Skip to main content
PMC home page
Frontiers in Neuroscience logoLink to Frontiers in Neuroscience
. 2023 Feb 10;17:1096789. doi: 10.3389/fnins.2023.1096789

Global trends of traditional Chinese exercises for musculoskeletal disorders treatment research from 2000 to 2022: A bibliometric analysis

Chong Guan 1,†, Yuanjia Gu 1,†, Ziji Cheng 1, Fangfang Xie 1, Fei Yao 1,*
PMCID: PMC9950260  PMID: 36845420

Abstract

Background

Traditional Chinese exercise has been shown to be effective in relieving long-term chronic pain, physical dysfunction, decreased ability to participate in society and decreased quality of life in musculoskeletal diseases. In recent years, there has been a steady increase in publications on the treatment of musculoskeletal disorders by traditional Chinese exercises. The purpose of this study is to review the characteristics and trends of Chinese traditional exercise studies on musculoskeletal diseases published since 2000 through bibliometric analysis, and identify current research hotspots, so as to guide the direction of future research.

Methods

Publications regarding traditional Chinese exercises for musculoskeletal disorders from 2000 to 2022 were downloaded from the Web of Science Core Collection. VOSviewer 1.6.18 and CiteSpace V software were used for bibliometric analyses. Bibliometric visualization and comparative analysis were conducted for authors, cited authors, journals, co-cited journals, institutions, countries, references, and keywords.

Results

A total of 432 articles were obtained, with an upward trend over time. The most productive countries and institutions in this field are the USA (183) and Harvard University (70). Evidence-based Complementary and Alternative Medicine (20) was the most prolific journal, Cochrane Database System Review (758) was the most commonly cited journal. Wang Chenchen published the largest number of articles (18). According to high frequency keywords, the hot spot musculoskeletal disorder and the type of traditional Chinese exercise are knee osteoarthritis and Tai Chi.

Conclusion

This study provides a scientific perspective for the research of traditional Chinese exercises for musculoskeletal disorders and provides valuable information for researchers to discover the current research status, hot spots and new trends of future research.

Keywords: traditional Chinese exercises, musculoskeletal disorders, bibliometric, VOSviewer, CiteSpace

Background

Musculoskeletal disorders are a group of diseases of the body’s motor structures, particularly the bones, joints, muscles, fascia, and other supporting structures such as ligaments and cartilages (Safiri et al., 2021). Musculoskeletal disorders include neck pain, low back pain, osteoarthritis, rheumatoid arthritis and other diseases (Jin et al., 2020). Many musculoskeletal disorders are recurrent or lifelong, with the main consequences are long-term chronic pain, physical dysfunction, self-care ability, social participation and reduced quality of life (Tung et al., 2021). Patients with musculoskeletal disorders are more likely to suffer from depression, anxiety, and further exacerbation of musculoskeletal disorders (Singh, 2022). Long-term musculoskeletal disorders may even increase the incidence of accidental disability and death, especially in the elderly. According to the WHO, falls are the leading cause of injury and death among older adults which also the second leading cause of unintentional injury deaths worldwide. Musculoskeletal disorders such as muscle weakness, knee osteoarthritis, and fractures are risk factors for falls (Dunlop et al., 2014; Wang et al., 2022b). Epidemiological studies in many developed countries show that musculoskeletal disorders are characterized by high rates of disability and absenteeism (Shanahan, 2019). It has a serious negative impact on the social life and emotions of patients, especially elderly patients. It causes great trouble to human health and great economic burden to individuals, families and even the society (Wu et al., 2021). Studies have shown that obesity, poor nutrition, smoking habits, excessive exercise and occupational injuries are all risk factors for musculoskeletal disorders.

Adjusting diet, moderate exercise, quitting smoking and drinking, are considered to be effective ways to reduce the incidence of muscle diseases and treat musculoskeletal diseases (Gwinnutt et al., 2022a,b). Traditional Chinese exercises is a kind of physical and mental exercise and complementary medical exercise therapy with Chinese cultural characteristics (Guo et al., 2016). Common traditional Chinese exercises include Tai Chi, Yi Jin Jing, Baduanjin, Wuqinxi and so on (Feng et al., 2020). Traditional Chinese exercises are low-intensity aerobic exercise suitable for people of all ages due to its slow and gentle movements. For example, Tai Chi is a traditional Chinese exercise which is widely regarded as a physical and mental exercise (Zou et al., 2018). Tai Chi is widely practiced for its health benefits (Lan et al., 2013). Tai Chi is a low intensity, non-competitive and non-impact exercise. It puts emphasis on the coordination of breathing, thinking and physical activity. The traditional Chinese exercises are gradually formed on the basis of the holistic concept of Traditional Chinese medicine, with the theory of five elements, Yin and Yang, meridians and zangfu. Many studies have shown that Tai Chi is beneficial for the medical management of musculoskeletal disorders such as neck pain, low back pain, knee osteoarthritis, Fibromyalgia and so on (Zhang et al., 2017; Slomski, 2018; Xie et al., 2021; Wang et al., 2022a.

Bibliometrics is widely used to discover research hotspots and analyze research results and research trends, which can help researchers identify current research hotspots and guide future research directions. In recent years, bibliometrics has been applied to Traditional Chinese exercises research fields, such as Tai Chi and traditional Chinese exercises for pain so on (Zhang et al., 2020a; You et al., 2021). But no article has ever been written to analyze the treatment of musculoskeletal disorders by traditional Chinese exercises from a bibliometric perspective.

Therefore, from the perspective of bibliometrics, this article sorts out and summarize the development, research hotspots and development trends of traditional Chinese exercises for musculoskeletal research. The aim of this study is to provide an overview of the published characteristics and trends of traditional Chinese exercises for musculoskeletal disorders since 2000 through bibliometric analysis.

Materials and methods

Data sources and search strategy

We selected Web of Science Core Collection (WoSCC) as the data source to identify and extract relevant publications. To cover as many target documents as possible, we chose terms that most scientific publications might use to build the search strategy. Terms related to traditional Chinese exercises and musculoskeletal disorders were extracted from the Medical Subject Headings (MeSH) in PubMed (Supplementary material for retrieval information). In order to avoid possible problems such as duplication, missing or inconsistency with the theme, it is necessary to screen and standardize the data before analysis to avoid the quality of the data itself affecting the results. The detailed search strategy is in Supplementary material.

The inclusion criteria are as follows:(1) The literature retrieval period is from 1 January 2000 to 14 August 2022; (2) the literature type is “article” and “review;” and (3) the language type is English.

The exclusion criteria are as follows: (1) The literature whose research topic was not related to the traditional Chinese exercise exercises for musculoskeletal diseases; (2) Letters, reports, short papers or briefs.

