响; 2B）确定太极拳对注意力和执行功能测试中的表现的影响; 2C）确定太极拳对复杂移动任务中的表现的影响（双任务步态测量）; 2D）确定太极拳对C-反应蛋白（CRP）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）水平的影响。）和β内啡肽（<$-内啡肽）。这项研究将为非侵入性行为干预太极拳对老年人慢性多部位疼痛和相关认知运动功能的影响提供新的见解。这项探索性研究的结果将提供关键的试点数据，这些数据将指导和通知一项更大的随机对照试验，旨在建立太极拳对老年人慢性多部位疼痛的临床意义，并研究太极拳可能改善慢性疼痛和疼痛相关的认知运动功能的机制。

DESCRIPTION (provided by applicant): Accumulating evidence supports that more pain, whether measured by number of pain sites or pain severity, is associated with poorer cognitive function and mobility, and fall risk in older persons. The attentional burden of pain may be a factor in the high rate of falls among older persons who have chronic multisite pain. Tai Chi which holistically integrates physical and cognitive functions offers the possibility not only of alleviating pain but also improving attention and mobility in the many older adults who have chronic multisite pain. This proposed pilot study of a Tai Chi intervention among older adults with multisite pain is a direct extension of our current work examining attentional demands of chronic pain in the older population. The main purpose of this randomized controlled trial is to assess the feasibility and acceptability of a 12-week Tai Chi program for older adults with chronic multisite pain and a history of falling. We will examine the effects of Tai Chi on pain characteristics, cognitive function, cognitively-mediated mobility, and levels of pain-related biomarkers in community-dwelling older adults with multisite pain and at least one fall in the past year (65 years and older, N=30 for Tai Chi group and N=30 for mild exercise control group). Our specific aims for this R21 developmental grant application are: 1) to assess the feasibility and acceptability of a 12-week randomized controlled Tai Chi program in preparation for a larger trial in community-residing older adults. Specifically, we will: 1A) Evaluate the feasibility of recruitment and engagement of older adults who have chronic multisite pain in a 12-week Tai Chi intervention; 1B) Determine the optimal Tai Chi/exercise protocol and data collection protocol for planning a larger trial; 1C) Assess the adherence of randomized participants to their assigned treatment; 1D) Obtain information on differences in outcome measures and variations to be used for power analysis in a larger trial. 2) To examine the efficacy of Tai Chi on pain characteristics, pain-related biomarkers, cognitive function and cognitively-mediated mobility. Specifically, we will: 2A) Determine the effects of Tai Chi on measures of pain severity and pain interference; 2B) Determine the effects of Tai Chi on performance in tests of attention and executive function; 2C) Determine the effects of Tai Chi on performance in complex mobility tasks (dual task gait measures); 2D) Determine the effects of Tai Chi on levels of C-reactive protein (CRP), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-¿), and beta endorphin (¿-endorphin). This study will provide novel insights into the effects of a non-invasive behavioral intervention, Tai Chi, on chronic multisite pain and the associated cognitive-motor functions in older adults. The results of this exploratory study will provide critical pilot data that will guid and inform a larger randomized controlled trial designed to establish the clinical significance of Tai Chi on chronic multisite pain in older adults and to investigate the mechanisms by which Tai Chi may improve chronic pain and pain-related cognitive-motor functions using brain imaging and human genetic approaches.