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Only a small percentage of college students are consuming the recommended number of servings for fruits, vegetables, and dairy (Hiza & Gerrior, 2002; Georgiou et al., 1997). In the present survey, 58% and 64% of the participants state they consume vegetables or whole or canned fruit less than once per day, respectively. This agrees with the 51% of participants who rate the “healthiness” of their eating habits as poor or fair. Dinger and Waigandt (1997) surveyed over 2,600 college students and found that 40% had not eaten any fruit in the previous 24 hours and 55% had not eaten green salad or cooked vegetables. According to a study by Debate et al. (2001), in a population of 630 college students, only 18% consume 5 servings per day of fruits and vegetables, 7% consume 6 or more grain products, and 53% consume 2 or more dairy products. An earlier study by Melby et al. (1986) reported that 69% of college students do no eat any fruit once a day and 48% eat vegetables less than once a day. These findings are cause for concern because there is ample data suggesting that fruit and vegetable consumption may be protective against most cancers and cardiovascular disease. The decreased risk of chronic disease associated with a plant-based diet may be due to substances in fruit and vegetables such as antioxidants, folate, fiber, potassium, flavonoids and numerous other phytochemicals (Hyson, 2002; Van Duyn & Pivonka, 2000).

The most common barrier cited to eating well is “lack of time.” Other common reasons are “lack of money” and “taste preferences.” Lopez-Azpiazu et al. (1999) examined perceived barriers of healthy eating among 1009 Spanish adults, over the age of 15 years, and found the common barriers were “irregular work hours,” “willpower,” and “unappealing food.” Lappalainen et al. (1997) reported that “irregular work hours,” “giving up foods I like,” and “willpower” are the most common barriers to trying to eat healthier in a large study with over 14,000 European adults, 15 years of age and older. The present survey noted some differences in barriers between men and women. More women state “lack to time,” while three times as many men state “don’t care.”

The steepest decline in physical activity occurs during adolescence and young adulthood (Allison et al., 1999; Grace, 1997; Leslie et al., 1999). Pinto and Marcus (1995) report that 46% of young adults on college campuses are inactive or active irregularly and only about 35% have a regular schedule of physical activity. This is similar to results of Dinger and Waugandt (1997) who found that 30% of college students did not engage in moderate physical activity the previous week and only 45% report participating in vigorous physical activity. Haberman and Luffey (1998) also state that only 39% of 302 college students exercise enough to meet the Healthy People 2000 goal for activity. In contrast, in this particular population of college students, 84% state they currently exercise. However, it should be noted that exercise (frequency or intensity) was not defined. Despite this high reported rate of activity, 42% state they exercise less since attending college. Leslie et al. (1999) found that about 70% of a population of over 2,700 college students report less activity at college. Men exercise more frequently and at a greater intensity level than women and men select strength-training and competitive sports more than women. Women select aerobics more than men. These gender differences also are reported by Leslie et al. (1999) and Pinto and Marcus (1995).

The main reason participants’ exercised in this survey was for “health.” Among other stated reasons, women exercise because of weight and stress reduction and men exercise for enjoyment and gains in muscle and strength. Similarly, Myers and Roth (1997) found that college women exercise for its psychological and body image benefits and Leslie et al. (1999) found that men are motivated to exercise for muscle.

Discussion
The purpose of this survey was to assess the diet and exercise habits and perceived barriers to following a healthy lifestyle of college students and to determine if differences exist by gender. The survey population is young; most students are 21 years of age or younger, and there are a fairly even distribution of students by class standing. Twenty-five percent of students have a body mass index (BMI) placing them in the overweight category and 6% are classified as obese. In close agreement with the current survey, Lowry et al. (2000) report that 35% of college students are overweight or obese based on the 1995 National College Health Risk Behavior Survey. In contrast, Haberman and Luffey (1998), in a population of 302 college students, report that 8% are overweight. Female students in this survey population have a similar incidence of overweight (20%) as that reported by Anding et al. (2001) in a small population of 60 female students (25%). While 40% of men in this survey have a BMI greater than 25, 19% of these men report that they strength-train and 41% report they do a combination of exercise. Many of these men may have a greater proportion of lean body mass. Self-reported height and weight data must be viewed with caution as Jacobson and DeBock (2001) recently reported that college men underestimate height and college women underestimate weight.

