Frontiers | Tai Chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of random

Frontiers | Tai Chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomized controlled trials
SYSTEMATIC REVIEW article
Front. Public Health
, 01 September 2023
Sec. Aging and Public Health
Volume 11 - 2023 |
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Hamad Medical Corporation, Qatar
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University of Illinois at Urbana-Champaign, United States
Jun Hyun Bae
Hyupsung University, Republic of Korea
Silvia Giovannini
Catholic University of the Sacred Heart, Rome, Italy
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SYSTEMATIC REVIEW article
Front. Public Health
, 01 September 2023
Sec. Aging and Public Health
Volume 11 - 2023 |
Tai Chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomized controlled trials
Weidong Chen
1,2
Min Li
Hai Li
Yanzhao Lin
Zhoushan Feng
4,5
1.
Department of Integrated Traditional Chinese and Western Medicine Nutrition, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China
2.
The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
3.
College and Hospital of Stomatology, Guangxi Medical University, Nanning, China
4.
Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangzhou, China
5.
Guangzhou Key Laboratory of Neonatal Intestinal Diseases, Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Abstract
Background and objective:
As the population ages, the health of older adults is becoming a public health concern. Falls are a significant threat to their health due to weakened balance. This study aims to investigate the beneficial effects of Tai Chi on fall prevention and balance improvement in older adults.
Methods:
We conducted a systematic review and meta-analysis of randomized controlled trials related to Tai Chi, falls, and balance ability, searching PubMed, Embase, and Cochrane Library databases from their establishment until December 31, 2022. Two independent reviewers performed the search, screening of results, extraction of relevant data, and assessment of study quality. This study followed the PRISMA guidelines for systematic review and meta-analysis.
Results:
Totally 24 RCTs were included for meta-analysis, and the results showed that Tai Chi can effectively reduce the risk of falls in older adults (RR: 0.76, 95% CI: 0.71 to 0.82) and decrease the number of falls (MD [95% CI]: −0.26 [−0.39, −0.13]). Tai Chi can also improve the balance ability of older adults, such as the timed up and go test (MD [95% CI]: −0.69 [−1.09, −0.29]) and the functional reach test (MD [95% CI]: 2.69 [1.14, 4.24]), as well as other balance tests such as single-leg balance test, Berg balance scale, and gait speed (
< 0.05). Subgroup analysis showed that Tai Chi is effective for both healthy older adults and those at high risk of falls (
< 0.001), and its effectiveness increases with the duration and frequency of exercise. In addition, the effect of Yang-style Tai Chi is better than that of Sun-style Tai Chi.
Conclusion:
Tai Chi is an effective exercise for preventing falls and improving balance ability in older adults, whether they are healthy or at high risk of falling. The effectiveness of Tai Chi increases with exercise time and frequency. Yang-style Tai Chi is more effective than Sun-style Tai Chi.
Systematic review registration:
, identifier CRD42022354594.
1. Introduction
The global population is currently experiencing an aging trend, and it is predicted that by the mid-21st century, individuals aged 60 years and above will constitute approximately 20% of the total population (
). As individuals age, physiological changes are inevitable, leading to challenges such as decreased balance ability, weakened muscle strength, and a higher risk of falling (
). Falls are a primary cause of injuries among the older adult, which can result in severe consequences such as fractures, head injuries, and even death, placing a significant burden on the public health system (
). Annually, between 28 and 35% of individuals aged 65 years and older experience falls worldwide, with rates reaching 32–42% among those over 70 years of age (
). Therefore, preventing falls has become a critical global objective for the older adult population.
Tai Chi is a distinctive form of exercise that involves movements primarily performed in a semi-squatting position. These movements require a continuous shift in the body’s center of gravity, incorporating posture control, trunk rotation, weight transfer, and strength training. All these features are advantageous for improving balance and strength, reducing the risk of falling and the fear of falling (
6–8
). In comparison to other types of exercise, Tai Chi practice has fewer requirements for equipment, venues, and caregivers, making it a more accessible form of exercise to promote (
).
However, previous recommendations regarding Tai Chi as an effective tool for reducing the risk of falling may be limited due to a small number of selected studies, a lack of subgroup analysis on factors such as Tai Chi style, exercise time and frequency, and balance ability analysis (
10
11
). Considering the insufficient information available on the impact of Tai Chi on fall prevention among the older adult, this current systematic review aims to explore the recent randomized controlled trials (RCTs) that analyze the effective reduction of fallers, fall rates, and improvement of balance ability in the older adult through the practice of Tai Chi. This systematic review provides valuable insights for using Tai Chi as an intervention for fall prevention in the older adult.
2. Methods
Our systematic review was performed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (
12
) and was registered with PROSPERO using the registration number CRD42022354594.
2.1. Search strategy
We conducted a search of databases such as PubMed, EMBASE, and the Cochrane Library using a specific search strategy for each database, covering literature from inception up to December 31, 2022. Additionally, we conducted a review of the references of each included study to ensure that no relevant papers were missed during the search. The full search strategy is available in
Supplementary Table S1
2.2. Inclusion criteria for the study
(1) Participants: older adult people aged ≥60 years, as defined by the World Health Organization (
13
14
).
(2) Inventions: any form of Tai Chi exercise.
(3) Controls: receiving either exercise that is stretching or other low-level exercises, usual care, or wellness education.
(4) Outcomes: the number of fallers (participants who experienced at least one fall), average number of falls per person, and balance assessment indicators including the timed up and go (TUG) test, functional reach test (FRT), single leg balance test (SLB), Berg balance scale (BBS), short physical performance battery (SPPB) score, fall efficacy scale (FES), and gait speed assessment. Among these, FRT is a simple, practical, and widely used clinical tool to assess an individual’s balance capability and risk of falling. In this test, the maximum distance an individual can reach forward while maintaining a fixed support base in a standing position is measured.
(5) Study: only include RCTs in English.
2.3. Management of the study and retrieval of data
After eliminating duplicate studies using Endnote software, two reviewers (W.C. and M.L.) independently selected eligible studies and extracted relevant data. In case of any discrepancies, the reviewers reached a consensus through discussion and negotiation. The collected data included the author’s name, year of publication, sample size, older adult population, health status, age, Tai Chi style, frequency, total exercise time, and follow-up time and outcomes.
