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Stress reduction through taiji: a systematic review and meta-analysis



In light of the mounting prevalence of stress in contemporary society and the growing interest in stress reduction methods, this review investigates the potential of taiji as a viable strategy for alleviating stress.


MEDLINE, EMBASE, the Cochrane Controlled Trials Register (CENTRAL), PsycINFO, and Web of Science were searched up to April 2023 to identify randomized controlled trials of taiji. Studies in both patients and healthy populations were considered. They had to provide a measure of perceived stress and include a no treatment or placebo control group. Data were extracted by two reviewers. Pooled standardized mean differences (SMD) were calculated for perceived stress, biological stress markers, anxiety, depression, and quality of life (QoL). Meta-regression analyses were performed to identify sources of heterogeneity.


Eleven trials with a total of 1323 patients comparing taiji to no intervention met the inclusion criteria. The included studies varied strongly with regard to patient characteristics, taiji intervention, and methodological quality. The overall SMD for perceived stress was significant at -0.41 (95% confidence interval, CI, -0.63 to -0.19; I2 = 63%). Exclusion of studies with less than 100 participants yielded a diminished SMD at -0.26 (95% CI, -0.45 to -0.06). The SMD for perceived stress at follow-up was significant (-0.25, 95% CI -0.46 to -0.05). Secondary outcomes highlighted improvements in anxiety and physical QoL, while depression, mental QoL, and biological stress markers remained unchanged.


Results underscore taiji's potential in mitigating perceived stress in both patients and healthy populations, paralleled by enhancements in depressive symptoms, anxiety levels, and physical QoL.

Peer Review reports


Stress, a ubiquitous component of modern life, has a multifaceted impact on health. It can exert direct effects through autonomic and neuroendocrine pathways or indirectly influence health behaviors [1]. While acute stress can enhance cognitive and physical performance, chronic and intense stress contributes to a variety of health issues, ranging from obesity and hypertension to migraine, asthma, and depression [2].

In light of the pervasive nature of stress in contemporary societies, stress reduction techniques have become quite popular. One influential mind–body technique rooted in Eastern traditions is taiji (also known as tai chi). Originally developed as a martial art, taiji is a form of mindful moving technique, combining slow and flowing movements with mindful breathing [3,4,5]. Over recent years, scientific interest in the health-enhancing potential of taiji has increased, and beneficial effects on physiological and psychological well-being have been confirmed [3, 6].

Several systematic reviews and meta-analyses on taiji included outcomes related to stress and psychological well-being. For example, in adolescents and college students, there is increasing evidence that taiji can improve depression, anxiety, stress, and cortisol levels [1, 2]. Beneficial effects of taiji in mitigating work-related stress among health professionals have also been reported [3]. A meta-analysis in patients with cardiovascular disease demonstrated favorable effects of taiji for anxiety, depression, and quality of life (QoL) [4, 5]. In cancer survivors, taiji positively impacted fatigue and sleep quality, while there were no significant improvements in anxiety, stress, depressive symptoms, or overall QoL [6].

Aside from partly inconsistent results, these findings are limited by small numbers of participants [7] and the partly low quality of included studies [1, 3, 4]. For example, many of these studies do not adhere to current methodological standards, including the incorporation of a control group or randomized allocation to treatment and control groups [8]. Hence, more comprehensive reviews and meta-analyses are needed to conclusively determine the stress-relieving potential of taiji.

This review aimed to systematically evaluate the available evidence from randomized controlled trials that taiji reduces perceived stress. Secondary outcomes encompassed physiological stress indicators, depression, anxiety, and health-related QoL. Our evaluation considered both patients and healthy populations.


This systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard [9].