Many college students have poor nutritional habits (Georgiou et al., 1997). Most do not meet the minimum recommended intake of dietary fiber, fruits, and vegetables; and exceed recommended intakes of total fat and saturated fat, sugar, and sodium (Anding et al., 2001; Grace, 1997; Hiza & Gerrior, 2002; TLHS, 2000). Thirty-three percent of this survey population report they consume breakfast “never” or “seldom.” Hertsler and Frary (1989) studied food behavior among 212 college students where 43% report skipping breakfast more than half the time. Eighty percent also indicate that they snack one to three times per day while 4% note four or more times per day. In the present survey, 63% are inclined to snack one to two times per day, 26% three to four times per day and 5% four or more times per day. “Boredom” was the most frequently cited reason for snacking. The present survey also found gender differences in types of snack foods and additional reasons for snacking. Men state “partying” as a reason for snacking more frequently than women and women state “emotional” more frequently than men. While most students snack on chips, crackers, or nuts; men snack on fast foods more and on ice cream, cookies and candy less frequently than women. Twenty-six percent of women and 38% of men in the current study report drinking regular soda or other sugared beverages one or more times per day. While the authors defined a serving as equaling one cup, it is clear that most students purchase much larger sodas; the standard serving sold on campus is 20 ounces. Larger portion sizes leading to significantly increased caloric intake are implicated in the national obesity epidemic (Young & Nestle, 2002). Soda may be just one source of excess calories in the college students’ diet. A recent study (Lang, 2003) suggests that the “freshman 15,” the gain of 15 pounds of weight by freshman during the first year of college, may be a real phenomenon fostered by “all you can eat” dining facilities, evening snacks, consumption of junk food, and dieting. It is reported that nation wide binge-drinking among college students exceeds 40% (Grace, 1997). Men are heavier drinkers than women in the present survey where 15% state they usually drink 22 or more drinks per week. Wechsler et al. (Wechsler & Isaac, 1992; Wechsler et al., 2000) also confirm that male students drink more frequently than female students.

Students were asked how often they ate meals. Breakfast is the most commonly missed meal. Responses (% of participants) are as follows; Breakfast: never (8), seldom (25), sometimes (21), usually (24), always (23); Lunch: never (1), seldom (2), sometimes (16), usually (44), always (37); Dinner: never (0), seldom (1), sometimes (4), usually (30), always (65). There are no differences between male and female participants.

Students were asked about frequency of snacking and consumption of soda and alcohol. Most students (63%) are inclined to snack one to two times per day. While “boredom” is the most frequently cited reason for snacking, men state “partying” as a reason for snacking more frequently than women and women state “emotional” more frequently than men. Most students snack on chips, crackers, or nuts; but men snack on fast foods more and on ice cream, cookies and candy less frequently than women. Men consume larger quantities of both soda and alcoholic beverages than women. Fifty-eight percent of participants state they eat vegetables less than once per day and 64% eat whole or canned fruit less than once per day.

When asked to rate the “healthiness” of their eating habits, 51% of participants state “poor” or “fair.” When asked to state the reasons for poor eating habits, 40% state “lack of time,” 22% state “lack of money,” 15% state “taste preferences” and 24% state other reasons. Some of the other reasons stated include “no motivation” (n = 21), “convenience” (n = 20), and “dine at student cafeteria” (n = 17). Forty-two percent of women state “lack of time” compared with 36% of men, whereas 3% of women state “don’t care” compared with 11% of men (χ2, p < 0.05). Exercise Habits, Body Image and Perceived Barriers to Exercise
Eighty-four percent of participants state they currently exercise and the same percentage state they exercised prior to attending college, however, 42% state they exercise less since attending college. Men exercise more frequently and at a greater intensity level than women, see Table 4. In regard to type of exercise, women do more aerobics and less strength-training and partake in fewer competitive sports than men. Men appear to be more confident with their body image. The most commonly cited reason why the participants exercised is “health” (n = 251). There are other stated differences between men and women, see Table 5. Women exercise for reasons of weight and stress reduction and men exercise for enjoyment and gains in muscle and strength. The most commonly cited barriers to exercise are “lack of time” (n = 171), “lack of motivation” (n = 103) and “lack of willpower” (n = 45). There are no differences in barriers to exercise by gender.