2.4. Assessment of study quality
The assessment parameters for the evaluation of study quality included random sequence generation, allocation concealment, blinding of participants and assessors, handling of incomplete outcome data, selective reporting, and other biases. Each item was assessed as having “low risk,” “unclear risk,” or “high risk.” Two reviewers (W.C. and M.L.) independently assessed the data using the Cochrane Risk of Bias tool (
15
) and resolved any discrepancies through mutual discussion based on justifications.
2.5. Data analysis
The effect size of binary variables was represented by the risk ratio (RR) with a 95% confidence interval (CI), and the effect size of continuous variables was represented by the mean difference (MD) with a 95% CI, evaluated using a random-effects model. The I
statistic was used to evaluate the heterogeneity among studies, where I
< 50% indicated low heterogeneity and I
≥ 50% indicated significant heterogeneity. Subgroup analysis was performed on exposure time, Tai Chi style, weekly frequency, risk of fall, and follow-up time.
Sensitivity analysis was performed by using the one-by-one exclusion method and excluding studies with a small number of participants to test the stability of the outcomes. For each result that included 10 or more original trials, we used funnel plots to test for publication bias, and assessed the symmetry of the funnel plot using Egger’s test and Begg’s test (
16
17
). If the funnel plot was asymmetric, we used the trim-and-fill method for adjustment (
18
). A two-tailed
< 0.05 was considered statistically significant. All analyses were conducted using RevMan 5.3 and Stata 14.0 software.
3. Results
3.1. Study selection and characteristics
A total of 1948 articles were initially searched, of which 837 duplicates and 25 articles without titles were excluded automatically. An additional 828 articles were excluded by reading titles and abstracts. From the remaining 258 articles, 88 were conference papers, other reports, and reviews. Further exclusions were made for 33 non-RCT, 85 articles with incomplete data or unrelated research content, and 28 articles for other reasons. In the end, 24 articles (with one or more outcomes) were included for analysis (
19–40
) (
Figure 1
).
Figure 1
Among the 24 articles, 6 reported participants with a history of falls (
24
27
29
30
36
), and 5 reported patients with a history of neurological diseases such as stroke or Parkinson’s disease (
21
35
37
38
). The Tai Chi styles used in the interventions were mainly Sun-style (
19
25
33
34
36
39
) or Yang-style (
21
23
24
26
32
35
37
40
), with one article using Chen-style (
30
) and others not specifying. Exercise frequency ranged from one to three times a week, with one article reporting five times a week (
23
). Total exercise time was mainly within 72 h, with one article reporting 96 h (
19
) and another reporting 144 h (
40
). Follow-up periods were ≤ 3 months in 6 articles (
25
30
32–35
), 3–6 months in 9 articles (
20
23
26–28
36
37
39
), 6–12 months in 7 articles (
19
21
22
29
38
40
), and > 12 months in 2 articles (
24
31
) (
Table 1
).
Table 1
Study year
Country
Risk of falls
Age
Tai Chi/Control (n)
Intensity
Exposure Time (h)
Follow-up time
Day et al. (
19
Australia
Non-high risk
77.6
Sun style Tai Chi (205)
Twice a week for 48 weeks, 60 min per session.
96
12 months
77.8
Stretching (204)
Faber et al. (
20
Netherlands
Non-high risk
84.4
Tai Chi (80)
Once a week for 4 weeks, followed by twice weekly for 16 weeks. 90 min per session
54
5 months
85.4
Functional walking (66)
84.9
No intervention (92)
Gao et al. (
21
American
Parkinson’s disease and history of falls
69.54
Yang style Tai Chi (40)
Three sessions per week for 12 weeks, 60 min per session.
36
12 months
68.28
Usual care (40)
Huang et al. (
22
China
Non-high risk
71.40
Tai Chi (31)
Three sessions per week for 20 weeks,60 min per session.
60
12 months
71.50
No Tai Chi (47)
Huang et al. (
23
China
Non-high risk
>60
Yang style Tai Chi (62)
Five sessions per week for 8 weeks, 60 min per session.
40
6 months
Cognitive Intervention (62)
No intervention (62)
Hwang et al. (
24
China
History of falls
72.0
Yang style Tai Chi (182)
Once a week for 6 months, 60 min per session.
24
18 months
72.7
Balance training (175)
Kim et al. (
25
South Korea
Non-high risk
71.4
Sun style Tai Chi (23)
Twice a week for 12 weeks, 60 min per session.
24
3 months
70.9
Taekwondo (23)
Li et al. (
26
American
Non-high risk
77.4
Yang-style Tai Chi (125)
Three times per week for 6 months, 60 min per session.
72
6 months
77.4
Stretching (131)
Li et al. (
American
Parkinson’s disease
68
Tai Chi (65)
Twice a week for 24 weeks, 60 min per session.
48
6 months
69
Resistance (65)
69
Stretching (65)
Li et al. (
27
American
History of falls
77.5
Tai Chi (224)
Twice a week for 24 weeks, 60 min per session.
48
6 months
77.8
Multimodal Exercise (223)
77.8
Stretching (223)
Li et al. (
28
American
Non-high risk
76.13
Tai Chi (15)
Three sessions per week for 24 weeks, 60 min per session.
72
6 months
76.20
Stretching (15)
Logghe et al. (
29
Netherlands
History of falls
77.5
Yang-style Tai Chi (138)
Twice a week for 13 weeks, 60 min per session.
26
12 months
76.8
Usual care (131)
Ni et al. (
30
American
History of falls
70.27
Chen-style Tai Chi (11)
Twice a week for 12 weeks, 60 min per session.
24
3 months
77.80
Balance training (15)
Nowalk et al. (
31
American
Non-high risk
82.8
Tai Chi (38)
Three times per week
24 months
85.5
FNBF exercise (37)
85.9
Basic enhanced program (35)
Penn et al. (
32
China
Non-high risk
75.3
Yang-style Tai Chi (15)
Three sessions per week for 8 weeks, 30 min per session.
12
2 months
73.4
Wellness education (15)
Pluchino et al. (
33
American
Non-high risk
69.3
Sun-style Tai Chi (14)
Twice a week for 8 weeks, 60 min per session.
16
2 months
76.0
Standard balance item (14)
Son et al. (
34
South Korea
Non-high risk
72.8
Sun-style Tai Chi (21)
Twice a week for 12 weeks, 60 min per session.