Literature search

The literature search was performed by two reviewers (KM, JK) as part of a larger systematic review evaluating the stress-reducing potential of various yangsheng techniques, namely taiji, qigong, and acupressure. The following databases were searched: MEDLINE, EMBASE, the Cochrane Controlled Trials Register (CENTRAL), PsychINFO, and Web of Science (from inception to April 2023) using a combination of keywords and text words related to stress, relaxation, and taiji, qigong, and acupressure, combined with validated filters for controlled clinical trials. The search strategy for MEDLINE is shown in Table 1. Further potentially relevant publications were retrieved directly from the references cited in RCTs and systematic reviews.

Table 1 Search strategy for MEDLINE

Eligibility criteria

Only randomized controlled trials were considered. Study protocols were excluded. Participants could come from any demographic, including patients, healthy volunteers, or specific occupational groups. The primary intervention must have been taiji. Studies combining taiji with other interventions, such as relaxation methods or psychotherapy, were excluded. Interventions needed to last at least four weeks. Control groups were required to receive either a placebo treatment, or treatment as usual, or no intervention, such as being placed on a waiting list (WL) or receiving no treatment (NT). Eligible studies needed to provide a measure of perceived stress.

The primary outcome was the level of perceived stress at the conclusion of the intervention in the taiji group compared to the control group (placebo, WL, or NT). Stress had to be measured using a validated questionnaire or, alternatively, through visual analogue scales or numeric analogue scales. Secondary outcomes encompassed perceived stress at the latest available follow-up, stress compared to additional active control groups (typically those engaging in physical activity), as well as biological stress markers such as systolic blood pressure (BP), diastolic BP, heart rate, and cortisol levels. Additional secondary outcomes included psychological distress indicators like depression and anxiety, as well as both mental and physical QoL at the intervention's end.

Study selection

All abstracts identified through the literature search were screened, and irrelevant hits, such as nonrandomized studies and study protocols, were excluded. All remaining articles were obtained in full text and checked for eligibility based on the predefined selection criteria.

Data collection

Data was extracted using a standardized Excel form that captured the following details: bibliographic study information; study population demographics, including the age and gender of participants; numbers of participants involved at each stage (randomization, intervention, and analysis) as well as dropouts; details of the taiji intervention (type, duration, frequency) and, where relevant, sham interventions; nature of the control group; duration of both the intervention and follow-up periods; study design specifics (e.g., parallel-group or crossover); predefinition of primary outcomes; and type of analysis (intent-to-treat or per protocol). The data extraction for each study was independently performed by two of the three reviewers (KM, JK, PW), and any disagreements were resolved through discussion.

Risk of bias assessment

The risk of bias was assessed using the Cochrane Collaboration's risk of bias tool [10]. For each of the following domains – random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessors, incomplete outcome data, and selective reporting – the risk of bias was categorized as high, low, or unclear. The risk of bias assessment was performed for each study by two of the three reviewers (KM, JK, PW), and any disagreements were clarified through discussion. Summary graphs depicting the risk of bias were generated using Review Manager (RevMan) version 5.3..

Statistical analyses

Meta-analyses were conducted using RevMan. For the meta-analyses of the primary outcomes, standardized mean differences (SMD) between the intervention group and the control group and their 95% confidence intervals (CI) were calculated for each study. Results were then pooled using random-effects models. To check the robustness of results, sensitivity analyses were performed for (1) studies with low risk of bias related to allocation concealment, blinding of outcome assessors, and incomplete outcome data; (2) studies with total sample sizes of ≥ 100; and (3) studies with clearly predefined primary outcome measures (≤ 2 pre-specified primary outcomes, including how and when they were assessed). The effects of study characteristics on primary outcomes were investigated using multivariable meta-regression analyses by in IBM SPSS Statistics (version 25). For the meta-analyses of the secondary outcomes, standardized mean difference (SMD) between the intervention group and the respective control group and their 95% confidence intervals (CI) were calculated for each study.

