Tai Chi: What You Need To Know
What is tai chi?
Tai chi is a practice that involves a series of slow gentle movements and physical postures, a meditative state of mind, and controlled breathing. Tai chi originated as an ancient martial art in China. Over the years, it has become more focused on health promotion and rehabilitation.
Does tai chi help prevent falls?
Tai chi may be beneficial in improving balance and preventing falls in older adults and people with Parkinson’s disease. It is unknown whether tai chi can help reduce falls in people who have had a stroke or people with osteoarthritis or heart failure.
A 2019 review looked at different types of exercise for preventing falls in community-dwelling older people. The duration and frequency of tai chi sessions varied among the studies. Compared to control interventions that were not thought to reduce falls, there was low-certainty evidence that tai chi may reduce the rate of falls by 19 percent (based on 7 studies with 2,655 participants) and high-certainty evidence that tai chi may reduce the number of people who experience falls by 20 percent (based on 8 studies with 2,677 participants). Other forms of exercise were also helpful. The authors found high-certainty evidence that balance and functional exercises—exercises that are similar to everyday actions like rising from a chair, stepping up, or rotating while standing—could reduce the rate of falls by 24 percent (based on 39 studies with 7,920 participants) and lower the number of people experiencing one or more falls by 13 percent (based on 37 studies with 8,288 participants).
A 2021 review analyzed three studies of tai chi’s effect on falls in people with Parkinson’s disease. The 3 studies included a total of 273 participants who did 60-minute tai chi sessions two to three times per week for 12 weeks to 6 months. The analysis indicated that tai chi had a significant positive effect on reducing falls when compared with both no intervention and different interventions like resistance training and stretching.
A 2020 summary of three reviews that included some relevant studies found that tai chi may help improve balance and reduce falls in people with Parkinson’s disease, but the certainty of the evidence was considered to be low.
A 2018 review evaluated 5 randomized controlled trials with 346 participants who had experienced a prior stroke. (Randomized controlled trials are studies in which participants are randomly assigned to an intervention group and control group.) Tai chi sessions were typically 60 minutes long and done two to three times weekly for 6 or 12 weeks. The review found that tai chi helped to improve the participants’ walking gait in the short term but not their balance when they stand and move their upper body outside their center of gravity, such as reaching forward as much as possible while in a fixed standing position. The authors of the review said that all of the studies had high bias and were small and that large, long-term randomized controlled trials are needed to confirm the review’s findings.
A 2015 review included 9 osteoarthritis studies with a total of 543 participants. The review concluded that tai chi improved pain and stiffness in osteoarthritis, and the authors noted that the improvement may increase balance. Updated 2019 guidelines from the American College of Rheumatology and the Arthritis Foundation strongly recommend tai chi for the management of both knee and hip osteoarthritis.
A 2020 summary of one review said no definite conclusion could be drawn for using tai chi to reduce falls in people with heart failure. The authors indicated that more high-quality studies are needed. The one review, which was done in 2016, included 5 heart failure studies with a total of 271 participants. The review did not provide any details on tai chi’s effect on balance in people with heart failure.
Does tai chi reduce pain?
A small amount of research suggests that tai may be helpful in reducing pain in people with low-back pain, fibromyalgia, and knee osteoarthritis. It is unclear whether tai chi is beneficial for alleviating pain from rheumatoid arthritis.
A 2019 review evaluated 10 studies with 959 participants who had low-back pain. The duration of the tai chi interventions ranged from 2 to 28 weeks, with sessions done two to six times weekly and the majority lasting from 40 to 60 minutes. Because the studies used different tai chi interventions and assessment methods, the authors drew a cautious conclusion that tai chi alone or in addition to physical therapy may decrease pain intensity and improve everyday function (such as the ability to carry groceries, climb stairs, walk, and bathe and dress oneself). The authors noted a need for studies that use the same tai chi intervention and frequency.
A 2019 review of 7 studies (345 participants) indicated uncertainty on whether tai chi reduces pain and disease activity or improves function (such as standing up from an armless chair, opening a drink or food carton, and climbing stairs) in people with rheumatoid arthritis. The tai chi sessions usually lasted 1 hour and were done two to three times per week for 8 to 12 weeks. It is also not clear how much, how intense, and for how long tai should be done to see benefits. The review authors rated the quality of the evidence very low because of concerns with study designs, a low number of participants in some studies, and a high number of people stopping their participation in some studies.
A 2019 review of 6 studies (657 participants) found that tai chi was beneficial for reducing pain scores in people with fibromyalgia. Tai chi also helped to improve sleep quality, relieve fatigue, reduce depression, and increase quality of life. The tai chi interventions typically involved 60-minute sessions done one to three times weekly for 12 weeks. The review authors said, however, that larger, higher quality studies are needed to provide stronger evidence for these findings and to determine whether tai chi is better than conventional therapeutic exercise for people with fibromyalgia.