24
3 months
71.5
Balance training (24)
Taylor et al. (
36
American
Post-stroke
72.8
Yang-style Tai Chi (12)
Three sessions per week for 12 weeks, 50 min per session.
30
3 months
64.5
Usual care (16)
Taylor et al. (
35
New Zealand
History of falls
75.3
Sun-style Tai Chi (223)
Once/twice a week for 20 weeks, 60 min per session.
20
5 months
74.4
Sun-style Tai Chi (220)
40
73.7
Low-level exercise (231)
Taylor et al. (
37
American
Post-stroke
71.5
Yang-style Tai Chi (30)
Three sessions per week for 12 weeks, 60 min per session.
36
5 months
69.6
Usual community-based exercise (31)
68.2
Usual care (28)
Tousignant et al. (
38
Canada
Frail older adults* and history of falls
79.1
Tai Chi (76)
Twice a week for 15 weeks, 60 min per session.
30
12 months
80.7
Conventional physical therapy (76)
Voukelatos et al. (
39
Australia
Non-high risk
Mean 69 year
Sun (83%) or Yang-style Tai Chi (353)
Once a week for 16 weeks, 60 min per session
16
4 months
No Tai Chi (349)
Wolf et al. (
American
History of falls
80.9
Yang-style Tai Chi (145)
Twice a week for 48 weeks, 30 ~ 45 min per session
48–64
12 months
80.9
Wellness education (141)
Woo et al. (
40
China
Non-high risk
68.9
Yang-style Tai Chi (60)
Three times per week for 12 months，60 min per session.
144
12 months
68.8
Resistance training (60)
68.1
No intervention (60)
Characteristics of included studies.
*Types of diagnoses varied from stroke/neurological diseases, musculoskeletal and gait disorders.
At least one fall in the past 12 months.
Occurred in the past 6 months.
3.2. Evaluating the risk of bias
Due to the appropriate methods used in random sequence generation and allocation concealment, 22 (
19–31
) or 17 (
19
20
23–28
31
33
35–40
) articles were considered low risk, respectively. In addition, only 7 articles (
20
26
29
36
38
) were considered low risk due to the difficulty in blinding participants, while 19 articles used blinding well in assessing outcomes (
19–21
23–29
32
34–37
39
40
). In terms of incomplete outcome data and selective reporting, 21 (
19–21
23–35
37–40
) and 22 (
19–27
29–32
) articles were considered low bias, respectively (
Figure 2
and
Supplementary Figure S1
).
Figure 2
3.3. Number of fallers
A total of 18 studies provided data on the number of fallers (
19–24
26–29
31
36–40
), and meta-analysis found that Tai Chi exercise could significantly reduce the number of fallers (1,041/2766 VS. 1,321/2703; RR: 0.76, 95% CI: 0.71–0.82, I
: 25%,
< 0.001) (
Figure 3A
). Sensitivity analysis was performed by sequentially excluding each trial or removing studies with fewer than 100 participants, and the results showed that there was no significant change in statistical significance and heterogeneity. Subgroup analysis showed that Tai Chi could prevent falls in any population at risk, regardless of the overall duration of Tai Chi exercise, follow-up time, or Tai Chi style (Sun or Yang) (all
< 0.01). However, in terms of exercise frequency, exercising twice (
19
20
27
29
36
38
) or ≥ 3 times (
21–23
26
28
31
37
40
) per week showed more significant benefits than exercising once a week (RR [95% CI] were 0.78 [0.73, 0.84] and 0.67 [0.58, 0.79], respectively) (
Table 2
).
Figure 3
Table 2
Subgroup
Included studies
Tai Chi group positive/total
Control group positive/total
Heterogeneity (I
RR [95% CI]
Test for subgroup difference
Exposure time (h)
0.69
≤24
4 (
23
24
37
39
247/818
304/803
75%
0.74 [0.53, 1.02]
0.06
24 ~ 48
7 (
21
27
29
36–38
422/1082
561/1069
15%
0.74 [0.68, 0.82]
<0.001
>48
7 (
19
20
22
26
28
40
328/790
403/759
0.76 [0.69, 0.85]
<0.001
Tai Chi style
0.004
Sun
3 (
19
37
39
413/1004
473/1004
0%
0.88 [0.81, 0.97]
0.008
Yang
9 (
21
23
24
26
29
37
40
244/833
829/1822
36%
0.76 [0.68, 0.86]
<0.001
Weekly frequency
0.22
Once
3 (
24
36
39
244/762
296/743
81%
0.76 [0.55, 1.06]
0.11
Twice
8 (
19
20
27
29
36
38
664/1514
815/1455
4%
0.78 [0.73, 0.84]
<0.001
≥Three times
8 (
21–23
26
28
31
37
40
133/490
210/505
0.67 [0.58, 0.79]
<0.001
Risk of fall
0.18
Non-high risk
9 (
19
20
22
23
26
28
31
39
40
377/1124
460/1087
0.78 [0.71, 0.86]
<0.001
History of falls only
5 (
24
27
29
35
581/1366
738/1355
62%
0.78 [0.69, 0.89]
<0.001
Falls related diseases
4 (
21
37
38
83/276
123/261
0.42 [0.54, 0.80]
<0.001
Follow-up time
0.71
≤6 months
9 (
20
23
26–28
36
37
39
659/1784
820/1729
15%
0.77 [0.71, 0.84]
<0.001
6 ~ 12 months
7 (
19
21
22
29
38
40
297/724
373/727
32%
0.77 [0.67, 0.89]
<0.001
>12 months
2 (
24
31
85/258
1228/247
56%
0.69 [0.51, 0.91]
0.009
Subgroup analysis of fallers.
RR, risk ratio.