Statistical heterogeneity was examined using Cochrane’s Q test and the I2 statistics. I2 values of 25%, 50%, and 75% were considered as low, moderate, and high heterogeneity, respectively. Funnel plot asymmetry was assessed using Egger’s test as a measure of publication bias [11]. The Egger’s test was performed using SPSS. For all statistical tests, a p-value < 0.05 was considered significant.


Literature search

The study selection process is shown in Fig. 1 [12]. The literature search yielded 933 hits, of which 108 were duplicates. Upon screening the abstracts, 667 clearly irrelevant records were excluded. The full texts of 158 potentially relevant hits were retrieved, from which 133 full text articles were excluded because they did not meet the inclusion criteria or examined qigong or acupressure interventions. Eleven RCTs on taiji were included in this review.

Fig. 1
figure 1

Flow diagram

Characteristics of included studies

Table 2 provides a summary of the characteristics of the eleven included studies [13,14,15,16,17,18,19,20,21,22,23]. Most of the studies were published in the last ten years. In total, 1323 participants were randomly assigned to either an experimental taiji intervention, or NT (7 trials WL, 3 trials NT, 1 trial TAU), or an additional active control group (5 trials, with different types of exercise). Five trials investigated patients and six trials healthy/stressed populations. The median age of participants was 53 years (IQR, 34–64), with men comprising 29% (median; IQR, 16–36) of the participants. Four of the trials had a clearly predefined primary outcome measure, four trials a partly predefined primary outcome measure (like predefinition of the outcome but not the time point, or more than two outcomes predefined as primary), and three trials had no predefined primary outcome measure. The duration of taiji practice ranged from 45 to 120 min, one to five times weekly, spanning 8 to 24 weeks (not counting self-practice at home). Table 3 gives an overview of the applied taiji interventions.

Table 2 Characteristics of included studies
Table 3 Main characteristics of taiji treatments

Risk of bias assessment

About half of the studies were judged to have significant weaknesses with regard to sequence generation, allocation concealment, and/or blinding of outcome assessment. In none of the trials were the participants and personnel blinded. In four studies, the dropout rates at the post-intervention measurement exceeded 15%, potentially leading to distortions. All trials were considered to have a low risk of selective reporting. An overall Risk of Bias Graph is displayed in Fig. 2, while Fig. 3 provides a detailed summary of the Risk of Bias for each individual study.

Fig. 2
figure 2

Risk of bias graph

Fig. 3
figure 3

Risk of bias summary

Meta-analyses of included studies

Perceived stress after intervention

Figure 4 displays the forest plot for the primary outcome of perceived stress at the end of the intervention period. The pooled effect of taiji on perceived stress was significant (SMD -0.41, 95% CI -0.63 to -0.19; p < 0.001). There was moderate-to-large heterogeneity (I2 = 63%, p = 0.003). The Egger’s test for funnel plot asymmetry was not significant (asymmetry coefficient -2.05, p = 0.123), while the funnel plot suggested the presence of small study bias (Fig. 5).

Fig. 4
figure 4

Forest plot for the primary outcome perceived stress (post-intervention)

Fig. 5
figure 5

Funnel plot for perceived stress (post-intervention)

We performed sensitivity analyses to assess potential influences of study quality characteristics on the SMDs for perceived stress. Specifically, we examined the impact of risk of bias concerning allocation concealment, blinding of study personnel, and incomplete outcome data. Given the possible presence of small study bias, we added a sensitivity analysis including only studies with sample sizes larger than 100 participants. Furthermore, we added a sensitivity analysis that included only studies with clearly predefined outcome measures (≤ 2 pre-specified primary outcomes, including how and when they were assessed). As indicated in Table 4, pooled effect sizes remained significant in all sensitivity analyses.

