Table 3.
Summary of findings of the health effects of Tai Chi
| Study ID | Populations; settings; countries | |||
|---|---|---|---|---|
|
AMSTAR-2 SR quality |
Outcome, subgroup population (no. studies: no. overlapping studies) |
Intervention vs Comparisons (no. participants) |
Estimate of effect* (95% CI) Effect size |
GRADE certainty |
| Adverse events (AE) | ||||
| Adults, older adults; healthy, obesity, cancer, myocardial infarction, chronic heart failure, osteoarthritis, type 2 diabetes mellitus, chronic pulmonary disease; in community settings; China, South Korea, Australia, USA, Brazil, Israel, France, Italy, Turkey | ||||
|
Cui 2019 [64] Critically low |
Serious AE (15 RCTs) | TC (n = 476) vs physically active interventions (n = 489) |
RD 0.0 (− 0.02 to 0.02) Equivalent risk |
LOW dd |
| Non-serious AE (15 RCTs) | TC (n = 476) vs physically active interventions (n = 489) |
RD 0.01 (− 0.01 to 0.03) Equivalent risk |
MODERATE d |
|
| TC related AE (15 RCTs) | TC (n = 476) vs physically active interventions (n = 489) |
RD 0.0 (− 0.01 to 0.02) Equivalent risk |
MODERATE d |
|
| Serious AE (9 RCTs) | TC (n = 421) vs physically inactive interventions (n = 408) |
RD − 0.03 (− 0.06 to 0.00) Equivalent risk |
MODERATE d |
|
| Non-serious AE (9 RCTs) | TC (n = 421) vs physically inactive interventions (n = 408) |
RD 0.03 (− 0.00 to 0.07) Equivalent risk |
MODERATE d |
|
| TC related AE (9 RCTs) | TC (n = 421) vs physically inactive interventions (n = 408) |
RD 0.0 (− 0.01 to 0.02) Equivalent risk |
MODERATE d |
|
| General health and quality of Life | ||||
| Older adults, with or without chronic diseases (also see cancer, cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, Parkinson’s disease, perimenopause) | ||||
| Older adults; healthy, low bone mass, chronic obstructive pulmonary disease, chronic heart failure & depression, benign prostate hyperplasia, total knee arthroplasty, highly maladjusted institutionalized; in community settings, intermediate care rehabilitation unit, long-term care institution; China, Hong Kong, South Korea, USA, Spain, Germany, Iran | ||||
|
Wang 2020 [91] Critically low |
QoL—overall (6 RCTs) | TC (n = 277) vs Ucare, Ex (n = 275) |
SMD 1.23 (0.56 to 1.89) Large effect |
LOW a, b |
| Older adults; with chronic disease—osteopenia, osteoporosis, osteoarthritis, stroke, hypertension, Parkinson’s disease, diabetes; in community settings; China, South Korea, USA, Australia, Turkey | ||||
|
Choo 2020 [62] Critically low |
QoL—physical (6 RCTs: 1 RCT Taylor-Piliae 2020 [90], 1 RCT Wang 2017 [92]) | TC (n = 257) vs noRx, ADL, Ucare, HEd, attention control, waitlist (n = 238) |
SMD 0.46 (0.13 to 0.80) Small to moderate effect |
MODERATE a |
| QoL—mental health (6 RCTs: 1 RCT Wang 2017 [92]) | TC (n = 257) vs noRx, ADL, Ucare, HEd, attention control, waitlist (n = 238) |
SMD 0.21 (0.03 to 0.39) Small effect |
MODERATE a |
|
| Perimenopause | ||||
| Female adults and older adults; perimenopause, with or without low bone mineral density; in community settings; China, USA | ||||
|
Wang 2017 [92] Critically low |
QoL—physical function SF-36 (4 RCTs) | TC + / − placebo capsule (n = 154) vs Ucare, ADL, placebo capsule (n = 160) |
MD − 1.8 points (− 5.2 to 1.6) Equivalent effect, MCID − 2 points [50] |
LOW a, d |
| QoL—bodily pain SF-36 (3 RCTs) | TC + / − placebo capsule (n = 112) vs usual care, ADL, placebo capsule (n = 118) |
