The effect of Tai Chi in elderly individuals with sarcopenia and frailty: A systematic review and meta-analysis of randomized controlled trials

The potential role of Tai Chi in improving sarcopenia and frailty has been shown in randomized controlled trials (RCTs). This systematic review and meta-analysis aimed to examine the effect of Tai Chi on muscle mass, muscle strength, physical function, and other geriatric syndromes in elderly individuals with sarcopenia and frailty. Systematic searches of the PubMed, Cochrane Library, PEDro, EMBASE, Web of Science, CINAHL, and Medline databases for RCTs published between 1989 and 2022 were conducted; the database searchers were supplemented with manual reference searches. The inclusion criteria were as follows: (1) the study was designed as a RCT; (2) Tai Chi was one of the intervention arms; (3) the participants had a minimum age of ≥ 60 years and were diagnosed with frailty or sarcopenia, and the diagnostic guidelines or criteria were mentioned; (4) the number of participants in each arm was ≥ 10; and (5) the outcome reports included ≥ 1 item from the following primary or secondary outcomes. The exclusion criteria were as follows: (1) non-RCT studies; (2) nonhuman subjects; (3) participants aged < 60 years; (4) no description of the diagnostic guidelines or criteria for frailty or sarcopenia in the text; and (5) reported outcomes not among the following primary or secondary outcomes. The primary outcomes were muscle mass, grip strength and muscle performance (gait speed, 30-second chair stand test (30CST), sit-to-stand test (SST), Timed up and go test (TUGT), balance, and the Short Physical Performance Battery (SPPB)). The secondary outcomes included the number of falls and fear of falling (FOF), diastolic blood pressure (DBP), Mini-Mental State Examination (MMSE) score, and depression and quality of life (QOL) assessments. Eleven RCTs were conducted from 1996 to 2022 in 5 countries that investigated 1676 sarcopenic or frail elderly individuals were included in the review. There were 804 participants in the Tai Chi exercise cohort and 872 participants in the control cohort (nonexercised (n = 5)/ exercise (n = 8)). The mean age of participants was 70–89.5 years and the numbers of participants from each arm in each study were 10–158. The majority of the participants practiced Yang-style Tai Chi (n = 9), and the numbers of movement ranged from 6 to 24. The prescriptions of training were 8–48 weeks, 2–7 sessions per weeks, and 30–90 min per session. Most studies used Tai Chi expert as instructor (n = 8). The lengths of follow-up period were 8–48 weeks. The results from our meta-analysis revealed significant improvements for Tai Chi compared to control group (nonexercise/ exercise) on measures of the 30CST (weighted mean difference (WMD): 2.36, 95% confidence interval (CI) 1.50–3.21, p < 0.00001, I2 = 87%), the TUGT (WMD: −0.72, 95% CI −1.10 to −0.34, p = 0.0002, I2 =0%), numbers of fall (WMD: −0.41, 95% CI −0.64 to −0.17, p = 0.0006, I2 =0%) and FOF (standardized MD (SMD): −0.50, 95% CI −0.79 to −0.22, p = 0.0006, I2 = 57%); and for Tai Chi compared to ‘nonexercise’ controls on measures of SST (WMD: −2.20, 95% CI −2.22 to −2.18, p < 0.00001), balance (SMD: 9.85, 95% CI 8.88–10.82, p < 0.00001), DBP (WMD: −7.00, 95% CI −7.35 to −6.65, p < 0.00001), MMSE (WMD: 1.91, 95% CI 1.73–2.09, p < 0.00001, I2 =0%), depression (SMD: −1.37, 95% CI −1.91 to −0.83, p < 0.00001) and QOL (SMD: 10.72, 95% CI 9.38–12.07, p < 0.00001). There were no significant differences between Tai Chi and control groups on any of the remaining 4 comparisons: body muscle mass (WMD: 0.53, 95% CI −0.18 to 1.24; P = 0.14; I2 =0%), grip strength (WMD: −0.06, 95% CI −1.98 to 1.86; P = 0.95; I2 =0%), gait speed (WMD: 0.05, 95% CI −0.11 to 0.20; P = 0.55; I2 =99%), and SPPB (WMD: 0.55, 95% CI −0.04 to 1.14; P = 0.07). The variables of bias summary, Tai Chi instructor, Tai Chi movements, and Tai Chi training duration without significant association with the 30CST or the TUGT through meta-regression analyses. Our results demonstrated that patients with frailty or sarcopenia who practiced Tai Chi exhibited improved physical performance in the 30-second chair stand test, the Timed up and go test, number of falls and fear of falling. However, there was no difference in muscle mass, grip strength, gait speed, or Short Physical Performance Battery score between the Tai Chi and control groups. Improvements in the sit-to-stand test, balance, diastolic blood pressure, Mini-Mental State Examination score, and depression and quality of life assessments were found when comparing the Tai Chi cohort to the nonexercise control cohort rather than the exercise control cohort. To explore the effectiveness of Tai Chi in sarcopenic and frail elderly individuals more comprehensively, a standardized Tai Chi training prescription and a detailed description of the study design are suggested for future studies.