e4-12: Tai Chi

Tai chi chuan is a martial art that can be practiced as a gentle, meditative exercise that consists of flowing movements, balance and weight shifting, breathing, and body awareness.

The exact origin of tai chi is obscure, but it likely began between 300 and 800 years ago and developed in monastic settings in China.

There is no widely recognized, standardized teacher training or certification in tai chi. Teachers are established through a lineage tradition of master-to-student transmission. When referring patients to tai chi programs, it is helpful to inquire about the characteristics of that lineage and how many years of experience the teacher has.

There are four major styles of tai chi, but the majority of publicly available classes in the United States are in the Yang style. Yang style uses slow, flowing movements of medium excursion. Wu style uses smaller, more compact movements. The Chen style is the most physically demanding, especially on the knees and low back. Some of the movements in the Chen style are rapid and forceful. The Hao style emphasizes internal chi movement more than external visible movements.

Tai chi practice appears to be very safe. A systematic review of adverse events in the tai chi literature was conducted in 2014 and found 50 of 153 eligible randomized controlled trials reported any adverse events. Most of these trials found no adverse effects. Of the events that did occur, none were serious. The most common events were minor musculoskeletal pains (knees, ankles, low back). Nine falls were reported, but out of thousands of patients, many of whom are referred to tai chi for problems with balance, this is probably neither surprising nor alarming.

A 2020 review synthesized evidence from more than 200 meta-analyses of randomized controlled trials with over 100 unique health outcomes. It found there is evidence supporting tai chi in the improvement of physical and mental health among adults with cancer, neurologic disorders such as Parkinson disease, metabolic diseases, cardiopulmonary diseases including heart failure and coronary artery disease, musculoskeletal diseases such as fibromyalgia, and psychological disorders.

A. Balance/Falls

Tai chi improves balance and reduces falls. A 2017 systematic review and meta-analysis of 10 studies and 3000 patients concluded that persons in the tai chi experimental group experienced a significantly lower chance of falling at least once and a lower rate of falls altogether than persons in the control group.

B. Cognitive Function in Elders

There are 21 studies (including 12 randomized controlled trials) of tai chi in elders, examining the impact on cognitive function. A meta-analysis demonstrated a large effect size (0.9) when comparing tai chi with nonintervention controls and a moderate effect size (0.5) when comparing tai chi with exercise controls. Randomized controlled trials of cognitively impaired adults (mild cognitive impairment and dementia) showed smaller (0.3) but statistically significant effect size when tai chi was compared with other active interventions. A 2016 randomized controlled trial in older adults with mild cognitive impairment showed both a significantly reduced fall risk and significantly improved cognitive function.

C. Parkinson Disease

A meta-analysis of 15 randomized controlled trials and 6 nonrandomized controlled trials concluded that there were beneficial effects of tai chi in improving motor function, depression, balance, and functional mobility in patients with Parkinson disease. A three-arm randomized controlled trial of 195 patients with Parkinson disease found significant reduction in falls in the tai chi group compared to the stretching group.

D. Heart Failure

A 2017 meta-analysis of 13 randomized controlled trials found evidence that Tai chi significantly improved 6-minute walking distance, left ventricular ejection fraction, serum BNP, and quality of life.