The updated 2019 guidelines from the American College of Rheumatology and the Arthritis Foundation strongly recommend tai chi for the management of knee osteoarthritis.
A 2021 review of 16 studies involving 986 participants found evidence of low-to-moderate strength that tai chi was beneficial for treating and managing knee osteoarthritis. The tai chi interventions usually involved 30- to 60-minute sessions done two to four times weekly for 10 to 52 weeks. Participants practicing tai chi experienced improvements in pain as well as stiffness, physical function (such as walking, standing, rising from a bed, and getting in and out of a car), balance, and physiological and psychological health. The review authors noted, however, that high-quality studies are needed to confirm these findings and to determine the best type, intensity, frequency, and duration of tai chi for knee osteoarthritis.
Another 2021 review, which included 11 studies and 603 participants, found that tai chi had a positive effect on improving walking function and posture control in older adults with knee osteoarthritis. The review authors said more high-quality studies are needed to confirm the findings. In most of the studies, tai chi sessions were 60 minutes long and done two to three times per week for 8 to 24 weeks.
Is tai chi helpful for people with chronic diseases?
Chronic Obstructive Pulmonary Disease
A 2021 review of 23 studies (1,663 participants) concluded that tai chi may help to improve exercise capacity, lung function, and quality of life in people with chronic obstructive pulmonary disease (COPD). Tai chi was better than no treatment in all areas evaluated, and it was better than breathing and walking exercises in some of the areas. The duration and frequency of the tai chi sessions varied among the included studies, and the tai chi interventions lasted from 1 to 12 months. The review authors said more high-quality studies are needed to clearly understand tai chi’s effect on COPD.
A 2021 review looked at 26 studies of tai chi and qigong involving 1,672 participants with Parkinson’s disease. Tai chi sessions lasted from 30 to 90 minutes and were done over 5 to 24 weeks, with the total number of tai chi sessions ranging from 10 to 48, depending on the study. Most of the studies showed that tai chi was more helpful than no intervention and had a positive effect that was similar to that of other therapies like dancing, aerobic exercise, resistance training, and stretching. The authors said the overall results were limited by the different types and durations of tai chi and qigong interventions, the variety of other therapies, the small number of participants, and the different stages of Parkinson’s disease among participants.
Type 2 Diabetes
Some research shows that tai chi improves levels of fasting blood glucose and hemoglobin A1c (HbA1c) in people with type 2 diabetes and may improve quality of life factors. Tai chi, however, doesn’t appear to be any better than other aerobic exercises.
- A 2018 review of 14 studies (798 participants) found that tai chi was better than no exercise for managing levels of fasting blood glucose and HbA1c in adults with type 2 diabetes. Tai chi may have advantages over other aerobic exercises like walking and dancing for reducing HbA1c, but the evidence was not strong. There were no differences between tai chi and other aerobic exercises for blood glucose control. Practicing tai chi for longer periods of time resulted in better results. Tai chi interventions involved 15- to 60-minute sessions done two to seven times per week for 4 to 24 weeks.
- A 2019 review of 23 studies (1,235 participants) found that tai chi was beneficial in lowering fasting blood glucose, HbA1c, insulin resistance, body mass index, and total cholesterol in people with type 2 diabetes. Tai chi was also found to improve quality of life factors such as physical function, bodily pain, and social function, and it had no effect on balance. Tai chi sessions were 15 to 120 minutes long and were done 2 to 14 times weekly for 4 to 24 weeks. The authors said that differences between study methods and the small size of the studies might weaken the strength of the results.
High Blood Pressure
A 2020 review looked at 28 studies (2,937 participants) and found that tai chi was better at lowering systolic and diastolic blood pressure than health education/no treatment, other exercises, or antihypertensive drugs. The time duration, weekly frequency, and total weeks of tai chi sessions varied among the included studies. However, the authors said the studies were of poor quality and had many differences among them, warranting more research to confirm the conclusions.
A 2020 review evaluated the psychological well-being of adults who were 60 years of age and older and who had cardiovascular disease (diseases of the heart and blood vessels). The review, which included 15 studies of 1,853 adults, found that tai chi was better than usual care or other types of exercise (e.g., walking, strength training) for improving quality of life and psychological well-being. The length of tai chi interventions ranged from 6 to 52 weeks, with an average of 36 tai chi sessions over the duration of the studies. The specific improvements varied depending on the type of cardiovascular disease, however. For example, when compared to usual care or other exercises, tai chi participants with coronary heart disease had better mental health quality of life, those with chronic heart failure experienced less depression and psychological distress, and those with high blood pressure had better physical health quality of life. The authors said that the quality of the studies was on average acceptable and that more rigorous studies are needed.