Table 4 Sensitivity analyses for the primary outcome perceived stress (post-intervention)

Explorative regression analyses were performed to evaluate possible influences of sample characteristics on perceived stress including type of population, gender, age, intervention duration, and sample size (Table 5). Simple linear regressions revealed smaller treatment effects (p < 0.1) in studies with lower proportion of females (p = 0.024), in studies in patients (p = 0.055) and in larger studies (p < 0.001). In a next step, these variables were included in a multiple linear regression analysis to identify possible independent predictors for perceived stress. The overall model was statistically significant (R2 = 0.59, Q = 15.22, p = 0.002), with sample size (p = 0.013) turning out as the only independent predictor (Table 5).

Table 5 Explorative regression analyses for the primary outcome perceived stress (post-intervention)

Perceived stress at follow-up

Five studies provided a continuous outcome measure for perceived stress at follow-up (in median, 24 weeks after randomization) (Fig. 6). The SMD was smaller but still significant (-0.25, 95% CI -0.46 to -0.05; p = 0.02), and heterogeneity was low (I2 = 34%, p = 0.02).

Fig. 6
figure 6

Forest plot for perceived stress at follow-up

Comparison with physical activity

Additional analyses were performed to assess the effects of the interventions on perceived stress in comparison to active control groups (various forms of physical exercise). In the five studies that included such an additional group, the pooled SMD for perceived stress was not significant (SMD 0.10, 95% CI -0.08 to 0.27, p = 0.29; I2 = 0%) (Fig. 7).

Fig. 7
figure 7

Forest plot for perceived stress in comparison to active control groups (post-intervention)

Objective stress measures

Five RCTs provided at least one objective stress measure (5 trials systolic and diastolic BP, 2 trials heart rate). Neither systolic BP (SMD -0.0, 95% CI -0.37 to 0.38; p = 0.98; I2 = 78%, p < 0.001), nor diastolic BP (SMD -0.21, 95% CI -0.56 to 0.14; p = 0.24; I2 = 75%, p = 0.003), nor heart rate (SMD -0.45, 95% CI -1.42 to 0.51, p = 0.36; I2 = 82%, p < 0.02) showed a significant intervention effect in comparison to the NT control groups (Fig. 8).

Fig. 8
figure 8

Forest plot for physiological stress measures (post-intervention)

Depression and anxiety

Six RCTs provided a measure for depression and five trials for anxiety. The pooled SMD for depression did not reach the level of significance (-0.29, 95% CI -0.66 to 0.07, p = 0.12), while heterogeneity was high (I2 = 77%, p < 0.001; Fig. 9). The pooled SMD for anxiety was significant (-0.41, 95% CI -0.71 to -0.1, p < 0.001), with moderate heterogeneity (I2 = 52%, p = 0.08) (Fig. 9).

Fig. 9
figure 9

Forest plot for depression and anxiety

Quality of life

Five studies reported a composite score for mental QoL and 3 studies for physical QoL. A significant intervention effect was revealed for physical QoL (SMD -0.45, 95% CI -0.67 to -0.24, p < 0.001; I2 = 0%), while the SMD for mental QoL was not significant (SMD -0.25, 95% CI -0.61 to 0.12, p = 0.18; I2 = 59%). (Fig. 10).

Fig. 10
figure 10

Forest plot for the secondary outcome quality of life (post-intervention)


This systematic review examined and synthesized the evidence regarding taiji’s stress-relieving effects. Based on evidence from eleven RCTs included in the primary meta-analysis, taiji appears effective in reducing stress. The pooled SMD comparing taiji to no intervention showed a moderate effect size, with moderate-to-high between-study heterogeneity. The Funnel plot and the sensitivity analysis that excluded small studies both suggested the presence of small-study bias, with the latter yielding a reduced yet still significant SMD. Approximately half of the studies had notable weaknesses related to the definition of primary outcomes, allocation concealment, blinding of outcome assessment, and/or incomplete outcome data. Sensitivity analyses excluding these studies revealed reduced effect sizes in those with low risk regarding allocation concealment. The pooled SMD for perceived stress remained significant at 24-week follow-up. The stress-reducing effect of taiji in comparison to NT thus appears to be robust, enduring, and small-to-moderate in size.