MD − 3.6 points (− 6.6 to − 0.6) Moderate effect, MCID − 3 points [50] |
MODERATE a (†LOW) |
|
| QoL—general health SF-36 (3 RCTs) | TC + / − placebo capsule (n = 112) vs ADL, placebo capsule (n = 118) |
MD − 5.1 points (− 7.6 to − 2.6) Large effect, MCID − 2 points [50] |
MODERATE a (†LOW) |
|
| QoL—vitality SF-36 (3 RCTs) | TC + / − placebo capsule (n = 112) vs ADL, placebo capsule (n = 118) |
MD − 5.7 points (− 8.5 to − 2.8) Large effect, MCID − 2 points [50] |
MODERATE a (†LOW) |
|
| QoL—mental health SF-36 (4 RCTs) | TC + / − placebo capsule (n = 154) vs Ucare, ADL, placebo capsule (n = 160) |
MD − 2.5 (− 4.8 to − 0.2) Small effect, MCID − 3 points [50] |
MODERATE a (†LOW) |
|
| QoL—social function SF-36 (3 RCTs) | TC + / − placebo capsule (n = 112) vs ADL, placebo capsule (n = 118) |
MD − 2.2 points (− 5.0 to 0.6) Equivalent effect, MCID − 3 points [50] |
LOW a, d |
|
| Cancer | ||||
| Adults, older adults; cancer; in community settings; China, USA | ||||
|
Ni 2019 [83] Low (†Critically low) |
QoL—physical, breast cancer or female (9 RCTs) | TC (n = 331) vs Ucare, Rehab, HEd, Psych, Ex, sham Qigong (n = 348) |
SMD 0.34 (0.09 to 0.59) Small effect |
LOW aa |
| QoL—psychological, breast cancer or female (9 RCTs) | TC (n = 333) vs Ucare, Rehab, HEd, Psych, Ex, sham Qigong (n = 348) |
SMD 0.60 (0.12 to 1.08) Moderate effect |
VERY LOW aa, b |
|
| QoL—social relationship, breast cancer or female (8 RCTs) | TC (n = 292) vs Ucare, Rehab, HEd, Psych, Ex, sham Qigong (n = 303) |
SMD 0.26 (0.25 to 0.77) Small effect |
VERY LOW aa, b |
|
| Sleep quality, breast or lung cancer (3 RCTs: 2 RCTs Si 2020 [86]) | TC (n = 106) vs Ucare, Psych, sham Qigong (n = 112) |
SMD 0.26 (− 0.02 to 0.53) Equivalent effect |
VERY LOW aa, b, d |
|
| Adults, older adults; lung cancer, prostate cancer; in community settings; China | ||||
|
Song 2018 [87] Low (†Critically low) |
Fatigue < 8 weeks, lung cancer (2 RCTs) | TC (n = 77) vs Ucare, Ex (n = 74) |
SMD − 0.5 (− 0.83 to − 0.18) Moderate effect |
VERY LOW aa, d |
| Fatigue < 8 weeks, prostate cancer (1 RCT) | TC (n = 21) vs Ex (n = 45) |
SMD 0.01 (− 0.51 to 0.52) favours control Equivalent effect |
VERY LOW aa, dd |
|
| Adults, older adults; Breast cancer; in community settings; China, Thailand, USA | ||||
|
Liu LZ 2020 [77] Critically low |
Fatigue 3 months (2 RCTs) | TC + Ucare, Rehab (n = 60) vs Ucare, Rehab (n = 56) |
SMD − 0.91 (− 1.30 to − 0.53) Large effect |
LOW a, d |
| Fatigue 3 months (2 RCTs) | TC (n = 85) vs Psych, sham Qigong (n = 89) |
MD − 0.46 points (− 1.09 to 0.17) Equivalent effect, MCID unknown |
LOW a, d |
|
| Fatigue 6 months (2 RCTs) | TC (n = 80) vs Psych, sham Qigong (n = 83) |
MD − 0.16 (− 0.98 to 0.67) Equivalent effect, MCID unknown |
LOW a, d |
|
| Female adults; breast cancer; in community settings; China, Thailand, USA | ||||
|
Luo 2020 [79] Moderate(†Low) |
Pain, 3 weeks (2 RCTs) | TC (n = 110) vs Rehab (n = 109) |
SMD 0.25 (− 0.02 to 0.51) Equivalent effect |
LOW a, d |
| Pain, 3 months (4 RCTs) | TC (n = 169) vs Ucare, Rehab (n = 168) |
SMD 0.30 (0.08 to 0.51) Small effect |
MODERATE a (†LOW) |
|
| Cardiovascular, diabetes, and risk factors | ||||
| Chronic heart failure | ||||
| Adults, older adults; chronic heart failure, left ventricular ejection fraction (LVEF) ≤ 45%; in community settings; China, USA, UK, Italy | ||||
|
Gu 2017 [66] Low (†Critically low) |