Participants
A total of 471 college students enrolled in the study during the spring semester 2002. Participants were recruited using a stratified random sample of classes from upper and lower division general education classes. Final class selection was dependent on obtaining instructor permission to enter classes. A proportionate number of students from lower and upper division classes were selected. The study protocol and survey instrument were approved by the university’s institutional review board for the protection of human subjects.

Design

All participants were asked to complete a survey designed to assess the dietary and exercise habits and perceived barriers to following a healthy lifestyle of college students. The current survey was adapted from a University of North Florida’s survey of diet and exercise of freshman (Rodriguez, 1999). The survey had 38 questions and was divided into three sections. The first section (six questions) asked for anthropometric and demographic data. The second section (20 questions) asked participants about their current dietary habits and perceived barriers to eating a healthy diet. The third section (nine questions) asked participants about their current physical activity patterns, perceived body image and perceived barriers to an active life. The survey took approximately 15 minutes to complete.

Statistical Analyses

We used the SPSS package (LEAD Technologies, Inc.) for Windows, release 11.0, to analyze the data. Frequencies were used as descriptors of the student population. Chi-Square (χ2) statistics were used to examine differences in frequencies of responses to questions on dietary and exercise habits and perceived barriers to following a healthy lifestyle by gender.

Results

Approximately 60% of the participants were female and most were aged 18-21 years. There were very few graduate students represented in this sample. Thirty-one percent of the population had a body-mass-index (BMI) greater than 25 based on self-reported height and weight data, indicating a high percentage of overweight (BMI 25 – 29.9) and obese (BMI > 30) individuals in such a young population. Forty percent of men compared with 20% of women had a BMI greater than 25. One question on the survey asked participants if they had lost, gained or had no change in weight in the last few years. Of the 414 participants who responded to this question, 46% stated they had gained weight, 30% had no change in weight, and 24% had lost weight. Of those that had gained weight, the average + SD gain was 12 + 10 pounds (range: 2 – 100 pounds).

The authors assessed the diet and exercise habits and perceived barriers to following a healthy lifestyle of 471 college students. Sixty percent of the participants were female and 31% had BMIs > 25. Breakfast was the most commonly missed meal and 63% of students snacked one to two times per day. Fifty-eight percent of participants ate vegetables and 64% ate whole or canned fruit less than once per day. Men consumed more soda and alcohol and used higher fat dairy, ate more meat, and ate fewer vegetables and fruits than women. Over half of the subjects rated their diet as poor or fair with “lack of time” listed as the number one barrier to eating well. Men exercised more frequently and at greater intensity than women and were more confident with their body image. The most common barrier to exercise was “lack of time.” The results of this study have implications for the design of general and specific diet and physical activity interventions among college students.

Introduction

Introduction
Diet related diseases including cardiovascular disease, cancer, and stroke are consistently among the top three leading causes of death (American Cancer Society, 2000). A new report, issued by the Institute of Medicine (IOM) of the National Academy of Sciences, suggests that to save the most lives from chronic disease, policy makers, health care providers and researchers should focus their efforts on helping people to stop smoking; maintain a healthy weight and diet; exercise regularly; and drink alcohol at low to moderate levels (American Cancer Society, 2003). Most college students may not achieve the nutrition and exercise guidelines designed to reduce the risk of chronic disease, typically consuming diets high in fat, sodium, and sugar and low in fruits and vegetables (Anding et al., 2001; Dinger & Waigandt, 1997; Grace, 1997; Hiza & Gerrior, 2002; TLHS, 2000). These poor eating habits may result from frequent snacking, excess dieting, and consumption of calorie dense but nutrient poor snacks and meals, such as those provided by fast food restaurants (Georgiou et al., 1997).

