The Impact of Tai Chi Exercise on Sleep Quality in the Elderly: A Systematic Review and Meta-Analysis

Authors

DOI:

https://doi.org/10.12775/PPS.2025.26.66407

Keywords

taijiquan, sleep quality, systematic review, meta-analysis

Abstract

Background: Tai chi, often referred to as “slow kung fu” or “soft exercise,” has become a prevalent morning activity among older adults. Exploring its impacts on the sleep quality of elderly individuals is valuable, given the high prevalence of sleep disturbances in this population. Methods: Guided by the PERSiST guideline and PRISMA statement, we systematically searched Web of Science, Embase, PubMed, MEDLINE, and CNKI for journal articles published between 2015 and 2025. Search terms included “tai chi/tai chi chuan,” “sleep/quality of sleep/sleep disorders/insomnia,” and “elderly/senior citizens.” Included studies were analyzed using RevMan 5.3 and Stata SE 17 software. Results: 1) Tai chi significantly improved subjective sleep quality (weighted mean difference [WMD] = -0.23, p < 0.05), reduced daytime dysfunction (WMD = -0.38, p < 0.001), and enhanced overall sleep quality (WMD = -1.8, p < 0.001) in seniors; 2) For the Pittsburgh Sleep Quality Index (PSQI) total score, tai chi sessions lasting ≥60 minutes improved sleep (WMD = -2.11, p < 0.001), and interventions lasting ≥8 weeks produced cumulative benefits (WMD = -2.53, p < 0.001); 3) Tai chi reduced PSQI scores in seniors with or without insomnia, and modified tai chi (WMD = -1.8, p < 0.001) was more effective than traditional tai chi (WMD = -1.60, p < 0.001). Conclusion: Tai chi effectively improves sleep quality in older adults. Optimal effects are observed when sessions last ≥60 minutes and the total intervention duration exceeds 8 weeks. Additionally, adapting traditional tai chi stances to match the diverse health conditions of elderly individuals may further enhance its efficacy.

References

FAN, G. D. (2020). An Experimental Study on the improvement of Sleep Disordersin the Elderly by Tai Chi Chuan Sleep Aid [Master's thesis]. Beijing Sport University, Beijing, China https://doi.org/10.26961/d.cnki.gbjtu.2020.000245

FANG, Y. Y. (2021). Effects of Sitting Taijiquan on Sleep Quality 、Anxiety andFatigue in Elderly Patients with Sleep Disorders [Master's thesis]. Shanghai University of Sport, Shanghai, China. https://doi.org/10.27315/d.cnki.gstyx.2021.000225

Li，Y.Q. (2021). A Randomized Controlled Experimental Study on the Influence of Eight-style Taijiquan Exercise on Mental Health Level of Elderly in Nursing Homes [Master's thesis]. Shandong Sport University, Jinan, China.. https://doi.org/10.27725/d.cnki.gsdty.2020.000032

XIE, X. (2023). The effects of Tai Chi exercise on sleep and sleep-related cognitive function in older adults [Master's thesis]. Southwest University, Chongqing, China.. https://doi.org/10.27684/d.cnki.gxndx.2022.000252

YANG,X.W. (2019). The effects of Tai Chi on sleep quality in elderly patients with essential hypertension [Master's thesis]. Chengdu University of Traditional Chinese Medicine, Chengdu, China. https://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CMFD&dbname=CMFD201901&filename=1018890067.nh

Ardern, C. L., Büttner, F., Andrade, R., Weir, A., Ashe, M. C., Holden, S., Impellizzeri, F. M., Delahunt, E., Dijkstra, H. P., Mathieson, S., Rathleff, M. S., Reurink, G., Sherrington, C., Stamatakis, E., Vicenzino, B., Whittaker, J. L., Wright, A. A., Clarke, M., Moher, D., … Winters, M. (2022). Implementing the 27 PRISMA 2020 statement items for systematic reviews in the sport and exercise medicine, musculoskeletal rehabilitation and sports science fields: The PERSiST (implementing prisma in exercise, rehabilitation, sport medicine and SporTs science) guidance. British Journal of Sports Medicine, 56(4), 175～195. https://doi.org/10.1136/bjsports-2021-103987

Babaei Bonab, S., & Parvaneh, M. (2022). The effect of twelve weeks of tai chi exercises on sleep quality, pain perception, and death anxiety in elderly women. Annales Médico-Psychologiques, Revue Psychiatrique, 180(9), 9. https://doi.org/10.1016/j.amp.2022.01.019

Banno, M., Harada, Y., Taniguchi, M., Tobita, R., Tsujimoto, H., Tsujimoto, Y., Kataoka, Y., & Noda, A. (2018). Exercise can improve sleep quality: A systematic review and meta-analysis. PeerJ. https://doi.org/10.7717/peerj.5172