6-min walk test—6-MWT (10 RCTs) | TC (n = 344) vs Ucare, HEd, Ex (n = 379) |
MD 51 m (30.49 to 71.5) Moderate effect, MCID 36 m [57] |
VERY LOW aa, b |
|
Left ventricular ejection fraction—LVEF (7 RCTs) |
TC (n = 283) vs Ucare, HEd, Ex (n = 306) |
MD 7.7% (3.6 to 11.9) Moderate effect, MCID 3.2% [53] |
VERY LOW aa, b |
|
| QoL: Minnesota Living with Heart Failure Questionnaire—MLHFQ (8 RCTs) | TC (n = 280) vs Ucare, HEd, Ex (n = 318) |
MD − 10.4 points (− 14.4 to − 6.3) Moderate effect, MCID − 8 to − 19 [46] |
VERY LOW aa, b |
|
| Adults, older adults; chronic heart failure; in community settings; USA | ||||
|
Taylor-Piliae 2020 [90] Critically low |
Psychological distress, chronic heart failure (2 RCTs) | TC (n = 58) vs HEd, Ex (n = 58) |
SMD − 0.58 (− 0.95 to − 0.22) Moderate effect |
MODERATE d |
| Ischaemic heart disease | ||||
| Older adults; stable angina; in community settings; China, Brazil | ||||
|
Jiang 2018 [74] Low(†Critically low) |
VO2max (4 RCTs) | TC (n = 148) vs noRx, Ex (n = 88) |
SMD 2.2 (0.81 to 3.63) Large effect |
VERY LOW aa, b |
| Adults, older adults; myocardial infarction; in community settings; China | ||||
|
Wu 2020 [96] Low (†Critically low) |
6-min walk time—6MWT (5 RCTs) | TC (n = 234) vs Ucare, HEd, Ex (n = 231) |
SMD 1.3 (0.50 to 2.11) Large effect |
LOW a, b |
| Left ventricular ejection fraction—LVEF (5 RCTs) | TC (n = 234) vs Ucare, HEd, Ex (n = 231) |
SMD 1.0 (0.43 to 1.57) Large effect |
LOW a, b |
|
| Hyperlipidaemia | ||||
| Adults, older adults; hyperlipidemia, type 2 diabetes mellitus, hypertension, obesity; in community settings; China, Hong Kong, Taiwan, Australia | ||||
|
Pan 2016 [84] Low (†Critically low) |
Total cholesterol (6 RCTs) | TC (n = 220) vs Ucare, Ex, waitlist (n = 225) |
MD − 7.7 mg/dL (− 17.3 to 1.4) Equivalent effect, MCID 20 mg/dL (10% reduction from 200 mg/dL) |
VERY LOW a, b, d |
| Triglycerides (6 RCTs) | TC (n = 220) vs Ucare, Ex, waitlist (n = 225) |
MD − 16.8 mg/dL (− 31.3 to − 2.4) Moderate effect, MCID 15 mg/dL (10% reduction from 150 mg/dL) |
MODERATE a |
|
| High-density lipoprotein cholesterol—HDL-C (5 RCTs) | TC (n = 192) vs Ucare, Ex (n = 200) |
MD 0.46 mg/dL (− 0.71 to 1.64) Equivalenteffect, MCID 4 mg/dL (10% increase from 40 mg/dL) |
MODERATE a (†LOW) |
|
| Low-density lipoprotein cholesterol—LDL-C (4 RCTs) | TC (n = 136) vs Ucare, Ex (n = 152) |
MD − 1.61 mg/dL (− 16.25 to 13.02) Equivalent effect, MCIS − 10 mg/dL (10% reduction from 100 mg/dL) |
VERY LOW a, bb, d |
|
| Essential hypertension | ||||
| Adults, older adults; essential hypertension; in community settings; China, Taiwan | ||||
|
Zhong 2020 [105] High |
Systolic blood pressure (9 RCTs) | TC (n = 456) vs noRx, HEd (n = 458) |
MD − 14.8 (− 19.6 to − 10.0) Large effect, MCID − 10 mmHg |
LOW a, b |
| Diastolic blood pressure (9 RCTs) | TC (n = 456) vs noRx, HEd (n = 458) |
MD − 7.0 (− 9.1 to − 5.0) Large effect, MCID − 5 mmHg |
MODERATE a |
|
| Systolic blood pressure (15 RCTs) | TC (n = 406) vs Pharm (n = 348) |
MD − 9.1 (− 14.0 to − 4.1) Moderate effect, MCID − 10 mmHg |
LOW a, b |
|
| Diastolic blood pressure (15 RCTs) | TC (n = 406) vs Pharm (n = 348) |
MD − 5.6 (− 14.0 to − 4.1) Moderate effect, MCID − 5 mmHg |
LOW a, b |
|
| Systolic blood pressure (5 RCTs) | TC (n = 123) vs Ex (n = 123) |
MD − 7.9 (− 14.2 to − 1.7) Small effect, MCID − 10 mmHg |
LOW a, b (†VERY LOW) |
|
| Diastolic blood pressure (5 RCTs) | TC (n = 123) vs Ex (n = 123) |