3.4. Rate of falls
According to 15 articles providing the total number of falls, the Tai Chi group had a lower incidence of falls compared to the control group (1816/2539 VS. 2,681/2475, IRR, 0.66) (see
Supplementary Table S2
) (
19–21
23
24
26–29
36–39
). Among them, 9 articles provided mean and standard deviation information (
20
21
23
24
27
28
38
39
). Tai Chi significantly reduced the number of falls per person (MD [95%CI]: −0.26 [−0.39, −0.13], I
= 61%,
< 0.001) (
Figure 3B
). Excluding the Li et al. study effectively reduced heterogeneity (I
= 49%), but did not significantly affect the results (−0.12 [−0.17, −0.06],
< 0.001) (
20
21
23
24
28
38
39
). Moreover, studies excluding fewer participants did not significantly change the results (−0.12 [−0.18, −0.07],
< 0.001) (
20
23
24
38
39
). Subgroup analysis showed that Tai Chi is more effective in reducing falls per person with longer exercise time (
= 0.15, 0.02, and < 0.01, respectively), and that Yang-style Tai Chi is more effective than Sun-style Tai Chi (
< 0.01 and = 0.09, respectively). Furthermore, regardless of the exercise follow-up duration (≤6 months, 6 ~ 12 months, or > 12 months), Tai Chi exercise was found to significantly reduce the number of falls per person (
= 0.01, <0.01, and < 0.01, respectively) (
Supplementary Table S3
). These findings can be used to design better Tai Chi interventions for fall prevention.
3.5. Timed up and go test
Meta-analysis of 12 studies showed that Tai Chi can significantly reduce TUG time (MD [95%CI]: −0.69 [−1.09, −0.29],
< 0.001) (
Figure 4A
) (
21
22
25–28
30
32–34
36
). Sensitivity analysis was conducted by sequentially deleting each trial and excluding studies with smaller sample sizes, and the significance and heterogeneity of the results remained unchanged. With increasing exercise time and frequency, Tai Chi was more effective in reducing TUG time (
= 0.93, 0.01, and <0.001;
= 0.76, 0.28, and <0.001, respectively). Yang-style Tai Chi was more effective than Sun-style Tai Chi (
< 0.01 and = 0.66, respectively). In addition, Tai Chi can shorten TUG time in older adult people with falls related diseases (
= 0.02) (
Supplementary Table S4
) (
21
38
).
Figure 4
3.6. Functional reach test
Meta-analysis of 9 studies providing FRT data has shown that the functional reach distance of practicing Tai Chi was significantly greater than that of the control group (MD [95%CI]: 2.69 [1.14, 4.24],
< 0.001) (
Figure 4B
) (
22
25–27
30
32–34
). Sensitivity analysis, conducted by sequentially excluding each study or studies with smaller sample sizes, did not significantly alter the results (all
< 0.01). Subgroup analysis revealed that Yang-style Tai Chi was more effective than Sun-style Tai Chi (
< 0.001 and 0.82, respectively), and practicing Tai Chi twice a week had a better effect (
< 0.001). Furthermore, Tai Chi was found to be particularly effective in improving FRT test scores in older adult individuals with a history of falls or fall-related diseases (
= 0.003 and < 0.001, respectively) (
Supplementary Table S5
).
3.7. Other outcomes
Through a meta-analysis of other fall or balance ability tests, it was found that Tai Chi can effectively lengthen SLB test times (including with eyes open and closed) (MD [95% CI]: 9.63 [5.87, 13.40],
< 0.001) (
25
26
30
33
34
), increase BBS scores (MD [95% CI]: 1.80 [0.09, 3.51],
= 0.04) (
21
26
29
32
), and improve gait speed (MD [95% CI]: 9.26 [1.00, 17.52],
= 0.03) (
25
26
34
). In addition, Tai Chi did not have a significant effect on overall SPPB scores (
27
35
37
) or FES scores (
24
29
34
) (MD [95% CI]: −0.07 [−1.07, 0.93], 0.17 [−0.49, 0.83];
= 0.89, 0.61; respectively) (
Table 3
).
Table 3
Outcomes
Included studies
Tai Chi group
Control group
Heterogeneity (I
MD [95% CI]
SLB
5 (
25
26
30
33
34
330
353
69%
9.63 [5.87, 13.40]
<0.001
BBS
4 (
21
26
29
32
315
316
65%
1.80 [0.09, 3.51]
0.04
Gait speed
4 (
25
26
34
299
308
91%
9.26 [1.00, 17.52]
0.03
SPPB scores
3 (
27
35
37
524
517
90%
−0.07 [−1.07, 0.93]
0.89
FES
3 (
24
29
34
334
320
10%
0.17 [−0.49, 0.83]
0.61
Other outcomes.
MD, mean difference; CI, confidence interval; SLB, single leg balance test; BBS, Berg balance scale; SPPB, short physical performance battery; FES, fall efficacy scale.
3.8. Publication bias
Publication bias analyses were conducted on the results of more than 10 studies on fallers and TUG. It was found that there was a significant publication bias in the Fallers results (Begg’s test: 0.014 and Egger’s test: 0.003) (
Figure 5A
). The trim-and-fill method was used to adjust for publication bias, and the outcome still showed statistical differences (
< 0.001). In addition, there was no significant publication bias in the TUG results (Begg’s test: 0.092, Egger’s test: 0.315) (
Figure 5B
).
Figure 5
4. Discussion
In the meta-analysis, Tai Chi exercise can effectively decrease the rate of fallers and number of falls in older adults, including those with a high risk of falling, while also improving their balance, as measured by TUG, FRT, SLB, BBS score, or gait speed. The effectiveness of Tai Chi increases with the duration and frequency of exercise. Furthermore, Yang-style Tai Chi was found to be more effective than Sun-style Tai Chi. Sensitivity analysis by excluding individual studies and those with small sample sizes did not significantly alter the outcomes.
The importance of Tai Chi for older adults is increasingly recognized in research. Past meta-analyses have found that Tai Chi can improve cognitive abilities (
41
), enhance the quality of life and alleviate symptoms related to cancer (
42
), and relieve chronic pain (
43
), among other benefits. Our study results, in comparison to previous systematic reviews, consistently find that Tai Chi is indeed effective in preventing falls among the older adult. However, there is a lack of exploration regarding the results of improving balance and the relationship between improving balance and preventing falls (
44
45
). By including more RCTs, our research not only investigates Tai Chi’s role in fall prevention but also explores whether it is related to enhancing balance abilities. Moreover, our study adds more nuances to these findings. For example, the differences in various Tai Chi practices, exercise durations, and frequencies, could guide future Tai Chi exercise instructions more effectively.
Compared to other exercise interventions or non-interventions, Tai Chi is an effective fall prevention method for the older adult and has been validated in previous studies (
10
11
44
). This study included more updated randomized controlled trials and examined the impact of Tai Chi on balance ability. The fall prevention effect of Tai Chi may stem from its ability to improve balance (
21
26
). The study found that Tai Chi can not only improve static balance (e.g., SLB), but also dynamic balance (e.g., TUG and gait speed), and enhance postural control (e.g., FRT). Tai Chi exercise conforms to the statics balance theory, where the main factors affecting human balance are the size of the support surface and the height of the center of gravity (
46
). Therefore, Tai Chi can improve the ability of the older adult to control their center of gravity and adjust their posture, thereby improving balance ability (
47
48
).