Buysse, D., Reynolds, C., Monk, T., Berman, S., & Kupfer, D. (1989). The pittsburgh sleep quality index—A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193～213. https://doi.org/10.1016/0165-1781(89)90047-4

Cao, X.-L., Wang, S.-B., Zhong, B.-L., Zhang, L., Ungvari, G. S., Ng, C. H., Li, L., Chiu, H. F. K., Lok, G. K. I., Lu, J.-P., Jia, F.-J., & Xiang, Y.-T. (2017). The prevalence of insomnia in the general population in China: A meta-analysis. PLOS One, 12(2), e0170772. https://doi.org/10.1371/journal.pone.0170772

Carvalho, D. Z., St Louis, E. K., Knopman, D. S., Boeve, B. F., Lowe, V. J., Roberts, R. O., Mielke, M. M., Przybelski, S. A., Machulda, M. M., Petersen, R. C., Jack, C. R., & Vemuri, P. (2018). Association of excessive daytime sleepiness with longitudinal β-amyloid accumulation in elderly persons without dementia. JAMA Neurology, 75(6), 672～680. https://doi.org/10.1001/jamaneurol.2018.0049

Cumpston, M., Li, T., Page, M. J., Chandler, J., Welch, V. A., Higgins, J. P. T., & Thomas, J. (2019). Updated guidance for trusted systematic reviews: A new edition of the cochrane handbook for systematic reviews of interventions. Cochrane Database of Systematic Reviews, 10, ED000142. https://doi.org/10.1002/14651858.ED000142

Ding Y. (2020). Research on the intervention effect of Taijiquan exercise on insomnia in the elderly [Master's thesis].Anhui University of Chinese Medicine. Anhui，China. https://doi.org/10.26922/d.cnki.ganzc.2020.000306

Du, S., Dong, J., Zhang, H., Jin, S., Xu, G., Liu, Z., Chen, L., Yin, H., & Sun, Z. (2015). Taichi exercise for self-rated sleep quality in older people: A systematic review and meta-analysis. International Journal of Nursing Studies, 52(1), 368～379. https://doi.org/10.1016/j.ijnurstu.2014.05.009

Edinger, J. D., Wohlgemuth, W. K., Radtke, R. A., Marsh, G. R., & Quillian, R. E. (2001). Cognitive behavioral therapy for treatment of chronic primary insomnia: A randomized controlled trial. JAMA, the Journal of the American Medical Association, 285(14), 1856～1864. https://doi.org/10.1001/jama.285.14.1856

Effects of drugs on sleep. (1996). Neurologic Clinics, 14(4), 827～840. https://doi.org/10.1016/S0733-8619(05)70287-5

Gardner, M. M., Robertson, M. G., & Campbell, A. J. (2000). Exercise in preventing falls and fall related injuries in older people: A review of randomised controlled trials. British Journal of Sports Medicine, 34(1), 7～17. https://doi.org/10.1136/bjsm.34.1.7

Gong M., Tang Q., Tan S., & Hu X. (2024). Research Progress in the Effect of Exercise Intervention on Sleep Disorders and the Mechanisms Involved. Journal of Sichuan University(Medical Sciences), 55(1), 236～242.

Guo, L. (2022). Effects of 24-form tai chi on cardio-pulmonary functions, exercise performances, and cognitive functions of the aged. Iranian Journal of Public HEALTH, 51(10), 2253～2261.

Himali, J. J., Baril, A.-A., Cavuoto, M. G., Yiallourou, S., Wiedner, C. D., Himali, D., Decarli, C., Redline, S., Beiser, A. S., Seshadri, S., & Pase, M. P. (2023). Association between slow-wave sleep loss and incident dementia. JAMA Neurology, 80(12), 1326～1333. https://doi.org/10.1001/jamaneurol.2023.3889

Hou, B., Wu, Y., & Huang, Y. (2024). Physical exercise and mental health among older adults: The mediating role of social competence. Frontiers in Public Health, 12, 1385166. https://doi.org/10.3389/fpubh.2024.1385166

International, B. R. (2023). Retracted: Correlation between sleep time, sleep quality, and emotional and cognitive function in the elderly. Biomed Research International, 2023, 9843104. https://doi.org/10.1155/2023/9843104

Irwin, M. R., Olmstead, R., Carrillo, C., Sadeghi, N., Nicassio, P., Ganz, P. A., & Bower, J. E. (2017). Tai chi chih compared with cognitive behavioral therapy for the treatment of insomnia in survivors of breast cancer: A randomized, partially blinded, noninferiority trial. Journal of Clinical Oncology, 35(23), 2656. https://doi.org/10.1200/JCO.2016.71.0285

Irwin, M. R., Olmstead, R., & Motivala, S. J. (2008). Improving sleep quality in older adults with moderate sleep complaints: A randomized controlled trial of tai chi chih. Sleep, 31(7), 1001～1008.