MD − 3.9 (− 6.5 to − 1.2) Small effect, MCID − 5 mmHg |
MODERATE a (†LOW) |
|
| Adults, older adults; hypertension; in community settings; China, Hong Kong, USA | ||||
|
Taylor-Piliae 2020 [90] Critically low |
QoL—mental health (3 RCTs) | TC (n = 311) vs Ucare (n = 311) |
SMD 0.13 (NI) p = 0.13 Equivalent effect |
MODERATE d |
| QoL—physical (3 RCTs) | TC (n = 311) vs Ucare (n = 311) |
SMD 0.47 (NI) p < 0.001 Small effect |
HIGH | |
| Diabetes mellitus | ||||
| Adults, older adults; type 2 diabetes mellitus; in community settings; China, South Korea, Thailand, Australia | ||||
|
Zhou 2019 [106] Critically low |
Glycosylated haemoglobin—HbA1c % (14 RCTs) | TC (n = 466) vs Ucare, Ucare + TCM, HEd, sham exercise (n = 395) |
MD − 0.88% (− 1.45 to − 0.31) Small effect, MCID 1% [56] |
LOW a, b |
| Systolic blood pressure—SBP (5 RCTs) | TC (n = 151) vs Ucare, ADL, noEx (n = 139) |
MD − 10.0 mmHg (− 15.8 to − 4.3) Moderate effect, MCID 10 mmHg |
MODERATE a (†LOW) |
|
| Diastolic blood pressure—DBP (5 RCTs) | TC (n = 151) vs Ucare, ADL, noEx (n = 139) |
MD − 4.9 mmHg (− 8.2 to − 1.5) Moderate effect, MCID 5 mmHg |
MODERATE a (†LOW) |
|
| QoL physical function – SF36 (5 RCTs) | TC (n = 151) vs Ucare, ADL, noEx (n = 139) |
MD 7.1 (0.79 to 13.4) Large effect, MCID 3 points [50] |
LOW a, b (†VERY LOW) |
|
| QoL bodily pain – SF36 (5 RCTs) | TC (n = 151) vs Ucare, ADL, noEx (n = 139) |
MD 4.3 (0.8 to 7.8) Moderate effect, MCID 3 points [50] |
MODERATE a (†LOW) |
|
| Chronic obstructive pulmonary disease | ||||
| Adults, older adults; chronic obstructive pulmonary disease; in community settings; China, Hong Kong, USA | ||||
|
Guo 2020 [67] Low |
Forced expiratory volume in 1 s—FEV1, ≤ 3 months (3 RCTs) | TC (n = 111) vs noEx (n = 108) |
MD 0.13L (0.06 to 0.20) Moderate effect, MCID 0.1L [43] |
MODERATE a (†LOW) |
| FEV1, ≤ 3 months (5 RCTs) | TC (n = 272) vs Ex + /or breathing Ex (n = 275) |
MD 0.06L (− 0.01 to 0.14) Equivalent effect, MCID 0.1L [43] |
LOW a, d |
|
| 6-min walk time—6MWT, ≤ 3 months (6 RCTs) | TC (n = 182) vs noEx (n = 181) |
MD 24.3 m (6.3 to 42.3) |
LOW a, b (†VERY LOW) |
|
| 6MWT, ≤ 3 months (6 RCTs) | TC (n = 308) vs Ex + /or breathing Ex (n = 313) |
MD 7.5 m (2.1 to 12.3) |
MODERATE a |
|
| QoL—St George Respiratory Questionnaire—SGRQ, ≤ 3 months (3 RCTs) | TC (n = 129) vs noEx (n = 128) |
MD − 8.7 points (− 14.6 to − 2.7) |
MODERATE a (†LOW) |
|
| QoL—SGRQ, ≤ 3 months (4 RCTs) | TC (n = 260) v Ex + /or breathing Ex (n = 265) |
MD − 1.9 points (− 4.6 to 0.7) |
MODERATE a |
|
| Cognitive function and impairment | ||||
| Older adults; no cognitive impairment; in in community settings; China, Hong Kong, Japan, France | ||||
|
Wayne 2014 [94] Critically low |
Executive function (4 RCTs) | TC (n = 151) vs noEx (n = 270) |
SMD 0.90 (0.03 to 1.78) Large effect |
MODERATE b |
| Executive function (2 RCTs) | TC (n = 67) vs Ex (n = 69) |
SMD 0.51 (0.17 to 0.85) Moderate effect |
MODERATE d |
|
| Older adults; Mild cognitive impairment; in community settings; China, Thailand, USA, France | ||||
|
Zhang 2020 [102] Low (†Critically low) |
Global cognitive function—Mini-Mental State Examination—MMSE (5 RCTs) | TC (n = 325) vs Cognition-action, Ucare, HEd, Ex, other activities (n = 460) |
MD 0.29 points (− 0.61 to 0.74) Equivalent effect, MCID 1 point [41] |
HIGH |
| Memory—Delayed Recall Test (4 RCTs) | TC (n = 297) vs ADL, HEd, Ex (n = 429) |