In addition, despite the recognized benefit of exercise, surveys of college students’ health habits indicate that only 35% have a regular schedule of physical activity and that a slightly higher proportion of men (40%) than women (32%) regularly exercise (Pinto et al., 1998). However, college students are at a time and place in their lives where their behavior is conducive to change. In fact, the students’ social role of learner is largely defined by a readiness to change (NIH, 1998). Therefore, college campuses serve as crucial settings to overcome perceived barriers to healthy diet and exercise habits, and implement effective interventions (Wallace et al., 2000). Ideally, if college students make positive changes in exercise and dietary habits, these changes could persist into adult years. The purpose of this survey was to assess the diet and exercise habits and perceived barriers to following a healthy lifestyle of college students and to determine if differences exist by gender. The results may have implications for the design of effective general and gender specific interventions for college students.

This study filled a gap in the gerontological literature and showed that exposure to a 6-month Tai Chi exercise program can effect long-term changes in HRQL identified by the General Health Survey, a well-established HRQL measure which includes distinct dimensions of quality of life indicators.
On all measures, Tai Chi exercise resulted in significant changes in the HRQL indicators except social functioning, compared to the no-Tai Chi waiting-list control. Overall, Tai Chi participants reported significant improvements over the 6-month period in physical-, role-functioning, bodily pain, mental health, and health status.
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Over the 6-month intervention, we observed an 18% drop-out rate in the Tai Chi group. This is relatively low given the fact that many who decide to become more physically active return to a sedentary lifestyle within three to six months (Dishman, 1988; Martin & Sinden, 2001). Failure to complete the study was attributed to traveling or family-related commitments rather than dissatisfaction with the program itself. In fact, people who completed the study looked forward to enrolling in further courses offered in the community. Such a finding corroborates findings of Wolf et al. who noted that almost half of their Tai Chi participants chose to continue meeting informally after the study was completed.

Results from present study have a number of implications. First, important domains of HRQL such as physical and psychological health can be enhanced through Tai Chi because it improves balance and coordination in a framework of meditation and concentration thus, theoretically, integrating one’s physical and mental states. This is important because global wellness is predicated not merely on the functioning of each domain but the interaction between the two.

Second, physical functioning is an important HRQL indicator which affects continued independence of older adults. As with other studies that have shown difficult-to-observe change in physical functioning (Kutner et al., 1997; Stewart et al., 1997), this study demonstrated that physical functioning could be improved through a relatively short 6-month Tai Chi program. Overall, the Tai Chi group had 83% improvement across the six individual functional status items, suggesting the Tai Chi intervention enabled participants to improve aspects of their physical functioning. Thus, Tai Chi should be considered favorably as a health promoting program for older adults with or without physical limitations. Finally, results from this study appear to support health promotion and disease prevention benefits of Tai Chi in older adults, which may be achieved without the strenuous physical impact of more common activities such as jogging or aerobics.

There are several limitations of the current study. First, the study used exclusively self-report (self-rated) health measures, which rely on respondents’ memories. Future studies need to consider use of objective physical health measures (e.g., functional tests) that would not only allow us to confirm the current findings but also more rigorously examine the effects of Tai Chi on quality of life. Another limitation is that the study sample was comprised of volunteers who might have been more highly motivated to participate in activity than the typical sedentary older adult population. Additionally, the mode of advertising the study (local newspapers, senior center flyers, retirement community notices) could also have created a selection bias toward people who receive and read newspapers and those who live in or visit certain locales in the community. Therefore, the sample might not be representative of the older adult population as a whole. Finally, although the randomized nature of the study is a strength, we must be mindful of the absence of an attention control group. This experimental protocol does not control for the influence of attention on the outcome measures. It is possible that the participants in the Tai Chi group were benefiting from the social support and attention provided by the instructors and members of the classes, with respect to both the outcome variables and compliance. Further studies should control for this effect by having the control participants attend non-exercise health education classes in a group format (Wolf et al., 1996).