Kassam, A., & Patten, S. B. (2006). Hypnotic use in a population-based sample of over thirty-five thousand interviewed canadians. Population Health Metrics, 4(1), 15. https://doi.org/10.1186/1478-7954-4-15

Lavretsky, H., Alstein, L. L., Olmstead, R. E., Ercoli, L. M., Riparetti-Brown, M., St. Cyr, N., & Irwin, M. R. (2011). Complementary use of tai chi chih augments escitalopram treatment of geriatric depression: A randomized controlled trial. American Journal of Geriatric Psychiatry, 19(10), 839～850. https://doi.org/10.1097/JGP.0b013e31820ee9ef

Leblanc, M.-F., Desjardins ,Sophie, & and Desgagné, A. (2015). The relationship between sleep habits, anxiety, and depression in the elderly. Nature and Science of Sleep, 7, 33～42. https://doi.org/10.2147/NSS.S77045

Leung, R. S. T. (2009). Sleep-disordered breathing: Autonomic mechanisms and arrhythmias. Progress in Cardiovascular Diseases, 51(4), 324～338. https://doi.org/10.1016/j.pcad.2008.06.002

Li, F., Fisher, K. J., Harmer, P., & Shirai, M. (2003). A simpler eight-form easy tai chi for elderly adults. https://doi.org/10.1123/japa.11.2.206

Li, L.-Y., Xie, X., Jiang, H.-X., & Yu, J. (2024). Improving memory through better sleep in community-dwelling older adults: A tai chi intervention study. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 79(11), 条 11. https://doi.org/10.1093/geronb/gbae156

LIU na, & WANG J. (2024). The Relationship Between Quality of Life and Quality of Sleep: The Chain Mediation Effects of Perceived Stress and Sleep Anxiety. Journal of South China Normal University(Social Science Edition), 4, 74～93, 206.

Liu H., Li F., & Wang Y. (2017). Association between sleep and leukocyte telomere length in middle-aged and older adults. Chinese journal of Epidemiology, 38(7). https://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CJFQ&dbname=CJFDTEMP&filename=ZHLX201707008

Liu Y., Dong Y., Li X., & Mao X. (2014). Meta-analysis of the prevalence of sleep disorder among Chinese elderly aged 60 years and over. Modern Preventive Medicine, 41(8), 1442～1445, 1449.

Liu, Z., Zhang, L., Bai, L., Guo, Z., Gao, J., Lin, Y., Zhou, Y., Lai, J., Tao, J., & Chen, L. (2025). Repetitive transcranial magnetic stimulation and tai chi chuan for older adults with sleep disorders and mild cognitive impairment: A randomized clinical trial. JAMA Network Open, 8(1), 1. https://doi.org/10.1001/jamanetworkopen.2024.54307

Lü, J., Huang, L., Wu, X., Fu, W., & Liu, Y. (2017). Effect of tai ji quan training on self-reported sleep quality in elderly chinese women with knee osteoarthritis: A randomized controlled trail. Sleep Medicine, 33, 70～75. https://doi.org/10.1016/j.sleep.2016.12.024

Lu, W.-A., & Kuo, C.-D. (2003). The effect of tai chi chuan on the autonomic nervous modulation in older persons. Medicine & Science in Sports & Exercise, 35(12), 1972. https://doi.org/10.1249/01.MSS.0000099242.10669.F7

Montgomery, P., & Dennis, J. (2003). Cognitive behavioural interventions for sleep problems in adults aged 60+. The Cochrane Database of Systematic Reviews, 1, CD003161.

Otones, P., Garcia, E., Sanz, T., & Pedraz, A. (2020). A physical activity program versus usual care in the management of quality of life for pre-frail older adults with chronic pain: Randomized controlled trial. BMC Geriatrics, 20(1), 396. https://doi.org/10.1186/s12877-020-01805-3

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hrobjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ: British Medical Journal, 372, n71. https://doi.org/10.1136/bmj.n71

Sabia, S., Fayosse, A., Dumurgier, J., van Hees, V. T., Paquet, C., Sommerlad, A., Kivimaeki, M., Dugravot, A., & Singh-Manoux, A. (2021). Association of sleep duration in middle and old age with incidence of dementia. Nature Communications, 12(1), 2289. https://doi.org/10.1038/s41467-021-22354-2

Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An american academy of sleep medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307～349. https://doi.org/10.5664/jcsm.6470

Shan H., Liu A., & He Y. (2015). Rational Drug Use and Safety of the Elderly. Chinese General Practice, 18(35), 4362. https://doi.org/10.3969/j.issn.1007-9572.2015.35.022