The errata type of documents resulted in 432 papers. The data collection flow chart is shown in Figure 1.

FIGURE 1.

FIGURE 1

Open in a new tab

Flow diagram of literature search and screening.

The steps of data review and screening in this study were as follows: (1) Two team members independently reviewed the articles and screened out the articles which were inconsistent with the research topic. These controversial articles were voted out by our team. (2) We corrected and harmonized of the selected articles, institutions and countries in order to avoid the influence of author, institution, country name on the results. (3) Keywords were standardized, because the non-standardized keywords would lead to meaningless repetition in the keyword co-occurrence graph due to the inconsistency of pos and plural and singular versions, so keywords were standardized.

For example, the three keywords of “metaanalysis,” “meta analysis,” and “Meta analysis” are unified as “meta-analysis” in this study.

Statistical analysis

VOSviewer 1.6.18 and CiteSpace 6.1.R1 software were used to conduct bibliometrics analysis on key characteristics of literatures such as the number of publications, countries/regions, institutions, authors, journals, literatures, keywords and so on. VOSviewer and CiteSpace are widely used bibliometric tools. VOSviewer is a freely available program which has the added advantage of graphical representation in bibliometric mapping by displaying large bibliometric maps in an easy-to-interpret manner. CiteSpace is a free and available program, which has greater advantages in intuitively catching up the research hotspots and evolutionary processes of various fields in the knowledge system and predicting the development trends of various fields.

Results

Analysis of annual publications

Figure 2 shows the number of published in the field of traditional Chinese exercises for musculoskeletal disorders. From 2000 to 2006, there were few publications on the treatment of musculoskeletal disorders by traditional Chinese exercises. The number of articles was no more than five which indicated that this research field has not received attention. The number of publications from 2007 to 2014 was significantly higher than that before 2006, but the number of publications during the period did not change much, indicating that this field has gradually attracted attention. From 2014 to 2021, the number of publications was increased. Although the number of documents issued will decrease after 2020, this may be because the arrival of COVID-19 has hindered the traditional Chinese exercises, which is mainly clinical research. This trend is consistent with what has been observed in other areas of research. From the trend of Figure 2, It is found that more research on traditional Chinese exercises for musculoskeletal disorders is being conducted.

FIGURE 2.

FIGURE 2

Open in a new tab

The number of annual publications on traditional Chinese exercises for musculoskeletal disorders research from 2000 to 2022.

Analysis of journal

A total of 432 publications related to Chinese traditional exercise for musculoskeletal disorders were published in 209 journals. Table 1 shows the top 10 journals in terms of number of publications. Most of the publishers of these journals are located in the USA or England. The top three journals in terms of the number of publications are Evidence Based Comprehensive and Alternative Medicine, Medicine and Journal of Alternative and Comprehensive Medicine.

TABLE 1.

Top 10 journals with the highest frequency with traditional Chinese exercises for musculoskeletal disorders.

Rank Journal Publications Country Citations (WoS) Average citation/publication Impact factor (2021) Categories Quartile (JCR) OA
1 Evidence-Based Complementary and Alternative Medicine 20 England 342 17.10 2.650 Integrative and complementary medicine Q3 Yes
2 Medicine 18 USA 38 2.11 1.817 Medicine, general, and internal Q3 Yes
3 Journal of Alternative and Complementary Medicine 17 USA 390 22.94 2.381 Integrative and complementary medicine Q3 No
4 Complementary Therapies in Medicine 10 England 172 17.20 3.335 Integrative and complementary medicine Q2 Yes
5 Bmc Musculoskeletal Disorders 7 England 185 26.43 2.562 Orthopedics rheumatology Q3; Q4 Yes
5 Cochrane Database of Systematic Review 7 England 767 109.57 11.874 Medicine, general, and internal Q1 No
5 Osteoarthritis and Cartilage 7 England 245 35.00 7.507 Orthopedics rheumatology Q1; Q1 No
5 Pain Medicine 7 USA 245 35.00 3.637 Anesthesiology medicine, general, and internal Q2; Q2 No
5 Trials 7 England 56 8.00 2.728 Medicine, general, and internal Q4 Yes
10 Arthritis Care and Research 6 USA 2,132 355.33 5.178 Rheumatology Q2 No
10 British Journal of Sports Medicine 6 England 657 109.50 18.479 Sport sciences Q1 No
10 Current Pain and Headache Reports 6 USA 290 48.33 3.904 Clinical neurology Q2 No
10 Journal of Physical Therapy Science 6 Japan 92 15.33 0.392 Rehabilitation Q4 No
10 PLoS One 6 USA 333 55.50 3.752 Multidisciplinary sciences Q2 Yes
Open in a new tab

The analysis of co-citation journals shows that important knowledge sources are distributed in a specific field. Our statistical analysis results show that 4,113 articles published in Chinese traditional exercise for musculoskeletal disorders have been co-cited.

Table 2 shows the top 10 cited journals in terms of number of publications. The most frequently cited journal is Cochrane Database of Systematic Reviews, followed by Journal of Rheumatology and Pain. We found that most of the top 10 journals cited were in Q1, indicating that the research in this field mainly cited high-quality journals. According to the citation analysis of journals, the most cited journal is Annals of Internal Medicine, a high-level journal in the medical field, with a total of six articles, a single article was cited 75.83 times. This shows that the quality of the articles published in this journal is high and have received extensive attention in this research field.

TABLE 2.

Top 10 cited journals with the highest frequency with traditional Chinese exercises for musculoskeletal disorders.

Rank Journal Citations Country IF (2021) Categories Quartile (JCR)
1 Cochrane Database of Systematic Reviews 758 England 11.874 Medicine, general and internal Q1
2 Journal of Rheumatology 556 Canada 5.346 Rheumatology Q2
3 Pain 502 USA 7.926 Neurosciences clinical neurology anesthesiology Q1; Q1; Q1
4 Arthritis & Rheumatism-Arthritis Care & Research (Arthritis and Rheumatism) 489 USA / Rheumatology /
5 Archives of Physical Medicine and Rehabilitation 453 USA 4.06 Rehabilitation sport sciences Q1; Q1
6 Journal of Alternative and Complementary Medicine 408 USA 2.381 Integrative and complementary medicine Q3
7 Spine 402 USA 3.269 Orthopedics clinical neurology Q3; Q2
8 Journal of the American Geriatrics Society 392 USA 7.538 Gerontology geriatrics and gerontology Q1; Q1
9 Annals of Internal Medicine 329 USA 51.598 Medicine, general, and internal Q1
10 Osteoarthritis and Cartilage 327 England 7.507 Orthopedics rheumatology Q1; Q1
Open in a new tab

Figure 3 is a dual-map superposition of the references in traditional Chinese exercises for musculoskeletal disorders research. Cited journals are on the left and co-cited journals are on the right. The reference link comes from the journal on the left side of the map and points to the journal on the right side of the map. The green path indicates that documents published in “medicine, medical clinical” journals are often cited by “health, nursing, medicine, sports, rehabilitation, sport” and “psychology, education, social” journals. Pink path indicates that documents published in journals are often cited by “health, nursing, medicine, sports, rehabilitation, sport” journals.