In summary, we conclude that Tai Chi classes taught by experienced Tai Chi teachers improved self-reported quality of life among older persons in a 6-month randomized controlled study. The results confirm that Tai Chi can also be considered a suitable and acceptable health promoting activity for older adults over a long term period, as evidenced by the low rate of attrition in the classes. The extent to which the Tai Chi – HRQL relationship is moderated by psychosocial variables could be explored in future studies. Similarly, it would be useful to replicate our findings using individuals with functional deficits and psychological impairment.

Baseline Characteristics of Participants and Dropouts
Preliminary analyses (t-tests or chi-square tests) comparing participants in the Tai Chi group (n = 49) and the control group (n = 45) indicated that the two conditions did not differ significantly (p.09) at baseline on any of the demographic measures involving age, gender, income, and education. Additionally, there were no significant differences (p.13) by group on any of the HRQL measures at baseline. These results indicated no need for adjusting any demographic and/or baseline measures in the subsequent main analyses.
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Furthermore, two (completion status: drop vs. remain) by 2 (condition) analysis of variance (ANOVAs) on age, gender, income, and education revealed that there were no significant differences between those who dropped (n = 22) and those who remained (n = 72), nor were there any interactions between completion status and conditions (p=.25).

Change Over Time in HRQL Measures
The outcomes of the study were tested by comparing participants receiving Tai Chi with those on the waiting-list condition on change in HRQL measures from pretest to posttest. Scores from the various dimensions of SF-20 were entered into univariate repeated measures ANOVAs to test for differences in follow-up HRQL scores between individuals in the Tai Chi and control groups. Because preliminary analyses indicated that the participants who dropped out were similar to those who adhered to intervention on the demographic and outcome variables, we analyzed the change in HRQL measures with participants who completed the study (n = 72).

The results of ANOVAs indicated that, over the course of the study, individuals receiving Tai Chi had better outcomes had those on the waiting list on all the SF-20 subscales (significant Group by Time interaction): F(2,69) = 4.234, P < .02, for physical functioning; F(2,69) = 2.953, P < .05 for social functioning; F(2,69) = 5.369, P < .007, for role functioning; F(2,69) = 4.630, P < .05 for bodily pain; F(2,69) = 2.763, P < .01, for mental health; and F(2,69) = 6.653, P < .002, for health perceptions. Higher scores indicate an increase/improvement in HRQL measures over time. Examination of means for each condition showed that, in general, participants in the Tai Chi group reported a significant improvement (i.e., higher HRQL mean scores) over time in all domains of SF-20 measures. Identical results were obtained when these dropout individuals were also included in the analyses.

Using the five-point difference as the criterion (Ware et al., 1993), only changes (i.e., from baseline to posttest) in Physical Functioning and Health Perceptions reached clinical significance.
The effect sizes were: .69 (physical functioning), .92 for social functioning, .78 for role functioning, .5 for bodily pain, .56 for mental health, and .54 for change in health perceptions. Based on our criteria on effect size, these values were judged as meaningful treatment effects.

All subscales were transformed to a 0 to 100 scale, with higher scores indicting better functioning, and five points “defines differences that are clinically and socially relevant” (Ware et al., 1993). In general, physical-, role-, and social-functioning subscales capture behavioral dysfunctioning caused by health problems. The dimensions of overall health, bodily pain, and particularly mental health reflect more subjective components of health and general-welling (Stewart et al., 1989). The consistency estimates of the four multi-item SF-20 measures varied from .77 (physical functioning) to .89(mental health) for Week 1, .78 to .88 for Week 12, and .79 to .86 for Week 24.