Our exploratory simple regression analyses suggested smaller effects in patients and females; however, these influences were not confirmed by the multivariate regression analysis, in which only sample size emerged as an independent predictor. This confirms and extends prior research, which has demonstrated that taiji practice benefits mental health in diverse populations [24], comprising young and healthy subjects [1], adults [3], as well as patients [4, 5] and the elderly [25].

Five RCTs in this review included a third treatment group involving physical activity to control for body movement during taiji exercise. There was no evidence suggesting taiji had effects beyond those of regular physical activity. Interestingly, the health benefits of physical activity have been linked to its potential to dampen stress [26], which may explain the comparable effects on perceived stress.

Six studies reported results for one or more objective stress markers: five studies for systolic/diastolic BP and two for heart rate. However, the pooled SMD for neither measure indicated a significant effect of the intervention. This suggests that while taiji may influence perceived stress, it doesn't seem to impact the physiological stress response. In contrast, several reviews have highlighted reductions in BP resulting from taiji practice [27,28,29]. For instance, a recent meta-analysis found that regular taiji exercise could lead to clinically meaningful reductions in both SBP and DBP. This analysis also identified baseline BP as a major effect moderator, revealing larger BP reductions in hypertensive individuals and smaller reductions in those with normal BP [28]. Similarly, our findings showed the most pronounced positive effects of taiji on SBP and DBP in a study with hypertensive adults [23]. The lack of significant effects of taiji on BP in our review might therefore stem from the fact that most participants in the studies had normal BP. However, a preventive cardiovascular benefit of taiji practice might still be inferred, given taiji's regulatory effect on endothelial function and its potential role in maintaining healthy BP [27].

Stress is often accompanied by symptoms of depression and anxiety [30]. Our analyses indicate that practicing taiji had beneficial effects on anxiety. The SMD for depressive symptoms did not reach the level of significance. However, when we excluded one study that focused on patients with schizophrenia [21, 31] – a condition where depressive symptoms can overlap with negative symptoms [31], the SMD became significant (-0.47, 95% CI, -0.67 to -0.27, p < 0.001), and heterogeneity dropped from 77 to 13% (p = 0.33). More RCTs are needed to conclusively determine the impact of taiji on depressive symptoms.

Additionally, five studies presented a composite measure for physical and/or mental QoL. The results suggest small-to-moderate sized pooled effects for physical QoL, while the SMD for mental QoL was not significant. These findings align with a recent meta-analysis that evaluated taiji's effectiveness among older adults, both with and without chronic conditions. When QoL was analyzed only the physical but not the mental component showed significant improvement [32]. Other systematic reviews have highlighted taiji's beneficial impact on health-related QoL across various chronic conditions compared to NT, encompassing psychological factors [33,34,35,36]. However, the majority of these studies emphasized physical functioning and overall well-being. To draw definitive conclusions regarding taiji's specific impact on mental QoL, more research is needed that assesses both sub-dimensions.

Even though the present review clearly indicates that taiji is more effective than NT in reducing stress, it cannot answer the question of how much of the interventional effects of taiji are due to placebo effects, given the lack of placebo control groups. The effects of taiji could only be differentiated from other influences, such as natural history, regression to the mean, and unidentified co-interventions. For physicians, it is a professional ideal to use treatments only if their specific actions are proven [37]. However, one could argue that a self-help strategy like taiji is acceptable as long as it works better than NT. According to surveys in Switzerland and the US, the majority of patients (62%) would even accept medical interventions prescribed by a physician that are effective, even if a specific action has not been proven [38, 39]. Yet, the prerequisite for such a pragmatic approach is that the intervention is not harmful [40, 41], and certainly that necessary medical treatments are not overlooked. Since taiji is a non-invasive treatment and is typically used as an add-on treatment in patients with medical disorders, these prerequisites seem to be met. Nonetheless, taiji styles and forms should be adapted to a patient’s physical and mental state [42].