FIGURE 3.

FIGURE 3

Open in a new tab

The dual-map overlay of journals.

Analysis of country and institutions

VOSviewer is used to generate a network visualization map. In order to make the network clear, 16 countries/regions that publish at least five articles are visualized. The size of the node is determined by the number of published articles (the more the number, the larger the node). The lines between nodes represent the cooperation between countries/regions (the stronger the cooperation, the wider the lines). The number of total link strength reflects the strength of cooperation between countries/regions. From 2000 to 2022, articles on traditional Chinese exercises for musculoskeletal disorders came from 38 different countries/regions independently or cooperatively. Table 3 shows top 10 countries for publications of traditional Chinese medicine in musculoskeletal disorder. The publications authors are mainly from the USA, with 183 articles published, followed by China (129). Canada (41), Australia (31), and Germany (25) also made considerable contributions to the research of Chinese traditional exercise for musculoskeletal disorders.

TABLE 3.

Top 10 countries for publications of traditional Chinese exercises for musculoskeletal disorders.

Rank Country Publications Citations Average citations/publication
1 USA 183 9,308 50.86
2 China 129 2,151 16.67
3 Canada 41 4,602 112.24
4 Australia 31 1,761 56.81
5 Germany 25 828 33.12
6 England 23 1,129 49.09
7 South Korea 16 568 35.5
8 Italy 12 107 8.92
9 Spain 11 222 20.18
9 Sweden 11 422 38.36
Open in a new tab

Table 4 shows top 10 institutions with the highest frequency of traditional Chinese exercises for musculoskeletal disorders. In order to make the network clear, 36 institutions that publish at least five articles are visualized (Figure 4). The top 10 institutions with the largest number of publications have been identified, including 4 from China, 3 from the USA, 2 from Australia, 1 from Canada and 1 from Germany. The distribution of the top 10 organizations in terms of the number of documents issued is consistent with the distribution characteristics of each country. Among them, Harvard University contributed 31 articles to the largest number of publications in the USA. Shanghai University of Traditional Chinese Medicine contributed 17 articles to the largest number of publications in China. From the time line of articles published by institutions generated by VOSviewer, around 2020, university of traditional Chinese medicine, especially Shanghai University of Traditional Chinese Medicine and Chengdu University of Traditional Chinese Medicine paid more attention to the research of traditional Chinese exercises on musculoskeletal treatment.

TABLE 4.

Top 10 Institutions with the highest frequency of traditional Chinese exercises for musculoskeletal disorders.

Rank Country Publications Citations Average citations/publication
1 Harvard University 31 972 31.35
2 Tufts University 22 1,616 73.45
3 Shanghai University of Traditional Chinese Medicine 17 139 8.18
4 Shanghai University of Sport 15 255 17.00
5 University of Ottawa 13 2,077 159.77
6 The Chinese University of Hong Kong 12 456 38.00
7 University of Duisburg-Essen 12 427 35.58
8 Fujian University of Traditional Chinese Medicine 11 161 14.64
9 North Carolina University 11 970 88.18
10 The University of Sydney 10 961 96.10
10 University of Toronto 10 1,180 118.00
Open in a new tab

FIGURE 4.

FIGURE 4

Open in a new tab

Map of countries with publications in traditional Chinese exercises for musculoskeletal disorders research from 2000 to 2022.

Analysis of authors

Table 5 shows the top ten authors in this field. Among the authors in the field of traditional Chinese exercises for musculoskeletal disorders, Wang CC published the most articles (Zhang et al., 2017), which were cited 946 times, with an average of 52.56 times. Three of the top five articles cited in total are published by Wang CC. The top five active authors all published at least 10 articles. Mcalindon Timothy is the researcher who has cited the most per article, with an average of 93.86 times for each article.

TABLE 5.

Top 10 authors for publications on traditional Chinese exercises for musculoskeletal disorders.

Rank Author Publications Citations Average citations/publication
1 Wang, Chenchen 18 946 52.56
2 Harvey, William F 11 356 32.36
3 Driban, Jeffrey B 10 401 40.10
3 Price, Lori Lyn 10 401 40.10
3 Zou, Liye 10 330 33.00
6 Wayne, Peter M 9 248 27.56
7 Dobos, Gustav 8 290 36.25
8 Cramer, Holger 7 138 19.71
8 Mcalindon, Timothy 7 657 93.86
8 Rones, Ramel 7 655 93.57
Open in a new tab

Analysis of cited reference and co-cited reference

Table 6 shows the most cited articles in the field of traditional Chinese exercises for musculoskeletal disorders. Among the top 10 most cited publications on traditional Chinese exercises for musculoskeletal disorders, there was five systematic reviews, three guideline literature, one clinical randomized controlled trial and one review. The results show that high quality systematic review can sort out the evidence of clinical research in this field and get higher level evidence.

TABLE 6.

The top 10 references based on the number of citations traditional Chinese exercises for musculoskeletal disorders.

Rank Citations First author Corresponding author Document type Year Journal IF (2021)
1 1,817 American College of Rheumatology 2012 recommendations for the use of non-pharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee Hochberg, Marc C. Hochberg, Marc C Article 2012 Arthritis Care and Research 5.178
2 911 Non-invasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians Qaseem, Amir Qaseem, Amir Article 2017 Annals of Internal Medicine 51.598
3 626 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee Kolasinski, Sharon L. Kolasinski, Sharon L Article 2020 Arthritis and Rheumatology 15.483
4 341 Non-pharmacologic therapies for low back pain: A systematic review for an American College of Physicians Clinical Practice Guideline Chou, Roger Chou, Roger Review 2017 Annals of Internal Medicine 51.598
5 308 Exercise for osteoarthritis of the knee: A Cochrane systematic review Fransen, Marlene Van der Esch, Martin Review 2015 British Journal of Sports Medicine 18.479
6 299 The effect of Tai Chi on health outcomes in patients with chronic conditions–A systematic review Wang, CC Wang, CC Review 2004 Archives of Internal Medicine /
7 260 Effects of Tai Chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: A randomized clinical trial Song, R Bae, SC Article 2003 Journal of Rheumatology 5.346
8 255 Physical activity and exercise for chronic pain in adults: An overview of cochrane reviews Geneen, Louise J Geneen, Louise J. Review 2017 Cochrane Database of Systematic Reviews 11.874
9 247 A review of the clinical evidence for exercise in osteoarthritis of the hip and knee Bennell, Kim L. Bennell, Kim L. Review 2011 Journal of Science and Medicine in Sport 4.597
10 209 Tai Chi: Physiological characteristics and beneficial effects on health Li, JX Li, JX Review 2001 British Journal of Sports Medicine 18.479
Open in a new tab

Co-citation means that two articles appear in the citation of the third cited article at the same time, thus forming a co-citation relationship. Co-citation indicates that the cited literature is related to the corresponding research in terms of content and the literature usually contains high-quality content with significant influence in a specific research field. In addition, the relationship between literature co-citations may change over time. The study of the influence of network on literature co-citation can facilitate the investigation of the development and evolution of specific disciplines.