Tai Chi movements require a semi-squat position and involve concentric and eccentric contractions of leg muscles at varying degrees during practice, which has been reported to significantly enhance lower limb strength and endurance in the older adult (
49
50
). Tai Chi practice also provides moderate aerobic exercise and flexibility training, which can improve cognitive function in older adults (
41
51
). The enhancement of muscle strength is associated with the improvement of physical fitness and mental quality of life in the older adult (
52
). Compared to stretching training, Tai Chi’s precise joint control and muscle coordination helps achieve better balance control (
53
). Additionally, Tai Chi’s unique meditation component can improve attention and cognitive function, enhancing body control and balance ability in older adults (
54
). Therefore, Tai Chi’s unique exercise characteristics are an important factor in its success in fall prevention among the older adult, reducing hospitalization rates associated with falls in the community (
55
). These mechanisms may explain Tai Chi’s role in enhancing balance ability and preventing falls, with significant effects observed over certain follow-up periods. Although some studies have suggested that the protective effect of Tai Chi on fall prevention in the short-term appears to be greater than in the long-term, indicating a potential loss of effectiveness over time (
11
), this may be due to inconsistencies in the duration of Tai Chi exercise and follow-up time in some studies. It was discovered in our study that Tai Chi’s improvement in balance ability and fall prevention effectiveness increases with longer exercise duration and frequency. A meta-analysis showed that the optimal total exercise time is between 50 and 72 h with 3 exercise sessions per week (
56
). However, the optimal exercise frequency and duration per week remain unclear. This necessitates further in-depth research on our part.
This study found that Tai Chi is effective not only for healthy older adults but also for those at high risk of falling. In studies on stroke and Parkinson’s disease patients, Tai Chi was found to improve balance ability and prevent falls after stroke, and Tai Chi training was effective in improving the motor ability of stroke patients (
48
56
). Further research is needed to evaluate Tai Chi as an adjunctive rehabilitation method, an effective alternative rehabilitation option, or a maintenance strategy. Additionally, Tai Chi can improve cognitive function and immunity in older adults (
57
58
). Cost–benefit studies of fall prevention strategies have shown that Tai Chi is the most cost-effective exercise among older adults living in the community (
59
). Therefore, Tai Chi’s role in the older adult population is universal.
The strengths of our study lie in the inclusion of more recent RCT studies for analysis, the implementation of multiple subgroup analyses based on study characteristics, and the strict execution of sensitivity analyses. However, our study is not without limitations. Firstly, our selection of only English-language literature and specific criteria-based studies may have introduced selection bias. Secondly, the results of our research are only applicable to standard Tai Chi classes, not personalized courses, indicating a need for further investigation into the effects of personalized Tai Chi courses on older adult rehabilitation. Thirdly, despite conducting sensitivity and subgroup analyses, potential heterogeneity across studies may still impact the stability of our results. Lastly, our study only compares Tai Chi exercises with traditional non-Tai Chi exercises, yet a myriad of emerging technologies designed to enhance the quality of life for the older adult warrant further comparative research and exploration in the future (
60
).
Overall, Tai Chi exercise has a good preventive effect on falls in the older adult (both healthy and high-risk for falls) and enhances their balance ability. However, there is a relatively small number of studies on balance ability, and further research is needed in this area. Additionally, we need to increase the frequency of follow-up observations to observe the process of the Tai Chi intervention’s effectiveness. Furthermore, due to limitations in the number and quality of included studies, the above conclusions still require further high-quality verification.
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.
Statements
Data availability statement
The original contributions presented in the study are included in the article/
Supplementary material
, further inquiries can be directed to the corresponding author/s.
Author contributions
WC and ML made equal contributions to this study, including designing the search strategy for retrieving and screening articles, conducting data extraction and analysis. WC and HL wrote the manuscript, while YL and ZF managed the project and reviewed the manuscript. All authors have read and approved the final version of the manuscript.
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.
Supplementary material
The Supplementary material for this article can be found online at:
Supplementary Figure 1
Risk of bias summary.
References
1.
Beard
JR
Officer
de Carvalho
IA
Sadana
Pot
AM
Michel
JP
et al
The world report on ageing and health: a policy framework for healthy ageing
Lancet
. (
2016
387
2145
54
. doi:
10.1016/S0140-6736(15)00516-4
Pubmed Abstract
CrossRef
Google Scholar
2.
Chen
Yang
Li
Wang
Wu
Du
et al
Effects of population aging on the mortality burden of related cancers in urban and rural areas of China, 2004-2017: a population-based study
Cancer Biol Med
. (
2022
19
696
706
. doi:
10.20892/j.issn.2095-3941.2021.0538
Pubmed Abstract
CrossRef
Google Scholar
3.
Delbaere
Close
JC
Brodaty
Sachdev
Lord
SR
Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study
BMJ
. (
2010
341
c4165
. doi:
10.1136/bmj.
CrossRef
Google Scholar
4.
Gillespie
LD
Robertson
MC
Gillespie
WJ
Sherrington
Gates
Clemson
LM
et al
Interventions for preventing falls in older people living in the community
Cochrane Database Syst Rev
. (
2012
2021
CD007146
. doi:
10.1002/14651858.CD007146.pub3
Pubmed Abstract
CrossRef
Google Scholar
5.
Rubenstein
LZ
Falls in older people: epidemiology, risk factors and strategies for prevention
Age Ageing
. (
2006
35
ii37
41
. doi:
10.1093/ageing/afl084
CrossRef
Google Scholar
6.
Li
JX
Hong
Chan
KM
Tai Chi: physiological characteristics and beneficial effects on health
Br J Sports Med
. (
2001
35
148
56
. doi:
10.1136/bjsm.35.3.148
Pubmed Abstract
CrossRef
Google Scholar
7.
Wolf
SL
Sattin
RW
Kutner
O'Grady
Greenspan
AI
Gregor
RJ
Intense Tai Chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial
J Am Geriatr Soc
. (
2003
51
1693
701
. doi:
10.1046/j.1532-5415.2003.51552.x
Pubmed Abstract
CrossRef
Google Scholar
8.