The present results are limited by their unblinded nature and the absence of placebo control groups. This could have led to positive expectations only in the treatment groups, thereby triggering placebo effects as well as a possible response bias. Other nonspecific influences, such as natural history and regression to the mean, could largely be ruled out by comparison to NT control groups. The methodological and reporting quality of the included RCTs varied widely across trials. However, sensitivity analyses revealed significant, albeit sometimes smaller, effect sizes for studies with higher methodological quality. One limitation of the results is the small number of trials, and especially the results for the secondary outcomes should be interpreted with caution. Another potential limitation arises from the inclusion of trials with perceived stress as an outcome, regardless of whether stress was the primary or secondary outcome in the respective trial, and irrespective of whether the study targeted patients or stressed yet healthy populations. Consequently, the primary stressors likely varied among studies, ranging from psychosocial stressors related to a high workload to those typically associated with chronic diseases (e.g., loss of work, financial problems, loneliness). Lastly, the typical duration of the interventions in this review comprised 24 weeks. The potential effects of taiji's long-term use on stress remain to be investigated.


The scientific interest in the health-promoting effects of taiji has increased considerably during the past decades, and several new RCTs have been published in the past five years. Therefore, this systematic review aimed to evaluate the current evidence for the potential of this meditative movement intervention to reduce stress. Results indicate that, in comparison to untreated controls, taiji reduced perceived stress. The effect size was comparable in size to those associated with regular physical activity. Remarkably, taiji not only improved perceived stress but also anxiety and physical QoL. This broad effect on health and well-being is in accordance with the claim of integrative medicine to provide holistic care for the whole person rather than for single symptoms. However, more rigorously performed RCTs with sufficiently large sample sizes are needed to corroborate these findings.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.



Blood pressure


Confidence interval


No treatment


Quality of life


Standardized mean difference


Waiting list


  1. Liu X, Li R, Cui J, Liu F, Smith L, Chen X, Zhang D. The effects of tai chi and qigong exercise on psychological status in adolescents: a systematic review and meta-analysis. Front Psychol. 2021;12:746975.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Qi F, Soh KG, Mohd Nasirudddin NJ, Mai Y. Effects of taichi on physical and psychological health of college students: a systematic review. Front Physiol. 2022;13:1008604.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cocchiara RA, Dorelli B, Gholamalishahi S, Longo W, Musumeci E, Mannocci A, La Torre G. Tai Chi and workplace wellness for health care workers: a systematic review. Int J Environ Res Public Health. 2020;17:343.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Yang G, Li W, Klupp N, Cao H, Liu J, Bensoussan A, et al. Does tai chi improve psychological well-being and quality of life in patients with cardiovascular disease and/or cardiovascular risk factors? A systematic review. BMC Complement Med Ther. 2022;22:3.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Taylor-Piliae RE, Finley BA. Tai Chi exercise for psychological well-being among adults with cardiovascular disease: A systematic review and meta-analysis. Eur J Cardiovasc Nurs. 2020;19:580–91.

    Article  PubMed  Google Scholar 

  6. Zeng Y, Xie X, Cheng ASK. Qigong or tai chi in cancer care: an updated systematic review and meta-analysis. Curr Oncol Rep. 2019;21:48.

    Article  CAS  PubMed  Google Scholar 

  7. van Dam K. Individual stress prevention through qigong. Int J Environ Res Public Health. 2020;17:7342.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ospina MB, Bond K, Karkhaneh M, Buscemi N, Dryden DM, Barnes V, et al. Clinical trials of meditation practices in health care: characteristics and quality. J Altern Complement Med. 2008;14:1199–213.

    Article  PubMed  Google Scholar 

  9. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n160.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. London: Wiley; 2011.