Table 7 shows the most frequently cited articles published in the field of traditional exercise exercises for musculoskeletal disorders. Among the top 10 most cited publications on traditional Chinese exercises for musculoskeletal disorders, there were seven clinical randomized controlled trials, two reviews, one guideline literature and one systematic review. The results show that high quality clinical research is the focus of researchers in this field, which is helpful for the research in the field of traditional Chinese exercises for musculoskeletal disorders.

TABLE 7.

The top 10 co-cited references based on the number of citations traditional Chinese exercises for musculoskeletal disorders.

Rank Citations Title First author Corresponding author Document type Year Journal IF (2021)
1 91 Tai Chi is effective in treating knee osteoarthritis: A randomized controlled trial Wang, CC Wang, CC Article 2009 Arthritis and Rheumatism /
2 82 Effects of Tai Chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: A randomized clinical trial Song, R Bae, SC Article 2003 Journal of Rheumatology 5.346
3 67 Physical activity for osteoarthritis management: A randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes Fransen, Marlene Fransen, Marlene Article 2007 Arthritis and Rheumatism /
4 65 A randomized trial of Tai Chi for fibromyalgia Wang, CC Wang, CC Article 2010 New England Journal of Medicine 176.082
5 63 Group and home-based Tai Chi in elderly subjects with knee osteoarthritis: A randomized controlled trial Brismee, Jean-Michel Shen, Chwan-Li Article 2007 Clinical Rehabilitation 2.884
6 61 The effect of Tai Chi on health outcomes in patients with chronic conditions–A systematic review Wang, CC Wang, CC Review 2004 Archives of Internal Medicine /
7 51 Effects of t’ai chi training on function and quality of life indicators in older adults with osteoarthritis Hartman, CA Hartman, CA Article 2000 Journal of The American Geriatrics Society 7.538
8 49 Tai chi Qigong for the quality of life of patients with knee osteoarthritis: A pilot, randomized, waiting list controlled trial Lee, HJ Lee, HJ Article 2009 Clinical Rehabilitation 2.884
9 34 Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and therapeutic criteria committee of the American rheumatism association R. Altman R. Altman Review 1986 Arthritis and Rrheumatism /
10 33 Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee N Bellamy N Bellamy Review 1988 Journal of Rrheumatology 5.346
10 33 Challenges inherent to t’ai chi research: Part I–t’ai chi as a complex multicomponent intervention Wayne, PM Wayne Review 2008 Journal of Alternative and Complementary Medicine 2.381
Open in a new tab

Analysis of co-occurrence keyword

Keywords with high frequency can reveal hot spots in past research and keywords with strong burst power can predict future research frontiers. By August 2022, the top 10 keywords of frequency were Tai Chi, Exercise, Pain, Older Adult, Randomized Controlled Trial, Osteoarthritis, Quality of Life, Knee Osteoarthritis, Management and Low Back Pain (Table 8). According to the high-frequency keywords, we can infer that knee osteoarthritis is the most frequently studied musculoskeletal disorder in this field, and Tai Chi is the most frequently studied traditional Chinese exercises in this field.

TABLE 8.

Top 20 keywords in the treatment of traditional Chinese exercises for musculoskeletal disorders.

Rank Keyword Frequence
1 Tai chi 231
2 Exercise 152
3 Pain 112
4 Older adult 105
5 Randomized controlled trial 103
6 Osteoarthritis 85
6 Quality of life 85
8 Knee osteoarthritis 80
9 Management 80
10 Low back pain 71
11 Physical activity 58
12 Meta analysis 53
13 Balance 51
14 Rheumatoid arthritis 50
15 Health 49
16 Qigong 48
17 Clinical trials 46
18 Efficacy 43
19 Fibromyalgia 42
20 Arthritis 39
Open in a new tab

In this study, 432 articles were merged and classified by VOSviewer, 83 keywords that were used more than 10 times were clustered and analyzed. The results are shown in Figure 5 and Table 9. In the VOSviewer keyword network visualization, 83 keywords are grouped into clusters and different clusters are labeled with different colors. As shown in Figure 5, The clusters of red, green and blue were found. The red and green clusters are relatively independent, while the blue clusters are associated with both red and green clusters. The main keywords in the red cluster are Randomized Controlled Trial; Low Back Pain; Meta Analysis; Rheumatoid Arthritis; The main keywords of green cluster Tai Chi; Exercise; Older Adult; Osteoarthritis; Quality of Life. The main keyword of blue cluster is Pain; Knee Osteoarthritis; Management.

FIGURE 5.

FIGURE 5

Open in a new tab

Co-occurrence network of high-frequency keywords of traditional Chinese exercises for musculoskeletal disorders.

TABLE 9.

Cluster of keywords in the traditional Chinese exercises for musculoskeletal disorders.

Cluster Color Keywords
1 graphic file with name fnins-17-1096789-i001.jpg Randomized controlled trial; Low back pain; meta analysis; rheumatoid arthritis; health; qigong; efficacy; fibromyalgia; intervention; therapy; systematic review; chronic pain; disability; prevalence; acupuncture; aerobic exercise; toga; quality; alternative medicine; complementary; outcomes; depression; neck pain; exercise therapy; recommendations; double-blind; care; complementary and alternative medicine; controlled-trial; challenges inherent; cognitive-behavioral therapy; follow-up; mindfulness meditation; self-efficacy; symptoms; complementary therapies; feasibility; mindfulness; physical-therapy; self-management
2 graphic file with name fnins-17-1096789-i002.jpg Tai chi; exercise; older adult; osteoarthritis; quality of life; physical activity; balance; people; muscle strength; program; women; strength; adult; physical function; risk; falls; pilot; prevention; trial; postmenopausal women; impact; risk factors; walking; bone-mineral density; gait; classification; disease; flexibility; fitness; individuals
3 graphic file with name fnins-17-1096789-i003.jpg Pain; knee osteoarthritis; management; clinical trials; arthritis; hip; rehabilitation; knee; reliability; oarsi recommendations; performance; functional status; validation
Open in a new tab

The VOSviewer keyword symbiosis visualization hotspot map can identify hotspots in the field of traditional Chinese exercises for musculoskeletal research where most of the research was conducted. Keywords were clustered in the heat map, keywords with different frequencies presented different colors, such as the high density (red) among the above keywords.