MD 0.37 points (0.13 to 0.61) A positive effect, MCID unknown |
HIGH | |
| Performance—Digit Span Test (4 RCTs) | TC (n = 297) vs ADL, HEd, Ex (n = 429) |
MD 0.03 point (− 0.16 to 0.22) Equivalent effect, MCID unknown |
HIGH | |
| Fatigue, fibromyalgia, and sleep quality | ||||
| Fatigue, any cause | ||||
| Adults, older adults; fatigue without serious ailments, cancer, multiple sclerosis, chronic obstructive pulmonary disease, insomnia, rheumatoid arthritis; in community settings; China, Hong Kong, USA, Spain, Germany | ||||
|
Xiang 2017 [97] Moderate (†Low) |
Fatigue (10 RCTs) | TC (n = 356) vs noRx, Ucare, HEd, Ex, sham Qigong (n = 333) |
SMD − 0.45 (− 0.70 to − 0.20) Small effect |
MODERATE a |
| Vitality (4 RCTs) | TC (n = 115) vs noRx, HEd, Ex (n = 333) |
SMD 0.63 (0.20 to 1.07) Moderate effect |
LOW aa |
|
| Depression (7 RCTs) | TC (n = 216) vs noRx, Ucare, HEd, Ex, other control (n = 199) |
SMD − 0.58 (− 1.04 to − 0.11) Moderate effect |
VERY LOW aa, b |
|
| Fibromyalgia | ||||
| Adults; fibromyalgia; in community settings; USA, South Korea, UK, Italy | ||||
|
Cheng 2019 [61] Low (†Critically low) |
QoL—Fibromyalgia impact questionnaire—FIQ 12–16 weeks (4 RCTs) | TC (n = 158) vs Ucare (n = 149) |
SMD − 0.61 (− 0.90 to − 0.31) Moderate effect |
MODERATE a (†LOW) |
| QoL—FIQ 24–32 weeks (2 RCTs) | TC (n = 82) vs Ucare (n = 78) |
SMD − 0.49 (− 1.56 to 0.58) Equivalent effect |
VERY LOW a, b, dd |
|
| Pain (3 RCTs) | TC (n = 100) vs noRx, Ucare, HEd, Ex (n = 90) |
SMD − 0.88 (− 1.58 to − 0.18) Large effect |
VERY LOW a, b, d |
|
| Sleep quality | ||||
| Adults, older adults; healthy, stroke, fibromyalgia, cancer, arthritis, depression, chronic kidney disease, heart disease; in community settings; China, Japan, Vietnam, USA, Italy, Iran | ||||
|
Si 2020 [86] Low (†Critically low) |
Pittsburgh Sleep Quality Index, healthy (10 RCTs) | TC (n = 426) vs noRx, Ex, HEd (n = 401) |
SMD − 0.68 (− 1.06 to − 0.31) Moderate effect |
LOW a, b |
| Pittsburgh Sleep Quality Index, chronic disease (15 RCTs) | TC (n = 543) vs Ucare, Hed, Psych, Rehab, sham Qigong, acupuncture, waitlist (n = 564) |
SMD − 0.39 (− 0.74 to − 0.05) Small effect |
LOW a, b |
|
| Mental health | ||||
| Depression, anxiety, stress, mood for general populations (also see chronic heart failure, stroke, knee osteoarthritis, fatigue) | ||||
| Adults, older adults; depression and/or chronic diseases; Asian, North American and European countries | ||||
|
Yin 2014 [98] Low |
Depression (25 RCTs: 1RCT Lyu 2020 [80], 1 RCT Hu 2020 [70]) |
TC vs noRx, Ex, sham/other (total sample < 1435) |
SMD 0.36 (0.19 to 0.53) Small effect |
HIGH |
| Anxiety (11 RCTs) |
TC vs noRx (total sample < 1435) |
SMD 0.34 (0.02 to 0.66) Small effect |
MODERATE b |
|
| Adults, older adults; healthy, osteoarthritis, rheumatoid arthritis, fibromyalgia, HIV infection, depression, frail; in community settings; China, USA, Australia, UK, Germany, France | ||||
|
Wang 2010 [93] Critically low |
Stress (4 RCTs) |
TC vs ADL, Psych, waitlist (total sample n = 308) |
SMD 0.97 (0.06 to 1.87) Large effect |
VERY LOW aa, bb |
| Mood / affect (2 RCTs) |
TC vs ADL, Psych, waitlist (total sample n = 191) |
SMD 0.25 (− 0.04 to 0.53) Equivalent effect |
VERY LOW aa, d |
|
| Schizophrenia | ||||
| Adults, older adults; schizophrenia; in hospital, long-stay care, halfway house service; China | ||||
|