Li
Harmer
Fitzgerald
Eckstrom
Stock
Galver
et al
Tai Chi and postural stability in patients with Parkinson's disease
N Engl J Med
. (
2012
366
511
. doi:
10.1056/NEJMoa1107911
Pubmed Abstract
CrossRef
Google Scholar
9.
Chen
Savarese
Cai
Ma
Lundborg
CS
Jiang
et al
Tai Chi and Qigong practices for chronic heart failure: a systematic review and meta-analysis of randomized controlled trials
Evid Based Complement Alternat Med
. (
2020
2020
15
. doi:
10.1155/2020/2034625
CrossRef
Google Scholar
10.
Del-Pino-Casado
Obrero-Gaitan
Lomas-Vega
The effect of Tai Chi on reducing the risk of falling: a systematic review and meta-analysis
Am J Chin Med
. (
2016
44
895
906
. doi:
10.1142/S0192415X1650049X
Pubmed Abstract
CrossRef
Google Scholar
11.
Lomas-Vega
Obrero-Gaitan
Molina-Ortega
FJ
Del-Pino-Casado
Tai Chi for risk of falls. A meta-analysis
J Am Geriatr Soc
. (
2017
65
2037
43
. doi:
10.1111/jgs.15008
Pubmed Abstract
CrossRef
Google Scholar
12.
Liberati
Altman
DG
Tetzlaff
Mulrow
Gotzsche
PC
Ioannidis
JP
et al
The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration
BMJ
. (
2009
339
b2700
. doi:
10.1136/bmj.b2700
Pubmed Abstract
CrossRef
Google Scholar
13.
World Health Organization
Ageing and health
. Available at:
2021
).
Google Scholar
14.
Yen
FS
Wang
SI
Lin
SY
Chao
YH
Wei
JC
The impact of heavy alcohol consumption on cognitive impairment in young old and middle old persons
J Transl Med
. (
2022
20
155
. doi:
10.1186/s12967-022-03353-3
Pubmed Abstract
CrossRef
Google Scholar
15.
Cumpston
Li
Page
MJ
Chandler
Welch
VA
Higgins
JP
et al
Updated guidance for trusted systematic reviews: a new edition of the Cochrane handbook for systematic reviews of interventions
Cochrane Database Syst Rev
. (
2019
10
ED000142
. doi:
10.1002/14651858.ED000142
Pubmed Abstract
CrossRef
Google Scholar
16.
Begg
CB
Mazumdar
Operating characteristics of a rank correlation test for publication bias
Biometrics
. (
1994
50
1088
101
. doi:
10.2307/2533446
CrossRef
Google Scholar
17.
Egger
Davey Smith
Schneider
Minder
Bias in meta-analysis detected by a simple, graphical test
BMJ
. (
1997
315
629
34
. doi:
10.1136/bmj.315.7109.629
Pubmed Abstract
CrossRef
Google Scholar
18.
Duval
Tweedie
Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis
Biometrics
. (
2000
56
455
63
. doi:
10.1111/j.0006-341x.2000.00455.x
Pubmed Abstract
CrossRef
Google Scholar
19.
Day
Hill
KD
Stathakis
VZ
Flicker
Segal
Cicuttini
et al
Impact of Tai-Chi on falls among preclinically disabled older people. A randomized controlled trial
J Am Med Dir Assoc
. (
2015
16
420
. doi:
10.1016/j.jamda.2015.01.089
Pubmed Abstract
CrossRef
Google Scholar
20.
Faber
MJ
Bosscher
RJ
Chin
APMJ
van Wieringen
PC
Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial
Arch Phys Med Rehabil
. (
2006
87
885
96
. doi:
10.1016/j.apmr.2006.04.005
Pubmed Abstract
CrossRef
Google Scholar
21.
Gao
Leung
Yang
Wei
Guan
Jia
et al
Effects of Tai Chi on balance and fall prevention in Parkinson's disease: a randomized controlled trial
Clin Rehabil
. (
2014
28
748
53
. doi:
10.1177/0269215514521044
Pubmed Abstract
CrossRef
Google Scholar
22.
Huang
HC
Liu
CY
Huang
YT
Kernohan
WG
Community-based interventions to reduce falls among older adults in Taiwan - long time follow-up randomised controlled study
J Clin Nurs
. (
2010
19
959
68
. doi:
10.1111/j.1365-2702.2009.02834.x
Pubmed Abstract
CrossRef
Google Scholar
23.
Huang
TT
Yang
LH
Liu
CY
Reducing the fear of falling among community-dwelling elderly adults through cognitive-behavioural strategies and intense Tai Chi exercise: a randomized controlled trial
J Adv Nurs
. (
2011
67
961
71
. doi:
10.1111/j.1365-2648.2010.05553.x
Pubmed Abstract
CrossRef
Google Scholar
24.
Hwang
HF
Chen
SJ
Lee-Hsieh
Chien
DK
Chen
CY
Lin
MR
Effects of home-based Tai Chi and Lower extremity training and self-practice on falls and functional outcomes in older fallers from the emergency department-a randomized controlled trial
J Am Geriatr Soc
. (
2016
64
518
25
. doi:
10.1111/jgs.13952
Pubmed Abstract
CrossRef
Google Scholar
25.
Kim
CY
Je
HD
Jeong
Jeong
JH
Kim
HD
Effects of Tai Chi versus Taekkyon on balance, lower-extremity strength, and gait ability in community-dwelling older women: a single-blinded randomized clinical trial
J Back Musculoskelet Rehabil
. (
2020
33
41
. doi:
10.3233/BMR-181493
Pubmed Abstract
CrossRef
Google Scholar
26.
Li
Harmer
Fisher
KJ
McAuley
Chaumeton
Eckstrom
et al
Tai Chi and fall reductions in older adults: a randomized controlled trial
J Gerontol A Biol Sci Med Sci
. (
2005
60
187
94
. doi:
10.1093/gerona/60.2.187
Pubmed Abstract
CrossRef
Google Scholar
27.
Li
Harmer
Fitzgerald
Eckstrom
Akers
Chou
LS
et al
Effectiveness of a therapeutic
Tai Ji Quan
intervention vs a multimodal exercise intervention to prevent falls among older adults at high risk of falling: a randomized clinical trial
JAMA Intern Med
. (
2018
178
1301
10
. doi:
10.1001/jamainternmed.2018.3915
Pubmed Abstract
CrossRef
Google Scholar
28.