  11. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Zheng S, Kim C, Lal S, Meier P, Sibbritt D, Zaslawski C. The effects of twelve weeks of tai chi practice on anxiety in stressed but healthy people compared to exercise and wait-list groups-A randomized controlled trial. J Clin Psychol. 2018;74:83–92.

    Article  PubMed  Google Scholar 

  14. Zheng G, Lan X, Li M, Ling K, Lin H, Chen L, et al. Effectiveness of tai chi on physical and psychological health of college students: results of a randomized controlled trial. PLoS One. 2015;10:e0132605.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Zhang J, Qin S, Zhou Y, Meng L, Su H, Zhao S. A randomized controlled trial of mindfulness-based tai chi chuan for subthreshold depression adolescents. Neuropsychiatr Dis Treat. 2018;14:2313–21.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Solianik R, Mickevičienė D, Žlibinaitė L, Čekanauskaitė A. Tai chi improves psychoemotional state, cognition, and motor learning in older adults during the COVID-19 pandemic. Exp Gerontol. 2021;150:111363.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Palumbo MV, Wu G, Shaner-McRae H, Rambur B, McIntosh B. Tai Chi for older nurses: A workplace wellness pilot study. Appl Nurs Res. 2012;25:54–9.

    Article  PubMed  Google Scholar 

  18. Nedeljkovic M, Wepfer V, Ausfeld-Hafter B, Wirtz PH, Streitberger KM. Influence of general self-efficacy as a mediator in Taiji-induced stress reduction - Results from a randomized controlled trial. Eur J Integr Med. 2013;5:284–90.

    Article  Google Scholar 

  19. Liu X, Vitetta L, Kostner K, Crompton D, Williams G, Brown WJ, et al. The effects of tai chi in centrally obese adults with depression symptoms. Evid Based Complement Alternat Med. 2015:8.

  20. Lauche R, Stumpe C, Fehr J, Cramer H, Cheng YW, Wayne P, et al. The effects of tai chi and neck exercises in the treatment of chronic non-specific neck pain: a randomized controlled trial. J Pain. 2016;17:1013–27.

    Article  PubMed  Google Scholar 

  21. Ho RT, Fong TC, Wan AH, Au-Yeung FS, Wong CP, Ng WY, et al. A randomized controlled trial on the psychophysiological effects of physical exercise and Tai-chi in patients with chronic schizophrenia. Schizophr Res. 2016;171:42–9.

    Article  PubMed  Google Scholar 

  22. Fransen M, Nairn L, Winstanley J, Lam P, Edmonds J. Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Arthritis Care Res. 2007;57:407–14.

    Article  Google Scholar 

  23. Chan AWK, Chair SY, Lee DTF, Leung DYP, Sit JWH, Cheng HY, Taylor-Piliae RE. Tai Chi exercise is more effective than brisk walking in reducing cardiovascular disease risk factors among adults with hypertension: A randomised controlled trial. Int J Nurs Stud. 2018;88:44–52.

    Article  PubMed  Google Scholar 

  24. Wang F, Lee EK, Wu T, Benson H, Fricchione G, Wang W, Yeung AS. The effects of tai chi on depression, anxiety, and psychological well-being: a systematic review and meta-analysis. Int J Behav Med. 2014;21:605–17.

    Article  PubMed  Google Scholar 

  25. Xianjian C, Datao X. Effects of Tai Chi Chuan on the Physical and Mental Health of the Elderly: A Systematic Review. Phys Act Health. 2021;5:21–7.

    Article  Google Scholar 

  26. Hamer M, Endrighi R, Poole L. Physical activity, stress reduction, and mood: insight into immunological mechanisms. In: Psychoneuroimmunology. New York: Springer; 2012. p. 89–102.