Siu, P. M., Yu, A. P., Tam, B. T., Chin, E. C., Yu, D. S., Chung, K.-F., Hui, S. S., Woo, J., Fong, D. Y., Lee, P. H., Wei, G. X., & Irwin, M. R. (2021). Effects of tai chi or exercise on sleep in older adults with insomnia: A randomized clinical trial. JAMA Network Open, 4(2), 2. https://doi.org/10.1001/jamanetworkopen.2020.37199

Siu, P. M., Yu, A. P., Tam, B. T., Chin, E. C., Yu, D. S., Chung, K.-F., Hui, S. S., Woo, J., Fong, D. Y., Lee, P. H., Wei, G. X., & Irwin, M. R. (2021). Effects of tai chi or exercise on sleep in older adults with insomnia: A randomized clinical trial. JAMA Network Open, 4(2), 2. https://doi.org/10.1001/jamanetworkopen.2020.37199

Stein, P. K., & Pu, Y. (2012). Heart rate variability, sleep and sleep disorders. Sleep Medicine Reviews, 16(1), 47～66. https://doi.org/10.1016/j.smrv.2011.02.005

Tian, L., Pan, D., Kuang, X., Ai, W., & Shi, H. (2024). The association between sleep duration trajectories and successful aging: A population-based cohort study. BMC Public Health, 24, 1～12. https://doi.org/10.1186/s12889-024-20524-7

Tian, Y., & Li, L. M. (2017). [Epidemiological study of sleep disorder in the elderly]. Zhonghua Liu Xing Bing Xue Za Zhi = Zhonghua Liuxingbingxue Zazhi, 38(7), 988～992. https://doi.org/10.3760/cma.j.issn.0254-6450.2017.07.028

Tseng, T.-H., Chen, H.-C., Wang, L.-Y., & Chien, M.-Y. (2020). Effects of exercise training on sleep quality and heart rate variability in middle-aged and older adults with poor sleep quality: A randomized controlled trial. Journal of Clinical Sleep Medicine, 16(9), 1483～1492. https://doi.org/10.5664/jcsm.8560

Wang, C., Jiang, T., Li, H., Cao, G., & Zhang, G. (2024). The effects of tai chi exercise on sleep quality among the elderly: A study based on polysomnographic monitoring. Frontiers in Neurology, 15. https://doi.org/10.3389/fneur.2024.1304463

Wang, C., Jiang, T., Li, H., Cao, G., & Zhang, G. (2024). The effects of tai chi exercise on sleep quality among the elderly: A study based on polysomnographic monitoring. Frontiers in Neurology, 15. https://doi.org/10.3389/fneur.2024.1304463

Wayne, P. M., Berkowitz, D. L., Litrownik, D. E., Buring, J. E., & Yeh, G. Y. (2014). What do we really know about the safety of tai chi?: A systematic review of adverse event reports in randomized trials. Archives of Physical Medicine and Rehabilitation, 95(12), 2470～2483. https://doi.org/10.1016/j.apmr.2014.05.005

Yang L., Jiang Z., & Zhao J. (2007). Causes of sleep disorders in elders and nursing care. Chinese Journal of Nursing, 1, 75～77.

Yeh, G. Y., Mietus, J. E., Peng, C.-K., Phillips, R. S., Davis, R. B., Wayne, P. M., Goldberger, A. L., & Thomas, R. J. (2008). Enhancement of sleep stability with tai chi exercise in chronic heart failure: Preliminary findings using an ECG-based spectrogram method. Sleep Medicine, 9(5), 527～536. https://doi.org/10.1016/j.sleep.2007.06.003

Zhang R., Zhang S., Qi H., Qiao W., & Zhao J. (2022). Influencing Factors of Sleep Disorders in the Elderly and Their Effects on Immune Status, Cognitive Function and Quality of Life. Progress in Modern Biomedicine, 22(21), 4071～4075. https://doi.org/10.13241/j.cnki.pmb.2022.21.012

Zhang Y., Fu Y., & Li D. (2024). Association of sleep duration and sleep quality with chronic disease and comorbidity among the elderly in China: An analysis of 2018 CLHLS survey data. Chinese Journal of Public Health, 40(8), 954～958.

Zisapel, N. (2007). Sleep and sleep disturbances: Biological basis and clinical implications. Cellular and Molecular Life Sciences, 64(10), 1174～1186. https://doi.org/10.1007/s00018-007-6529-9

Pedagogy and Psychology of Sport

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2025-11-11

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WANG, Chenyu, WANG, Chuanqiushui, WU, Xuemei and LUO, Jiong. The Impact of Tai Chi Exercise on Sleep Quality in the Elderly: A Systematic Review and Meta-Analysis. Pedagogy and Psychology of Sport. Online. 11 November 2025. Vol. 26, p. 66407. [Accessed 30 December 2025]. DOI 10.12775/PPS.2025.26.66407.

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Vol. 26 (2025)

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