Li
Harmer
Voit
Chou
LS
Implementing an online virtual falls prevention intervention during a public health pandemic for older adults with mild cognitive impairment: a feasibility trial
Clin Interv Aging
. (
2021
16
973
83
. doi:
10.2147/CIA.S306431
Pubmed Abstract
CrossRef
Google Scholar
29.
Logghe
IH
Zeeuwe
PE
Verhagen
AP
Wijnen-Sponselee
RM
Willemsen
SP
Bierma-Zeinstra
SM
et al
Lack of effect of Tai Chi Chuan in preventing falls in elderly people living at home: a randomized clinical trial
J Am Geriatr Soc
. (
2009
57
70
. doi:
10.1111/j.1532-5415.2008.02064.x
Pubmed Abstract
CrossRef
Google Scholar
30.
Ni
Mooney
Richards
Balachandran
Sun
Harriell
et al
Comparative impacts of Tai Chi, balance training, and a specially-designed yoga program on balance in older fallers
Arch Phys Med Rehabil
. (
2014
95
1620
1628.e30
. doi:
10.1016/j.apmr.2014.04.022
Pubmed Abstract
CrossRef
Google Scholar
31.
Nowalk
MP
Prendergast
JM
Bayles
CM
D'Amico
FJ
Colvin
GC
A randomized trial of exercise programs among older individuals living in two long-term care facilities: the FallsFREE program
J Am Geriatr Soc
. (
2001
49
859
65
. doi:
10.1046/j.1532-5415.2001.49174.x
Pubmed Abstract
CrossRef
Google Scholar
32.
Penn
IW
Sung
WH
Lin
CH
Chuang
Chuang
TY
Lin
PH
Effects of individualized Tai-Chi on balance and lower-limb strength in older adults
BMC Geriatr
. (
2019
19
235
. doi:
10.1186/s12877-019-1250-8
Pubmed Abstract
CrossRef
Google Scholar
33.
Pluchino
Lee
SY
Asfour
Roos
BA
Signorile
JF
Pilot study comparing changes in postural control after training using a video game balance board program and 2 standard activity-based balance intervention programs
Arch Phys Med Rehabil
. (
2012
93
1138
46
. doi:
10.1016/j.apmr.2012.01.023
Pubmed Abstract
CrossRef
Google Scholar
34.
Son
NK
Ryu
YU
Jeong
HW
Jang
YH
Kim
HD
Comparison of 2 different exercise approaches: Tai Chi versus Otago, in community-dwelling older women
J Geriatr Phys Ther
. (
2016
39
51
. doi:
10.1519/JPT.0000000000000042
Pubmed Abstract
CrossRef
Google Scholar
35.
Taylor
Hale
Schluter
Waters
DL
Binns
EE
McCracken
et al
Effectiveness of Tai Chi as a community-based falls prevention intervention: a randomized controlled trial
J Am Geriatr Soc
. (
2012
60
841
. doi:
10.1111/j.1532-5415.2012.03928.x
Pubmed Abstract
CrossRef
Google Scholar
36.
Taylor-Piliae
RE
Coull
BM
Community-based Yang-style Tai Chi is safe and feasible in chronic stroke: a pilot study
Clin Rehabil
. (
2012
26
121
31
. doi:
10.1177/0269215511419381
Pubmed Abstract
CrossRef
Google Scholar
37.
Taylor-Piliae
RE
Hoke
TM
Hepworth
JT
Latt
LD
Najafi
Coull
BM
Effect of Tai Chi on physical function, fall rates and quality of life among older stroke survivors
Arch Phys Med Rehabil
. (
2014
95
816
24
. doi:
10.1016/j.apmr.2014.01.001
Pubmed Abstract
CrossRef
Google Scholar
38.
Tousignant
Corriveau
Roy
PM
Desrosiers
Dubuc
Hebert
Efficacy of supervised Tai Chi exercises versus conventional physical therapy exercises in fall prevention for frail older adults: a randomized controlled trial
Disabil Rehabil
. (
2013
35
1429
35
. doi:
10.3109/09638288.2012.737084
Pubmed Abstract
CrossRef
Google Scholar
39.
Voukelatos
Cumming
RG
Lord
SR
Rissel
A randomized, controlled trial of Tai Chi for the prevention of falls: the Central Sydney Tai Chi trial
J Am Geriatr Soc
. (
2007
55
1185
91
. doi:
10.1111/j.1532-5415.2007.01244.x
Pubmed Abstract
CrossRef
Google Scholar
40.
Woo
Hong
Lau
Lynn
A randomised controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people
Age Ageing
. (
2007
36
262
. doi:
10.1093/ageing/afm005
Pubmed Abstract
CrossRef
Google Scholar
41.
Wayne
PM
Walsh
JN
Taylor-Piliae
RE
Wells
RE
Papp
KV
Donovan
NJ
et al
Effect of Tai Chi on cognitive performance in older adults: systematic review and meta-analysis
J Am Geriatr Soc
. (
2014
62
25
39
. doi:
10.1111/jgs.12611
Pubmed Abstract
CrossRef
Google Scholar
42.
Wayne
PM
Lee
MS
Novakowski
Osypiuk
Ligibel
Carlson
LE
et al
Tai Chi and Qigong for cancer-related symptoms and quality of life: a systematic review and meta-analysis
J Cancer Surviv
. (
2018
12
256
67
. doi:
10.1007/s11764-017-0665-5
Pubmed Abstract
CrossRef
Google Scholar
43.
Kong
LJ
Lauche
Klose
Bu
JH
Yang
XC
Guo
CQ
et al
Tai Chi for chronic pain conditions: a systematic review and Meta-analysis of randomized controlled trials
Sci Rep
. (
2016
25325
. doi:
10.1038/srep25325
Pubmed Abstract
CrossRef
Google Scholar
44.
Huang
ZG
Feng
YH
Li
YH
Lv
CS
Systematic review and meta-analysis: Tai Chi for preventing falls in older adults
BMJ Open
. (
2017
e013661
. doi:
10.1136/bmjopen-2016-013661
Pubmed Abstract
CrossRef
Google Scholar
45.