Analysis of keyword burst

Keyword burst is a valuable indicator reflecting the most active research topic in this field. It can not only reflect research hotspots in this field, but also reflect changes in hotspots and predict future research trends. As shown in Figure 6, the top 15 keywords with the strongest strength of burst are presented. The changes in keyword outbreaks over the past 22 years have proved the evolution of the hotspots of traditional Chinese exercises for musculoskeletal disorders. The keyword “cardiorespiratory function” had a strength of 3.41 from 2000 to 2011. The keyword “self-efficiency” has the longest cycle, which is 12 years and the strength is 3.31. The remaining eight keywords which have received more attention since 2016 are the focus of current research in this field. The keywords of explosion include “outcome” (strength = 4.13), “physical therapy” (strength = 3.9), “neck pain” (strength = 3.2), “people” (strength = 3.24), “systematic review” (strength = 7.26), “disease” (strength = 3.99), “meta-analysis” (strength = 3.32) and “prevention” (strength = 3.25).

FIGURE 6.

FIGURE 6

Open in a new tab

Top 15 keywords with the strongest citation bursts.

Discussion

General information

From 2000 to 2022, the number of publications on traditional Chinese exercises for musculoskeletal disorders showed an increasing trend. This research field has attracted more and more scholars’ attention and become a new hot field. This phenomenon may be related to the clinical effect of Chinese traditional exercise as complementary alternative medicine and sports medicine in the treatment of musculoskeletal disorders.

The top 10 journals published 130 articles, accounting for 30.09% of the total number of articles published, indicating that the top 10 academic journals have a strong interest in the articles on musculoskeletal research of traditional Chinese exercises. Among them, Medicine, evidence-based complementary and alternative medicine and other journals belong to OA journals, indicating that the strong development of open-access journals in recent years has greatly promoted the research progress in this field. Most of the journals belong to the category of complementary and alternative medicine, indicating that the field of complementary and alternative medicine is more interested in the musculoskeletal disorders research of traditional Chinese exercises.

The USA is the first country to study this field. Meanwhile, two of the top five institutions are from the USA, led by Harvard University. All these indicate that the USA is the most influential country in the field of traditional Chinese exercises treatment of musculoskeletal disorders. In recent years, China’s influence in this field has gradually increased and there is a good development trend in this field in the future. Two of the top five are from China, with Shanghai University of Traditional Chinese Medicine and Shanghai University of Physical Education published 17 and 15 papers respectively. In addition to China and the USA, many countries have carried out research in this field, indicating that research attention in this field has increased in recent years. Therefore, there should be a stronger network of collaboration between more countries, institutions and authors, especially in China.

Although the traditional Chinese exercises originated in China, there are more than 20 universities of traditional Chinese exercises for China, which do not publish as many publications as other institutions. This may be related to the fact that most Chinese physicians pay more attention to the cultural attributes of traditional Chinese exercises. Interestingly, universities of traditional Chinese medicine are increasingly aware of this phenomenon and are gradually devoting themselves to the research of traditional Chinese exercises for musculoskeletal disorders.

According to the keyword frequency, we found that Tai Chi is the most commonly used traditional Chinese exercise for musculoskeletal diseases, which we believe may be related to the following reasons: (1) Tai Chi has been practiced in China for centuries. At present, Tai Chi has about 150 million practitioners in more than 150 countries and regions around the world. It is the most widely spread traditional Chinese exercises; (2) There are large body of evidence on the health effects of Tai chi, with more than 500 articles and 120 systematic reviews of the health benefits of Tai chi published. Based on such evidence-based advice, more researchers will focus on Tai Chi in their research; (3) Modern researchers have developed many simplified forms of Tai Chi, which shorten the learning time of practitioners and promote the spread of Tai Chi.

Global trend and research hotspots

Frequently keywords and burst keywords are the core content of the research literature topic. Cluster analysis was carried out based on keywords and finally three colors clusters were formed. Then, according to the keyword burst analysis, the research hotspots and development frontiers in the field are identified. The main contents are as follows: The efficacy evaluation of traditional Chinese exercises for the treatment of musculoskeletal disorders; the efficacy of traditional Chinese exercises for the treatment of musculoskeletal disorders dysfunctions; the pain improvement of traditional Chinese exercises for musculoskeletal disorders.

Cluster one keywords in this cluster can be divided into two categories. One focuses on research methods, such as randomized controlled trial, systematic review, and Meta-analysis. This cluster focused on the evaluation of the efficacy of traditional Chinese exercises for musculoskeletal disorders. The other type focuses on clinical diseases such as low back pain, rheumatoid arthritis, fibromyalgia and neck pain. In early studies, researchers focused on the therapeutic effects of Tai Chi on knee arthritis, fibromyalgia and other diseases. In 2000, Yocum suggested that Tai Chi might relieve pain and stress in rheumatoid arthritis patients, based on the link between stress and neuronal immune function (Yocum et al., 2000). The hypothesis that Chinese traditional exercises can alleviate musculoskeletal diseases was put forward. In 2003, Song conducted a randomized controlled trial study to explore the effects of Tai Chi on pain, balance, muscle strength in elderly women with osteoarthritis (Song et al., 2003). According to Astin’s research, mindfulness meditation combined with Qigong can alleviate pain and depression in patients with fibromyalgia. Astin et al. (2003) randomized controlled trial will provides high-level evidence for the effectiveness of traditional Chinese exercises for musculoskeletal disorders. In 2010, Wang CC published “A Randomized Trial of Tai Chi for Fibromyalgia” in The New England Journal of Medicine, a top medical journal, confirmed the therapeutic effect of Tai Chi on patients with fibromyalgia (Wang et al., 2010). This is the first article on traditional Chinese exercises published in the top journal in the medical field. High quality randomized controlled trial will promote research in the field, with the number of articles published in the following years more than doubling the number of articles published in 2010. In the subsequent study, besides Tai Chi, yi jin jing and baduanjin were also added to the research in this field. For example, An’s research in 2013 found that 1-year baduanjin is an effective and safe exercise method for the treatment of knee osteoarthritis (An et al., 2013). In 2011, Hall found that 10 weeks of Tai Chi practice improved pain and disability outcomes in patients with low back pain (Hall et al., 2011). In 2016, Lauche Romy’s study showed that 12 weeks of Tai Chi and traditional neck exercises were effective in improving neck pain and quality of life (Lauche et al., 2016). The number of diseases studied in this field has increased, such as low back pain, hip arthritis and neck pain. According to the keyword burst, neck pain was a hot research topic in this field from 2016 to 2018. In 2022, Kong published an article in Frontiers in Aging Neuroscience, which showed that traditional Chinese exercises significantly improved neck pain and disability in patients with neck pain and Baduanjin was the most effective (Kong et al., 2022). In recent years, there has also been a Chinese randomized controlled trial protocol on the intervention of neck pain with traditional exercise (Cheng et al., 2021). We suspect that neck pain may be a continuing research focus in the future.