Procedures
All participants completed the measures described previously during an initial group orientation meeting (Week 1). Before beginning, participants signed consent forms, indicating the voluntary and anonymous nature of the study. Instructions were read aloud by the researcher, and sample questions were provided prior to the administration of the questionnaire. Additionally, participants were encouraged to clarify any questions/confusions they might have with regard to the questionnaire. No problems were encountered with participants understanding the questions or completing the questionnaire.
Participants from the experimental group completed these measures a second (Week 12) and third (Week 24) time either at the end of class or at home within a week interval. Participants in the control group completed their second and third assessments by mail. Trained research assistants in compliance with institutional review board procedures for studies involving human subjects, administered the survey measures.

Program Compliance
From the initial sample of 94 participants, seventy-two completed all assessments. Nine participants in the Tai Chi group (18% attrition rate) dropped out of the study for reasons such as traveling and family-related commitments. Thirteen participants dropped out of the control group (29% attrition rate) because of unwillingness to wait for the Tai Chi class offered at the end of the study. Thus, the total attrition rate at the end of the study was 23%. Class attendance was recorded for each subject in the experimental group. The average attendance rate (2 times/per week, a total of 48 possible sessions) in the Tai Chi group was approximately 90% with a median compliance of 41 sessions, and ranging from 29 to 47 sessions. Reasons for missing sessions included inclement weather, holidays, and family commitments.

Statistical Analyses
Before conducting the primary analyses of the study, we examined whether attrition influenced the representativeness of the remaining subject sample and whether the experimental participants were different on demographic variables that were not controlled in the random assignment procedure. All tests were completed using the analysis of variance (ANOVA) procedure. Following these preliminary tests, repeated measures ANOVA procedures (with Group as a between-subjects factor and Time as a within-subject factor) were used to examine changes over time and differences between Tai Chi and control groups. An interaction between Group and Time indicated a difference in group responses on HRQL measures, suggesting a treatment effect. The primary outcomes (dependent variables) analyzed were the six dimensions of SF-20. Statistical significance was defined as a P value of less than .05; all P values are two-tailed.

Three Tai Chi instructors auditioned and were selected by one of the investigators (FL) to teach the classes. All instructors had a minimum of 10 years prior Tai Chi teaching experience and came from different ethnic and cultural backgrounds. The Tai Chi intervention was the classical 24-Form Yang style incorporating elements of balance, postural alignment, and concentration (China National Sports Commission, 1983; Yan & Downing, 1998).
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Participants in the intervention group attended a 60-minute Tai Chi practice session twice a week for 6 months. The sessions consisted of a 15-minute warm-up, 30-minutes of Tai Chi, and a 15-minute cool-down period. During the practice, participants were led by an instructor and replicated the motions, postures, and speed of movement of the instructor.
Participants in the control group were instructed to maintain their routine daily activities and not to begin any new exercise programs. These participants were promised a 4-week Tai Chi program at the end of the 26-week intervention study period.

Measures
Background information. A short inventory was administered at baseline to assess demographic characteristics such as age, gender, education, income, and race/ethnicity.
Health-Related Quality of Life. HRQL was assessed with the Short-Form General Health Survey (Stewart et al., 1988) measured at baseline (Week 1), middle (Week 12), and termination (Week 24) of the study. The SF-20 was designed for use in clinical practice, research, health policy evaluation, and general population surveys. The SF 20 has proven useful in monitoring general and specific populations, comparing the burden of different diseases, differentiating the health benefits produced by different treatments, and in screening individual patients. The instrument comprises twenty items representing six domains of HRQL: physical functioning, role functioning, social functioning, bodily pain, mental health, and health perceptions. Each is defined below.
Physical function was assessed by six items assessing the extent to which health interferes with a variety of activities (e.g., carrying groceries, climbing stairs, and walking). Each item was measured on 3-point scale ranging from 1 (= limited for more than 3 months) to 3 (= not limited at all). Higher scores indicate better physical functioning.
Role functioning was assessed by two items assessing the extent to which health interferes with usual daily activity such as work or housework. Each item was measured on a 3-point scale ranging from 1 (= yes, for more than 3 months) to 3 (= no). Higher scores indicate better role functioning.