  27. Liu D, Yi L, Sheng M, Wang G, Zou Y. The Efficacy of Tai Chi and Qigong Exercises on Blood Pressure and Blood Levels of Nitric Oxide and Endothelin-1 in Patients with Essential Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Alternat Med. 2020;2020:3267971.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wu Y, Johnson BT, Chen S, Chen Y, Livingston J, Pescatello LS. Tai Ji Quan as antihypertensive lifestyle therapy: a systematic review and meta-analysis. J Sport Health Sci. 2021;10:211–21.

    Article  PubMed  Google Scholar 

  29. Dong X, Ding M, Yi X. Meta-Analysis of Randomized Controlled Trials of the Effects of Tai Chi on Blood Pressure. Evid Based Complement Alternat Med. 2020;2020:8503047.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lazarus RS. From psychological stress to the emotions: A history of changing outlooks. Annu Rev Psychol. 1993;44:1–22.

    Article  CAS  PubMed  Google Scholar 

  31. Correll CU, Schooler NR. Negative symptoms in schizophrenia: a review and clinical guide for recognition, assessment, and treatment. Neuropsychiatr Dis Treat. 2020;16:519–34.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wang D, Wang P, Lan K, Zhang Y, Pan Y. Effectiveness of Tai chi exercise on overall quality of life and its physical and psychological components among older adults: a systematic review and meta-analysis. Braz J Med Biol Res. 2020;53:e10196.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Song R, Grabowska W, Park M, Osypiuk K, Vergara-Diaz GP, Bonato P, et al. The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson’s disease: A systematic review and meta-analysis. Parkinsonism Relat Disord. 2017;41:3–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Wu W, Liu X, Wang L, Wang Z, Hu J, Yan J. Effects of Tai Chi on exercise capacity and health-related quality of life in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2014;9:1253–63.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Li G, Yuan H, Zhang W. Effects of Tai Chi on health related quality of life in patients with chronic conditions: a systematic review of randomized controlled trials. Complement Ther Med. 2014;22:743–55.

    Article  PubMed  Google Scholar 

  36. Wayne PM, Lee MS, Novakowski J, Osypiuk K, Ligibel J, Carlson LE, Song R. 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.

    Article  PubMed  Google Scholar 

  37. Linde K, Fassler M, Meissner K. Placebo interventions, placebo effects and clinical practice. Philos Trans R Soc Lond B Biol Sci. 2011;366:1905–12.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Fässler M, Gnädinger M, Rosemann T, Biller-Andorno N. Placebo interventions in practice: a questionnaire survey on the attitudes of patients and physicians. Br J Gen Pract. 2011;61:101–7.

  39. Hull SC, Colloca L, Avins A, Gordon NP, Somkin CP, Kaptchuk TJ, Miller FG. Patients’ attitudes about the use of placebo treatments: telephone survey. BMJ. 2013;347:f3757.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Evers AWM, Colloca L, Blease C, Annoni M, Atlas LY, Benedetti F, et al. Implications of placebo and nocebo effects for clinical practice: expert consensus. Psychother Psychosom. 2018;87:204–10.

    Article  PubMed  Google Scholar 

  41. Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018;19:455–74.

    Article  PubMed  Google Scholar 

  42. Engelhardt U, Hildenbrand G, Zumfelde-Hüneburg C, editors. Leitfaden Qigong. 2nd ed. München: Urban & Fischer Verlag; 2007.

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We would like to thank Ute Engelhardt and Klaus Linde for their valuable comments during the conduct of this study.


KM received financial support from the Schweizer-Arau Foundation, Germany, during the conduct of the study.

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KM designed the study, searched, selected, extracted and assessed the literature and performed the statistical analyses. PW and JK contributed to study selection, data collection, and risk of bias assessment. JK and KM drafted the manuscript, PW critically reviewed the manuscript. All authors read and approved the final manuscript.

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Correspondence to Karin Meissner.

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Kraft, J., Waibl, P.J. & Meissner, K. Stress reduction through taiji: a systematic review and meta-analysis. BMC Complement Med Ther 24, 210 (2024).

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