Meta-analysis is a systematic review of quantitative analysis, which can synthesize the research results of multiple small samples on the same topic and improve the statistical efficiency of the original results. According to keywords burst systematic review and meta-analysis broke out from 2017 to 2020. Systematic review, published by Roger Chou in the annals of internal medicine in 2017, provides evidence that Tai Chi is effective for chronic low back pain, but the strength of the evidence is low (Rogers et al., 2010). Meta-analysis of comprehensive high-quality randomized controlled trials has been regarded as the highest level of evidence in evidence-based medicine, which can provide support for clinical guidelines. 2017 Qaseem incorporates Tai Chi into Non-invasive Treatments for Acute, Subacute, and Chronic Low Back Pain: Guideline from the American College of Physicians (Qaseem et al., 2017). The high level of clinical guidelines promote the clinical application of traditional Chinese techniques However, many Meta analysis points out that RCT in this field has shortcomings such as small sample size. Therefore, we speculate that on the basis of high-quality RCT studies in the future, the effectiveness of traditional Chinese exercises for musculoskeletal disorders will be further clarified.

Cluster two Keywords include Tai Chi; Exercise; Older Adult; Osteoarthritis; Quality of Life; Physical Activity; Balance; Muscle Strength. This cluster focused on the efficacy of traditional Chinese exercises for the treatment of musculoskeletal disorders dysfunctions. The main clinical manifestations of musculoskeletal disorders are pain and dysfunction, which seriously affect patients’ physical function (Balance and Muscle Strength) and quality of life. Traditional Chinese exercises can improve muscle strength, enhance balance and prevent falls. Hartman, published in the Journal of the American Geriatrics Society in 2000, has demonstrated that 12 weeks of Tai Chi can improve self-efficacy, quality of life indicators and functional activity in elderly patients with knee arthritis (Hartman et al., 2000). Studies have shown that Tai Chi can improve balance and abdominal strength by improving joint pain, stiffness and sensory difficulties. An’s study in 2008 found that Baduanjin can improve pain, stiffness and disability in patients with knee osteoarthritis and improve quadriceps strength (An et al., 2008). Runhaar’s 2015 study suggested that exercises including Tai Chi, increased thigh strength in patients with osteoarthritis, reduced stretching difficulties and improved proprioception (Runhaar et al., 2015). Song’s 2010 study found that 6 months of Tai Chi improved muscle strength around the knees, increased bone mineral density and reduced the fear of falling (Song et al., 2010). According to a systematic review in Age and Ageing, Tai Chi improves balance and fall risk in elderly people with knee arthritis (Mat et al., 2015). In 2020 Zhang’s found that the effect of Tai Chi on balance and fall prevention in patients with knee arthritis may be related to the enhancement of lower limb strength and reduction of foot load by Tai Chi (Zhang et al., 2020b). Tai Chi gait significantly increases external knee adduction moment and long-term practice may be harmful to patients with knee osteoarthritis (Simic et al., 2011). Therefore, Tai Chi gait is best used as an intermittent exercise for balance and stability, which can significantly improve the deep minor muscle group strength of knee flexors in the elderly. These studies are from the perspective of muscle strength and balance to explain the mechanism of traditional Chinese exercise in the treatment of knee osteoarthritis. According to the keyword burst, “prevention” is a hot research topic in this field from 2019 to 2022. The improvement of muscle strength and balance in Tai Chi is mainly explained in terms of clinical symptoms and biomechanics. Future studies may reveal the mechanism of Tai Chi in treating musculoskeletal and joint diseases from a biomechanical perspective.

Cluster three keywords included Pain; Knee Osteoarthritis; Management; Clinical Trials; Arthritis. This Cluster focused on Pain management for musculoskeletal disorders. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or an experience similar to it. It is usually an important concomitant symptom of musculoskeletal disorders and profoundly affects the quality of life of patients. In 2009, Wang conducted a randomized controlled trial to explore the therapeutic effect of Tai Chi on knee osteoarthritis (KOA) and found that Tai Chi can not only effectively improve the physical function and quality of life of KOA patients, but also reduce the pain, anxiety and depression of KOA patients and improve self-efficacy (Wang et al., 2009). In 2016, it was confirmed that Tai Chi relieved KOA pain as much as standard physical therapy and showed greater improvement in quality of life and anxiety and depression than physical therapy (Wang et al., 2016). This evidence suggests that traditional Chinese exercises can play an important role as a mind-body therapy for the management of pain in musculoskeletal disorders.

Some researchers have explored the mechanism of Tai Chi in alleviating the pain of musculoskeletal disorders from neuroimaging. In 2019, Kong found that the effect of Tai Chi on pain improvement in fibromyalgia patients may be related to the enhancement of the cognitive control network and the resting-state functional connectivity of bilateral rostral anterior cingulate cortex (rACC)/medial prefrontal cortex (mPFC) (Kong et al., 2021). Chwan observed the changes of Tai Chi on KOA patient brain function by MRI and found that the improvement of Tai Chi on knee osteoarthritis pain pair was closely related to the increased resting-state functional magnetic resonance imaging connectivity observed between bilateral mPFC and amygdala seed regions (Shen et al., 2022). More studies have compared the specific changes of knee joint brain function with different Chinese traditional exercises. Studies have shown that both Tai Chi and Baduanjin can increase the resting state functional connectivity (rsFC) between supplementary motor area and bilateral dorsolateral prefrontal cortex (DLPFC), but there are differences in the changes of DLPFC rsFC between Tai Chi and Baduanjin (Shen et al., 2022). Current research into the mechanisms of musculoskeletal disorders has focused on knee arthritis. We believe that future studies will continue to reveal the specific effects of different traditional Chinese exercises on pain in musculoskeletal disorders from a neuroimaging perspective.