Zheng 2016 [104] Moderate (†Low) |
Negative symptoms—Positive and Negative Syndrome Scale—PANSS (6 RCTs) | TC + Ucare (n = 200) vs Ucare + / − Pharm, HEd, Ex, noEx, waitlist (n = 251) |
SMD − 0.87 (− 1.51 to − 0.24) Large effect |
LOW a, b |
| Positive symptoms—PANSS (5 RCTs) | TC + Ucare (n = 170) vs Ucare + / − Pharm, HEd, Ex, noEx, waitlist (n = 221) |
SMD − 0.09 (− 0.44 to 0.26) Equivalent effect |
MODERATE a (†LOW) |
|
| Discontinuation rate (4 RCTs) | TC + Ucare (n = 170) vs Ucare + / − Pharm, HEd, Ex, noEx, waitlist (n = 221) |
RR 0.06 (0.23 to 1.40) 3 fewer per 100 adults |
VERY LOW a, dd |
|
| Musculoskeletal conditions and pain | ||||
| Osteoarthritis | ||||
| Older adults; knee osteoarthritis; in community settings; China, South Korea, USA | ||||
|
Hu 2020 [70] Low (†Critically low) |
WOMAC pain (14 RCTs) | TC (n = 455) vs Ucare, noEx, HEd, PT (n = 422) |
SMD − 0.69 (− 0.95 to − 0.44) Moderate effect |
MODERATE a |
| WOMAC stiffness (12 RCTs) | TC (n = 396) vs Ucare, noEx, HEd, PT (n = 373) |
SMD − 0.65 (− 0.98 to − 0.33) Moderate effect |
LOW a, b |
|
| WOMAC physical function (13 RCTs) | TC (n = 437) vs Ucare, noEx, HEd, PT (n = 407) |
SMD − 0.92 (− 1.16 to − 0.69) Large effect |
MODERATE a |
|
| Depression (3 RCTs: 1 RCT in Yin 2014 [98]) | TC (n = 167) vs Ucare, noEx, HEd, PT (n = 152) |
SMD − 0.46 (− 0.68, − 0.24) Small effect |
MODERATE a |
|
| Arthritis self-efficacy scale (4 RCTs) | TC (n = 185) vs Ucare, noEx, HEd, PT (n = 167) |
SMD 0.27 (0.06 to 0.48) Small effect |
MODERATE a (†LOW) |
|
| Adults, older adults; healthy, osteoarthritis; in in community settings | ||||
|
Su 2020 [88] Critically low |
Knee extensor muscle strength, females (60°/s) (2 RCTs) | TC (n = 40) vs noRx, Ex, Pharm, HEd (n = 45) |
MD 17.5 (− 12.0 to 47.0) Equivalent effect, MCID unknown |
VERY LOW a, b, dd |
| Knee flexor muscle strength, females (60°/s) (2 RCTs) | TC (n = 40) vs noRx, Ex, Pharm, HEd (n = 45) |
MD 22.1 (1.1 to 43.2) Positive effect, MCID unknown |
VERY LOW a, dd (†LOW) |
|
| Knee flexor muscle strength one maximum strength—1-RM (2 RCTs) | TC (n = 57) vs noRx, HEd (n = 57) |
MD 3.3 (2.1 to 4.4) Positive effect, MCID unknown |
LOW a, d |
|
|
Knee extensor muscle strength 1-RM (4 RCTs) |
TC (n = 114) vs noRx, HEd, Ex (n = 112) |
SMD 0.90 (0.34 to 1.45) Large effect |
MODERATE a (†LOW) |
|
| Rheumatoid arthritis | ||||
| Adults, older adults; rheumatoid arthritis; in community settings; China, South Korea, USA | ||||
|
Mudano 2019 [82] High |
Pain, visual analogue scale, 12 weeks (2 RCTs) | TC (n = 42) vs noEx, Ex (n = 39) |
SMD − 0.95 (− 1.41 to − 0.49) Large effect |
VERY LOW aa, dd |
| Disease activity, DAS-28-ESR, 12 weeks (1 RCT) | TC (n = 29) vs HEd (n = 14) |
MD − 0.40 points (− 1.10 to 0.30) Equivalent effect, MCID − 1.17 points [58] |
VERY LOW aa, dd |
|
| Function, Health Assessment Questionnaire – HAQ, 12 weeks (2 RCTs) | TC (n = 39) vs Hed, Ex (n = 24) |
MD − 0.33 points (− 0.79 to 0.12) Equivalent effect, MCID − 0.38 points [58] |
VERY LOW aa, b, dd |
|
| Low back pain | ||||
| Adults, older adults; Low back pain; in community settings; China, Australia | ||||
|
Qin 2019 [85] Low (†Critically low) |
Pain VAS 1–10 scale (3 RCTs) | TC (n = 123) vs ADL, waitlist (n = 120) |
MD − 1.2 points (− 2.3 to − 1.1) Moderate effect, MCID − 1.2 |
LOW a, b (†VERY LOW) |
| Pain VAS 1–10 scale (5 RCTs) | TC + Ucare (n = 363) vs Ucare (n = 268) |