A single item determined participants levels of social functioning and measured the extent to which health interferes with normal social activities such as visiting with friends during past month. This item scale was measured on a 6-point scale ranging from 1 (= none of the time) to 6 (= all of the time) with higher scores indicating better social functioning.
Mental health was assessed by five items assessing general mood or affect, including depression, anxiety, and psychological well-being during the past month. Each item was measured on a 6-point scale ranging from 1 (= all of the time) to 6 (= none of the time) with higher scores representing better mental health.

The health perceptions dimension used five items designed to provide overall ratings of current health in general. Each item was measured on a 5-point scale from 1 (= definitely true) to 5 (= definitely false). Higher scores represent better health perceptions.

The scale of bodily pain was measured by a single item assessing the extent of bodily pain in previous four weeks. This item was measured on a 5-point scale from 1 (= none) to 5 (= severe). The bodily pain subscale was recoded so that a high score represents less pain.

Research to date has indicated health-related benefits of Tai Chi for older adults including improved balance control (Tse & Bailey, 1991) and reduction in the incidence of falling (Wolf et al., 1996; Li, Fisher & Harmer, in press), improved cardiovascular fitness (Lan et al., 1998; Lan et al., 1999; Young et al., 1999), enhanced psychological well-being (Li et al., 2001a) and increased perceptions of self-efficacy (Li et al., 2001b; Li et al., in press), and physical function (Li et al., 2001c). Less is known, however, about the effects of Tai Chi on overall health-related quality of life (HRQL). Given that the most important long-term endpoint for any practical and therapeutic intervention is not just improved physical and psychological benefits for its participants but enhanced HRQL, research is needed to establish the quantitative relationships between Tai Chi exercise and HRQL in older adults.

However, only one study to date (Kutner et al., 1997) has examined the relationship between Tai Chi and HRQL measures defined by the generic Health Status Battery (Ware & Sherbourne, 1992. Also known as MOS SF-36). In a 15-week intervention program, Kutner et al. (1997) compared Tai Chi practice group with balance training and education groups and reported no significant differences between intervention groups or any differences over time in perceived health status assessed by the Health Status Battery. Given the relatively short training period (15 weeks) employed, these findings may not be surprising. Determining the long-term effects of Tai Chi interventions on HRQL is warranted.
The purpose of this study was to extend our knowledge of Tai Chi’s effects on HRQL by examining its influence on multidimensional health status using a well-established medical outcome measure: the General Health Survey (Stewart et al., 1988). These self-report health survey data, which have not been previously reported, reflect participants’ perceptions of their function and well-being. Specifically, we examined the effects of a 6-month Tai Chi intervention on physical-, role-, and social-functioning, bodily pain, mental health, and change in health perceptions. It was hypothesized that Tai Chi practice would enhance these HRQL measures and that these changes would be characterized by mean changes that differed between the experimental and control groups.
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Participants were community-dwelling older adults recruited from a rural city in the Willamette valley, Oregon. Full details of recruitment and randomization are described elsewhere (i.e., Li et al., 2001a; Li et al., 2001c). Briefly, a total of 148 individuals responded to local newspaper advertisements and flyers at senior centers seeking volunteer participation in a longitudinal physical activity study. Inclusion criteria were: (a) aged 65 years or above, (b) low active, defined as non-involvement in a regular exercise program in the month prior to participation in the study, (c) healthy to the degree that participation in an exercise program would not exacerbate any existing health condition, and (d) willingness to be randomly assigned to a treatment condition. To screen for prior physical activity level, each respondent was interviewed by telephone using the Physical Activity Scale for the Elderly (Washburn et al., 1993).
Ninety-eight respondents (ranging from 65 to 96 years old (M age = 73.2 years, SD = 4.9), who met the inclusion/exclusion criteria and provided written informed consent before entry into the study, were randomized into the experimental conditions using a list of random numbers. Four individuals withdrew prior to the intervention. Of the remaining 94 qualified participants, 49 were assigned to the intervention group of Tai Chi practice (M age = 72.8, SD = 4.7) and 45 were assigned to a wait-list control group (M age = 72.7, SD = 5.7).