Limitations

The limitations of the traditional Chinese exercises for musculoskeletal disorders study should be considered in further studies. First of all, our study did not search other academic databases and was limited to science Web, which may have missed some influential articles. Second, we aimed to study global trends in traditional Chinese exercises for musculoskeletal disorders, but the language range was limited. This may have led to selection bias. Third, this study includes articles and reviews, so there may be some bias in reflecting the academic impact of articles by the number of citations.

Conclusion

We conducted a bibliometric analysis of the literature related to traditional Chinese exercises for musculoskeletal disorders over the past 22 years. We find a gradual increase in the number of annual publications, most of which appear in Medicine. The United States and China are the most published countries. The most relevant papers were published by Harvard Medical School, followed by Shanghai University of Traditional Chinese Medicine. But cooperation between different countries and institutions has been insufficient. Therefore, contact and communication should be strengthened to promote the application of traditional Chinese exercises for musculoskeletal disorders. According to the cited references and keywords, the main disease treated is osteoarthritis. At present, the focus of research in this field is still the safety and effectiveness of traditional Chinese exercises for the treatment of musculoskeletal disorders. At the same time, more research began to explore how traditional Chinese exercises played a role in the treatment of musculoskeletal disorders. Revealing the mechanism of traditional Chinese exercises from the interdisciplinary perspective of biomechanics and neuroimaging is the focus of research in this field and also the hotspot of future research.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Author contributions

CG and FY conceived the idea. CG and YG collected the literature. CG, YG, and FX conducted the data analysis. CG drafted the manuscript. YG, FX, ZC, and FY revised the manuscript. All authors have read and approved the final article.

Funding Statement

This study was funded by the National Natural Science Foundation of China (82105038) and the Future Plan for Traditional Chinese Medicine Inheritance and Development of Shanghai Municipal Hospital of Traditional Chinese Medicine (WL-JXXK-2021001K).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fnins.2023.1096789/full#supplementary-material

Click here for additional data file. (16.9KB, docx)