MD − 1.1 (− 1.3 to − 0.9) Moderate effect, MCID − 1.2 |
MODERATE a |
|
| Headache | ||||
| Adults, older adults; chronic pain from tension headaches; in community settings; USA | ||||
|
Hall 2017 [68] Low (†Critically low) |
Pain SF-36 15 weeks (1 RCT) | TC (n = 13) vs waitlist (n = 17) |
SMD − 1.85 (− 2.73 to − 0.97) Large effect |
VERY LOW aa, dd |
| Osteoporosis, osteopenia | ||||
| Adults, older adults; osteoporosis, osteopenia; in community settings; NI countries | ||||
|
Zhang 2019 [101] Moderate (†Low) |
Spine Bone mineral density—BMD (6 RCTs) | TC (n = 128) vs noRx (n = 119) |
MD 0.04 g/cm2 (0.02 to 0.06) Small effect, MCID ~ 0.05 g/cm2 [54] |
MODERATE a (†LOW) |
| Femur BMD (3 RCTs) | TC (n = 85) vs noRx (n = 83) |
MD 0.04 g/cm2 (0.01 to 0.06) Small effect, MCID ~ 0.05 g/cm2 [54] |
LOW a, d |
|
| Spine BMD (2 RCTs) | TC (n = 52) vs Ucare (n = 55) |
MD 0.16 g/cm2 (0.09 to 0.23) Large effect, MCID ~ 0.05 g/cm2 [54] |
LOW a, d |
|
| Femur BMD (2 RCTs) | TC (n = 52) vs Ucare (n = 55) |
MD 0.16 g/cm2 (0.04 to 0.29) Large effect, MCID ~ 0.05 g/cm2 [54] |
VERY LOW a, b, d |
|
| Stroke, Parkinson’s disease, and falls | ||||
| Stroke | ||||
| Adults, older adults; healthy, type 2 diabetes mellitus, hyperlipidaemia; in community settings; China | ||||
|
Zheng 2015 [103] Low (†Critically low) |
Incidence of nonfatal stroke over 1–2 years (2 RCTs) | TC + Ucare (n = 62) vs Ucare (n = 58) |
RR 0.11 (0.01 to 0.85) 89% reduced risk |
LOW a, d |
|
Incidence of fatal stroke over 1–2 years (2 RCTs) |
TC + Ucare (n = 62) vs Ucare (n = 58) |
RR 0.33 (0.05 to 2.05) 77% reduced risk |
LOW a, d (†VERY LOW) |
|
| Adults, older adults; stroke survivors; in community settings; NI countries | ||||
|
Lyu 2018[81] Moderate (†Low) |
Berg Balance Scale—BBS (2 RCTs) | TC (n = 75) vs Rehab (n = 75) |
MD 5.2 points (3.4 to 7.1) Moderate effect, MCID 4.3 to 7.3 points [47] |
LOW a, d |
|
Fugl-Meyer Assessment FMA—all four limbs (2 RCTs) |
TC + Rehab (n = 51) vs Rehab (n = 49) |
MD 4.5 points (1.9 to 7.1) A positive effect, MCID unknown |
LOW a, d |
|
| FMA—upper extremity (2 RCTs) | TC + Rehab (n = 56) vs Rehab (n = 51) |
MD 8.3 points (4.7 to 11.8) Large effect, MCID 5.3 points [51] |
LOW a, d |
|
| FMA—lower extremity (3 RCTs) | TC + Rehab (n = 85) vs Rehab (n = 81) |
MD 2.8 points (0.95 to 4.56) Small effect, MCID 6 points [52] |
VERY LOW a, b, d |
|
| Timed up and go—TUG (4 RCTs) | TC + Rehab (n = 100) vs Rehab (n = 96) |
MD 2.6 s (1.8 to 3.4) Small effect, MCID 8 s [47] |
LOW a, d |
|
|
Activities of daily living—Barthel Index (2 RCTs) |
TC (n = 81) vs Rehab (n = 85) |
MD 9.9 points (6.8 to 13.0) Large effect, MCID 6.8 points [44] |
LOW a, d |
|
| Adults, older adults; stroke survivors; in community settings; China, South Korea, Japan, USA, Israel | ||||
|
Lyu 2020 [80] Moderate (†Low) |
Depression (6 RCTs) | TC (n = 278) vs Rehab (n = 280) |
SMD 0.36 (0.10 to 0.61) Small effect |
LOW aa |
| Parkinson’s disease | ||||
| Older adults; Parkinson’s disease; in community settings; NI countries | ||||
|
Yu 2018 [100] Critically low |
Unified Parkinson’s Disease Rating III: Motor (8 RCTs) | TC (n = 204) vs noRx, Ucare, Pharm, Ex (n = 262) |
MD − 3.7 points (− 5.7 to − 1.7) Moderate effect, MCID − 3.3 points [48] |
MODERATE b |
| Timed up and go—TUG (7 RCTs) | TC (n = 188) vs noRx, Ucare, Pharm, Ex (n = 251) |
SMD − 0.50 (− 0.88 to − 0.11) Moderate effect |
HIGH | |