A 2018 review of 13 studies (972 participants) found that tai chi led to large and significant improvements in aerobic capacity among people with coronary heart disease when compared to active interventions (e.g., walking, stretching) and nonactive interventions (e.g., usual medical care). The tai chi interventions involved 30- to 90-minute sessions done one to seven times weekly for 12 weeks to 12 months. The authors rated the quality of the studies from moderate to strong, but the studies were very small, and the authors said that more high-quality studies are needed to confirm these findings.
Does tai chi help with dementia?
A 2019 review of 9 studies (656 participants) looked at the use of tai chi in the early stages of dementia in older adults (average age of 78). The short-term effect of tai chi on the overall cognition of people with mild cognitive impairment was found to be beneficial and similar to that seen with other types of exercise. The results of the studies suggested that tai chi done three times a week for 30 to 60 minutes per session for at least 3 months had a positive impact on some cognitive functions. The review authors said the quality of seven of the nine studies was rated as either good or excellent, but the studies were small.
Does tai chi improve the quality of life of older adults?
A 2020 review of 13 studies (869 participants) found that tai chi had a small positive effect on the quality of life and depressive symptoms of older adults with chronic conditions who lived in community settings. No significant effect was seen for mobility and physical endurance. The tai chi interventions involved 40- to 90-minute sessions done one to four times per week for 10 to 24 weeks. The authors said the studies had many differences among them, that the evidence was of low quality, and that larger high-quality studies are needed.
Is there any research on tai chi and COVID-19?
There have been only a few studies on tai chi and COVID-19.
- A 2021 study evaluated a 10-week tai chi intervention in older adults during the COVID-19 pandemic as a possible way to help improve their mental and physical health. (Participants maintained a physical distance of 4 meters from each other during the study.) The 30 participants were between the ages of 60 and 78, had not previously practiced tai chi, and had been doing fewer than 2 days a week of structured physical activity before the study. Half of the participants were randomly assigned to partake in two 60-minute group tai chi classes each week. The results of the study suggested that tai chi is an effective intervention that can be used under pandemic conditions to improve the psychoemotional state, cognition, and motor learning in older adults.
- A 2021 narrative review suggested that tai chi could possibly help people coping with COVID-19 and counteract the negative effect of physical inactivity, sedentary behavior, and mental disorders in the general population during the COVID-19 pandemic. The authors explained that tai chi can be practiced easily and safely at home, in isolation, or in groups, making it useful during pandemic conditions. This suggestion was not based on studies of tai chi during the COVID-19 pandemic but instead on past research about the general effects of tai chi. The authors said that future research is needed to determine the effectiveness of tai chi during the COVID-19 pandemic and to provide more valid and reliable data.
Is tai chi safe during pregnancy?
There are no published studies on the safety of tai chi during pregnancy. However, physical activities, such as tai chi, are likely safe and desirable during pregnancy in most instances, as long as appropriate precautions are taken. If you are pregnant, talk with your health care providers before starting tai chi.
Tai chi during pregnancy may help with blood circulation, balance, coordination, strength, relaxation, and mental health, but research in these areas is needed.
According to a 2021 review, there are no peer-reviewed studies on the effects of tai chi alone during pregnancy. The review found one study that evaluated a combined yoga and tai chi program designed for the second and third trimesters of pregnancy. In this 2013 study, 92 pregnant women with depression (46 of whom were initially in a waitlist control group) participated in a 20-minute yoga and tai chi class once a week for 12 weeks. When compared to the control group, the yoga and tai chi group had a significant reduction in levels of depression, anxiety, and sleep disturbances. Neither the 2021 review nor the 2013 study mentioned any adverse effects of tai chi during pregnancy.
Can tai chi be harmful?
Tai chi appears to be safe. A 2019 review of 24 studies (1,794 participants) found that the frequency of adverse events was similar for people doing tai chi, another active intervention, or no intervention. The review also found that in studies of people with heart failure, people in tai chi groups experienced fewer serious adverse events than people receiving no intervention. None of the serious adverse events reported in the 24 studies were thought to be caused by either tai chi or the control conditions (active interventions or no intervention). The adverse events that were reported as related to tai chi or other active interventions were minor, such as musculoskeletal aches and pain.
What kind of training, licensing, or certifications do tai chi instructors need to practice?
Tai chi instructors don’t have to be licensed, and the practice isn’t regulated by the Federal Government or individual states. There’s no national standard for tai chi certification. Various tai chi organizations offer training and certification programs—with differing criteria and levels of certification for instructors.
Research Funded by NCCIH
NCCIH is sponsoring research on tai chi, including the following studies:
Tips To Consider
- Don’t use tai chi to postpone seeing a health care provider about a medical problem.
- Ask about the training and experience of the tai chi instructor you’re considering.
- Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.
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NCCIH thanks Inna Belfer, M.D., Ph.D., Lanay Mudd, Ph.D., and David Shurtleff, Ph.D., NCCIH, for their review of this 2022 publication.
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