References

  1. An B., Dai K., Zhu Z., Wang Y., Hao Y., Tang T., et al. (2008). Baduanjin alleviates the symptoms of knee osteoarthritis. J. Altern. Complement. Med. 14 167–174. [DOI] [PubMed] [Google Scholar]
  2. An B., Wang Y., Jiang X., Lu H., Fang Z., Wang Y., et al. (2013). Effects of Baduanjin (sic) exercise on knee osteoarthritis: A one-year study. Chin. J. Integr. Med. 19 143–148. 10.1007/s11655-012-1211-y [DOI] [PubMed] [Google Scholar]
  3. Astin J., Berman B., Bausell B., Lee W., Hochberg M., Forys K. (2003). The efficacy of mindfulness meditation plus Qigong movement therapy in the treatment of fibromyalgia: A randomized controlled trial. J. Rheumatol. 30 2257–2262. [PubMed] [Google Scholar]
  4. Cheng Z., Chen Z., Xie F., Guan C., Gu Y., Wang R., et al. (2021). Efficacy of Yi jin jing combined with Tuina for patients with non-specific chronic neck pain: Study protocol for a randomized controlled trial. Trial 22:12. 10.1186/s13063-021-05557-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dunlop D., Song J., Semanik P., Sharma L., Bathon J., Eaton C., et al. (2014). Relation of physical activity time to incident disability in community dwelling adults with or at risk of knee arthritis: Prospective cohort study. BMJ 348:g2472. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Feng F., Tuchman S., Denninger J., Fricchione G., Yeung A. (2020). Qigong for the prevention, treatment, and rehabilitation of COVID-19 infection in older adults. Am. J. Geriatr. Psychiatry 28 812–819. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Guo Y., Shi H., Yu D., Qiu P. (2016). Health benefits of traditional Chinese sports and physical activity for older adults: A systematic review of evidence. J. Sport Health Sci. 5 270–280. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gwinnutt J., Wieczorek M., Balanescu A., Bischoff-Ferrari H., Boonen A., Cavalli G., et al. (2022a). 2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases. Ann. Rheum. Dis. 82 48–56. 10.1136/annrheumdis-2021-222020 [DOI] [PubMed] [Google Scholar]
  9. Gwinnutt J., Wieczorek M., Rodriguez-Carrio J., Balanescu A., Bischoff-Ferrari H., Boonen A., et al. (2022b). Effects of diet on the outcomes of rheumatic and musculoskeletal diseases (RMDs): Systematic review and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 8:e002167. 10.1136/rmdopen-2021-002167 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hall A., Maher C., Lam P., Ferreira M., Latimer J. (2011). Tai chi for treatment of pain and disability in people with persistent low back pain: A randomized controlled trial. Arthritis Care Res. 63 1576–1583. [DOI] [PubMed] [Google Scholar]
  11. Hartman C., Manos T., Winter C., Hartman D., Li B., Smith J. (2000). Effects of T’ai Chi training on function and quality of life indicators in older adult with osteoarthritis. J. Am. Geriatr. Soc. 48 1553–1559. 10.1111/j.1532-5415.2000.tb03863.x [DOI] [PubMed] [Google Scholar]
  12. Jin Z., Wang D., Zhang H., Liang J., Feng X., Zhao J., et al. (2020). Incidence trend of five common musculoskeletal disorders from 1990 to 2017 at the global, regional and national level: Results from the global burden of disease study 2017. Ann. Rheum. Dis. 79 1014–1022. [DOI] [PubMed] [Google Scholar]
  13. Kong J., Huang Y., Liu J., Yu S., Ming C., Chen H., et al. (2021). Altered functional connectivity between hypothalamus and limbic system in fibromyalgia. Mol. Brain 14:11. 10.1186/s13041-020-00705-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kong L., Ren J., Fang S., He T., Zhou X., Fang M. (2022). Traditional Chinese exercises on pain and disability in middle-aged and elderly patients with neck pain: A systematic review and meta analysis of randomized controlled trial. Front. Aging Neurosci. 14:11. 10.3389/fnagi.2022.912945 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Lan C., Chen S., Lai J., Wong A. (2013). Tai chi chuan in medicine and health promotion. Evid. Based Complement. Alternat. Med. 2013:502131. 10.1155/2013/502131 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Lauche R., Stumpe C., Fehr J., Cramer H., Cheng Y., Wayne P., et al. (2016). The effects of Tai Chi and neck exercises in the treatment of chronic nonspecific neck pain: A randomized controlled trial. J. Pain 17 1013–1027. 10.1016/j.jpain.2016.06.004 [DOI] [PubMed] [Google Scholar]
  17. Mat S., Tan M., Kamaruzzaman S., Ng C. (2015). Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: A systematic review. Age Ageing 44 16–24. 10.1093/ageing/afu112 [DOI] [PubMed] [Google Scholar]
  18. Qaseem A., Wilt T., McLean R., Forciea M., Amer Coll P. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American college of physicians. Ann. Intern. Med. 166 514–U142. 10.7326/M16-2367 [DOI] [PubMed] [Google Scholar]
  19. Rogers C., Keller C., Larkey L. (2010). Perceived benefits of meditative movement in older adult. Geriatr. Nurs. 31 37–51. [DOI] [PubMed] [Google Scholar]
  20. Runhaar J., Luijsterburg P., Dekker J., Bierma-Zeinstra S. (2015). Identifying potential working mechanisms behind the positive effects of exercise therapy on pain and function in osteoarthritis; A systematic review. Osteoarthr. Cartil. 23 1071–1082. 10.1016/j.joca.2014.12.027 [DOI] [PubMed] [Google Scholar]
  21. Safiri S., Kolahi A., Cross M., Carson-Chahhoud K., Almasi-Hashiani A., Kaufman J., et al. (2021). Global, regional, and national burden of other musculoskeletal disorders 1990-2017: Results from the global burden of disease study 2017. Rheumatology 60 855–865. [DOI] [PubMed] [Google Scholar]
  22. Shanahan E. (2019). Work disability and musculoskeletal disease. Int. J. Rheum. Dis. 22 965–966. [DOI] [PubMed] [Google Scholar]
  23. Shen C., Watkins B., Kahathuduwa C., Chyu M., Zabet-Moghaddam M., Elmassry M., et al. (2022). Tai Chi improves brain functional connectivity and plasma lysophosphatidylcholines in postmenopausal women with knee osteoarthritis: An exploratory pilot study. Front. Med. 8:16. 10.3389/fmed.2021.775344 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Simic M., Hinman R., Wrigley T., Bennell K., Hunt M. (2011). Gait modification strategies for altering medial knee joint load: A systematic review. Arthritis Care Res. 63 405–426. [DOI] [PubMed] [Google Scholar]
  25. Singh J. (2022). Epidemiology and outcomes of alcohol use hospitalizations in people with gout, rheumatoid arthritis, fibromyalgia, osteoarthritis, or low back pain: A national US study. J. Clin. Rheumatol. 28 e375–e380. [DOI] [PubMed] [Google Scholar]
  26. Slomski A. (2018). Tai Chi for fibromyalgia. JAMA 319:2069. [DOI] [PubMed] [Google Scholar]
  27. Song R., Lee E., Lam P., Bae S. (2003). Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: A randomized clinical trial. J. Rheumatol. 30 2039–2044. [PubMed] [Google Scholar]
  28. Song R., Roberts B., Lee E., Lam P., Bae S. C. A. (2010). Randomized study of the effects of T’ai Chi on muscle strength, bone mineral density, and fear of falling in women with osteoarthritis. J. Altern. Complement. Med. 16 227–233. 10.1089/acm.2009.0165 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Tung H., Galloway J., Matcham F., Hotopf M., Norton S. (2021). High-frequency follow-up studies in musculoskeletal disorders: A scoping review. Rheumatology 60 48–59. 10.1093/rheumatology/keaa487 [DOI] [PubMed] [Google Scholar]
  30. Wang C., Liang J., Si Y., Li Z., Lu A. (2022a). The effectiveness of traditional Chinese medicine-based exercise on physical performance, balance and muscle strength among older adults: A systematic review with meta-analysis. Aging Clin. Exp. Res. 34 725–740. 10.1007/s40520-021-01964-2 [DOI] [PubMed] [Google Scholar]
  31. Wang K., Chen M., Zhang X., Zhang L., Chang C., Tian Y., et al. (2022b). The incidence of falls and related factors among Chinese elderly community residents in six provinces. Int. J. Environ. Res. Public Health 19:14843. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Wang C., Schmid C., Hibberd P., Kalish R., Roubenoff R., Rones R., et al. (2009). Tai Chi is effective in treating knee osteoarthritis: A randomized controlled trial. Arthritis Care Res. 61 1545–1553. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Wang C., Schmid C., Iversen M., Harvey W., Fielding R., Driban J., et al. (2016). Comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis. Ann. Intern. Med. 165 77–86. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Wang C., Schmid C., Rones R., Kalish R., Yinh J., Goldenberg D., et al. (2010). A randomized trial of Tai Chi for fibromyalgia. N. Engl. J. Med. 363 743–754. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Wu D., Wong P., Guo C., Tam L., Gu J. (2021). Pattern and trend of five major musculoskeletal disorders in China from 1990 to 2017: Findings from the global burden of disease study 2017. BMC Med. 19:34. 10.1186/s12916-021-01905-w [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Xie Y., Liao M., Wang M., Fernando W., Gu Y., Wang X., et al. (2021). Traditional Chinese mind and body exercises for neck pain: A meta-analysis of randomized controlled trials. Pain Res. Manag. 2021:5426595. 10.1155/2021/5426595 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Yocum D., Castro W., Cornett M. (2000). Exercise, education, and behavioral modification as alternative therapy for pain and stress in rheumatic disease. Rheum. Dis. Clin. North Am. 26 145–159. [DOI] [PubMed] [Google Scholar]
  38. You Y., Min L., Tang M., Chen Y., Ma X. (2021). Bibliometric evaluation of global Tai Chi research from 1980-2020. Int. J. Environ. Res. Public Health 18:6150. 10.3390/ijerph18116150 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Zhang B., Xu H., Wang J., Liu B., Sun G. (2017). A narrative review of non-operative treatment, especially traditional Chinese medicine therapy, for lumbar intervertebral disc herniation. Biosci. Trends 11 406–417. 10.5582/bst.2017.01199 [DOI] [PubMed] [Google Scholar]
  40. Zhang Y., Hu R., Han M., Lai B., Liang S., Chen B., et al. (2020a). Evidence base of clinical studies on Qigong: A bibliometric analysis. Complement. Ther. Med. 50 8. 10.1016/j.ctim.2020.102392 [DOI] [PubMed] [Google Scholar]
  41. Zhang Z., Huang L., Liu Y., Wang L. (2020b). Effect of Tai Chi training on plantar loads during walking in individuals with knee osteoarthritis. Biomed Res. Int. 2020:7. 10.1155/2020/3096237 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Zou L., Sasaki J., Wei G., Huang T., Yeung A., Neto O., et al. (2018). Effects of mind(-)body exercises (Tai Chi/Yoga) on heart rate variability parameters and perceived stress: A systematic review with meta-analysis of randomized controlled trials. J. Clin. Med. 7:404. 10.3390/jcm7110404 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Click here for additional data file. (16.9KB, docx)

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Articles from Frontiers in Neuroscience are provided here courtesy of Frontiers Media SA

RESOURCES