Kendrick
Kumar
Carpenter
Zijlstra
GA
Skelton
DA
Cook
JR
et al
Exercise for reducing fear of falling in older people living in the community
Cochrane Database Syst Rev
. (
2014
2015
CD009848
. doi:
10.1002/14651858.CD009848.pub2
Pubmed Abstract
CrossRef
Google Scholar
46.
Zhang
JG
Ishikawa-Takata
Yamazaki
Morita
Ohta
The effects of Tai Chi Chuan on physiological function and fear of falling in the less robust elderly: an intervention study for preventing falls
Arch Gerontol Geriatr
. (
2006
42
107
16
. doi:
10.1016/j.archger.2005.06.007
Pubmed Abstract
CrossRef
Google Scholar
47.
Hong
Li
JX
Robinson
PD
Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners
Br J Sports Med
. (
2000
34
29
34
. doi:
10.1136/bjsm.34.1.29
Pubmed Abstract
CrossRef
Google Scholar
48.
Au-Yeung
SS
Hui-Chan
CW
Tang
JC
Short-form Tai Chi improves standing balance of people with chronic stroke
Neurorehabil Neural Repair
. (
2009
23
515
22
. doi:
10.1177/1545968308326425
Pubmed Abstract
CrossRef
Google Scholar
49.
Lan
Lai
JS
Chen
SY
Wong
MK
Tai Chi Chuan to improve muscular strength and endurance in elderly individuals: a pilot study
Arch Phys Med Rehabil
. (
2000
81
604
. doi:
10.1016/s0003-9993(00)90042-x
Pubmed Abstract
CrossRef
Google Scholar
50.
Song
QH
Zhang
QH
Xu
RM
Ma
Zhao
XP
Shen
GQ
et al
Effect of Tai-Chi exercise on lower limb muscle strength, bone mineral density and balance function of elderly women. Int
J Clin Exp Med
. (
2014
1569
76
. PMID:
Pubmed Abstract
Google Scholar
51.
Li
Tang
He
Jin
He
Huang
et al
Tai Chi enhances cognitive training effects on delaying cognitive decline in mild cognitive impairment
Alzheimers Dement
. (
2023
19
136
49
. doi:
10.1002/alz.12658
Pubmed Abstract
CrossRef
Google Scholar
52.
Laudisio
Giovannini
Finamore
Loreti
Vannetti
Coraci
et al
Muscle strength is related to mental and physical quality of life in the oldest old
Arch Gerontol Geriatr
. (
2020
89
104109
. doi:
10.1016/j.archger.2020.104109
Pubmed Abstract
CrossRef
Google Scholar
53.
Tsang
WW
Hui-Chan
CW
Effect of 4- and 8-wk intensive Tai Chi training on balance control in the elderly
Med Sci Sports Exerc
. (
2004
36
648
57
. doi:
10.1249/01.mss.0000121941.57669.bf
Pubmed Abstract
CrossRef
Google Scholar
54.
Chiesa
Calati
Serretti
Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings
Clin Psychol Rev
. (
2011
31
449
64
. doi:
10.1016/j.cpr.2010.11.003
Pubmed Abstract
CrossRef
Google Scholar
55.
Kumar
Delbaere
Zijlstra
GA
Carpenter
Iliffe
Masud
et al
Exercise for reducing fear of falling in older people living in the community: Cochrane systematic review and meta-analysis
Age Ageing
. (
2016
45
345
52
. doi:
10.1093/ageing/afw036
Pubmed Abstract
CrossRef
Google Scholar
56.
Zheng
Xia
Zhou
Tao
Chen
Aerobic exercise ameliorates cognitive function in older adults with mild cognitive impairment: a systematic review and meta-analysis of randomised controlled trials
Br J Sports Med
. (
2016
50
1443
50
. doi:
10.1136/bjsports-2015-095699
Pubmed Abstract
CrossRef
Google Scholar
57.
Irwin
MR
Olmstead
Breen
EC
Witarama
Carrillo
Sadeghi
et al
Tai Chi, cellular inflammation, and transcriptome dynamics in breast cancer survivors with insomnia: a randomized controlled trial
J Natl Cancer Inst Monogr
. (
2014
2014
295
301
. doi:
10.1093/jncimonographs/lgu028
Pubmed Abstract
CrossRef
Google Scholar
58.
Oh
Butow
PN
Mullan
BA
Clarke
SJ
Beale
PJ
Pavlakis
et al
Effect of medical qigong on cognitive function, quality of life, and a biomarker of inflammation in cancer patients: a randomized controlled trial
Support Care Cancer
. (
2012
20
1235
42
. doi:
10.1007/s00520-011-1209-6
Pubmed Abstract
CrossRef
Google Scholar
59.
Day
Finch
CF
Harrison
JE
Hoareau
Segal
Ullah
Modelling the population-level impact of Tai-Chi on falls and fall-related injury among community-dwelling older people
Inj Prev
. (
2010
16
321
. doi:
10.1136/ip.2009.025452
Pubmed Abstract
CrossRef
Google Scholar
60.
Giovannini
Iacovelli
Brau
Loreti
Fusco
Caliandro
et al
RObotic-assisted rehabilitation for balance and gait in stroke patients (ROAR-S): study protocol for a preliminary randomized controlled trial
Trials
. (
2022
23
872
. doi:
10.1186/s13063-022-06812-w
Pubmed Abstract
CrossRef
Google Scholar
Summary
Keywords
Tai Chi
fall
balance
older adults
meta-analysis
Citation
Chen W, Li M, Li H, Lin Y and Feng Z (2023)
Tai Chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomized controlled trials
Front. Public Health
11:1236050. doi:
10.3389/fpubh.2023.1236050
Received
07 June 2023
Accepted
17 August 2023
Published
01 September 2023
Volume
11 - 2023
Edited by
Brijesh Sathian, Hamad Medical Corporation, Qatar
Reviewed by
Jun Hyun Bae, Hyupsung University, Republic of Korea; Manuel Enrique Hernandez, University of Illinois at Urbana-Champaign, United States; Silvia Giovannini, Catholic University of the Sacred Heart, Rome, Italy
Updates
This is an open-access article distributed under the terms of the
Creative Commons Attribution License (CC BY)
. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Zhoushan Feng,
zhoushanf@qq.com
Yanzhao Lin,
linyanzhao@163.com
†These authors have contributed equally to this work and share first authorship
Disclaimer
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.
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