| Berg balance scale—BBS (6 RCTs) | TC (n = 144) vs noRx, Ucare, Pharm, Ex (n = 145) |
SMD 0.85 (0.44 to 1.27) Large effect |
HIGH (†MODERATE) |
|
| QoL – Parkinson’s Disease Questionnaire—PDQ-39, PDQ-8 (3 RCTs) | TC (n = 104) vs noRx, Ucare, Pharm, Ex (n = 159) |
SMD − 0.75 (− 1.45 to − 0.04) Moderate effect |
HIGH (†MODERATE) |
|
| Falls and risk factors | ||||
| Older adults; with or without a history of falling, stroke, Parkinson’s disease, females with osteopenia; in hospital, in community settings; China, Taiwan, USA, Canada, Australia, New Zealand, Netherlands | ||||
|
Huang 2017 [73] Low (†Critically low) |
Rate of people who fell (no. of fallers) (16 RCTs) | TC (n = 1889) vs ADL, noRx, PT, Ex (n = 1650) |
RR 0.80 (0.72 to 0.88) 20% reduced risk, 9 fewer per 100 |
MODERATE e |
| Incidence of falls (no. falls) (15 RCTs) | TC (n = 1512) vs ADL, noRx, PT, Ex (n = 1542) |
RR 0.69 (0.60 to 0.80) 31% reduced risk |
MODERATE e |
|
| Older adults; in hospital, nursing home, in community settings; China, USA, Canada, Australia, New Zealand, UK, Netherlands | ||||
|
Huang 2020 [71] Critically low |
Balance – Single Leg Stance (SLS) (8 RCTs) | TC (n = 417) vs ADL, Ex, other activities (n = 419) |
MD 5.8 s (0.62 to 10.90) Small effect, MCID 41 s [45] |
VERY LOW a, bb |
| Berg balance scale—BBS (4 RCTs) | TC (n = 412) vs ADL, Ex (n = 400) |
MD 1.0 points (0.2 to 1.9) Small effect, MCID 4 points [42] |
MODERATE a |
|
| Timed up and go—TUG (6 RCTs) | TC (n = 190) vs ADL, Ex (n = 178) |
MD − 0.71 s (− 0.88 to − 0.54) Probably small effect, MCID unknown |
MODERATE a (†LOW) |
|
| Older adults; with or without a history of falling; in community settings; USA, Canada, China, Vietnam, Iran | ||||
|
Kruisbrink 2020 [75] Low (†Critically low) |
Fear of falling (6 RCTs) | §TC with an instructor vs TC with no information about instructor (NI sample size) |
SMD.B − 1.05 (− 1.60 to − 0.50) Large effect |
VERY LOW aa, b, e |
§Erratum published 3 Sept. 2022 confirming control group was also TC. CI confidence interval, RD risk difference, MD mean difference, MID minimally important difference, SMD standardized mean difference, SMD.B: regression co-efficient for standardised mean difference, RR relative risk, RCT randomized controlled trial, QoL quality of life, ADL routine activities of daily living/ routine lifestyle, Ex exercise (any type, including stretching), HEd health/lifestyle/other education, noRx no treatment, control, Pharm pharmaceutical drugs / medication, Psych psychological interventions, counselling, support, PT physical therapy/physiotherapy, Rehab rehabilitation programs, TC Tai Chi intervention, TCM traditional Chinese herbal medicine, Ucare usual care, conventional treatment, standard medical care, MCID minimal clinically important difference, for SMD ≥ 0.50 is a moderate effect and SMD ≥ 0.80 large effect, a serious risk of bias, aa very serious risk of bias, b serious inconsistency between studies, bb very serious inconsistency between studies, c serious indirectness of evidence, cc very serious indirectness of evidence, d serious imprecision of effect, dd very serious imprecision of effect, e serious publication bias, ee very serious publication bias
*Estimate of effect favours Tai Chi unless stated otherwise
†Sensitivity analysis suggests a different rating.
For AMSTAR-2 refer to Additional File 5. For GRADE certainty refer to Additional File 6