Tai Chi (Tai Ji)

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Tai Chi (Tai Ji)

Common Names

  • Tai Chi Chuan
  • Taijiquan

For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.


What Is It

Based on Chinese philosophy and traditional medicine theory, tai chi is a movement therapy that seeks to harmonize the Yin and Yang vital forces and promote the flow of energy in the body known as Qi to improve health. It coordinates a series of prescribed movements with meditation and breathing exercises. Clinical trials of tai chi have been conducted in elderly, frail, and disabled patients, and those with chronic conditions such as fibromyalgia, arthritis, Parkinson’s disease, heart disease, and cancer. These studies show that tai chi can improve sleep, strength, stamina, flexibility, balance, limb function, blood pressure, mental outlook, and awareness. It can also help reduce stress, fall risk, and bone loss. Tai chi can be practiced by people of all age groups as the movements are gentle with little stress on the body. Like other mind-body approaches, benefits obtained from this modality increase with regular practice.

How It Works

Tai chi practice can improve posture, movement control, and ability to walk, in part due to the gradual weight shift that occurs with the lower and upper limbs. Slow foot movements such as forward heel-to-toe and backward toe-to-heel motions also improve flexibility, stamina, and muscle tone. The practice of moving from wide to narrow stances as well as turning in the movements expands the number of situations under which the body experiences support. The coordinated breathing used along with the exercises helps to improve lung function. Taken together, these details within the exercises are the mechanisms that serve to improve balance while reducing risk of falls. Tai chi has also been shown to reduce inflammation that is linked with many chronic diseases, including heart disease and cancer.

Purported Uses
  • Balance
    Several studies show that tai chi improves balance which may also help to reduce the risk of falls.
  • Fatigue
    Clinical trials suggest that tai chi can help reduce fatigue in breast cancer patients.
  • Fibromyalgia
    A randomized trial showed that tai chi was as good or even better than aerobic exercise to reduce fibromyalgia symptoms.   
  • Pain
    This use is supported by clinical trials.
  • Physical Functioning
    Several studies show that tai chi can improve muscle strength, flexibility, stamina, and stable posture in a variety of populations including cancer patients.
Is It Safe
  • Tai chi is generally considered to be safe.
  • Patients with muscle and bone injuries should consult their physician before starting tai chi practice. 
Who Can Provide this Service

Experienced tai chi instructors.

Where Can I Get Treatment

Many hospitals, cancer centers, and community and senior centers offer tai chi classes. The Integrative Medicine Service at MSK offers tai chi and other exercise and mind-body modalities in a new online program, Integrative Medicine at Home, to help support the recovery and well-being of cancer patients everywhere.

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For Healthcare Professionals

Clinical Summary

Tai chi is an exercise program that uses a sequence of precise body movements, meditation, and synchronized breathing to improve health and well-being. Based on Chinese philosophy and traditional medicine theory, tai chi exercises are thought to harmonize the Yin and Yang vital forces and promote the flow of Qi, or internal energy, to improve health. Like most moderate physical activities, tai chi can improve stamina, muscle tone, agility, and flexibility. The coordinated practice of breathing along with the exercises may serve a meditative function to increase awareness and reduce stress.

Reviews of clinical trials show that tai chi practice has many benefits including reduced pain and improved flexibility and strength (1) (2) (53). Clinical studies in women showed that tai chi may help reduce bone loss (3) and fracture-related risks (4), and improve physical function (5). Along with resistance training and diet intervention, tai chi significantly improved mobility in obese older women (6).

In a comparative effectiveness trial, tai chi compared with aerobic exercise had similar to significantly greater benefits for patients with fibromyalgia (52). In studies of potential benefits for joint diseases, tai chi improved range of motion in patients with rheumatoid arthritis (7) (8), reduced knee osteoarthritic pain (9), and improved functional fitness and physical and mental health among ethnically diverse participants (10). In patients with end-stage hip osteoarthritis, a combined tai chi/strength training program improved balance and aerobic capacity, but not pain or side hip motion (11). For older adults with previous fall-related emergency visits, those who were given a tai chi intervention were less likely to experience subsequent falls than those given a lower-extremity training (12). Tai chi in both community and home practice settings also appear to reduce fall risk and improve physical and executive function among older adults (54) (55), although a study among disabled elderly did not find a group program effective, perhaps due to insufficient intervention or low attendance (13).

Tai chi can also provide benefits in patients with other chronic conditions. It improved aerobic capacity in sedentary adults (2) and respiratory function in patients with COPD (14), although a systematic analysis did not show superiority with tai chi over other interventions for this condition (15). Tai chi improved quality of life (QoL) for those with chronic heart failure (16) (17), and reduced hypertension and associated risk factors (9) (18) (19), reversed markers of inflammation (20), and improved sleep (21) and physical function (22) in elderly individuals. Another study suggests that sleep improvements occur after long-term rather than short-term practice in patients with chronic insomnia (23). Tai chi also reduced cellular inflammatory responses and proinflammatory gene expression associated with sleep disturbance in older adults with insomnia (49). In a small study of chronic stroke patients, tai chi improved balance, gait, and QoL (24). In patients with recent myocardial infarction, tai chi was associated with increased peak oxygen consumption, suggesting its application in cardiac rehabilitation (25). Patients with fibromyalgia reported significant symptom improvements following a tai chi exercise program (26) (27), and in patients with Parkinson’s disease (28) (29) and multiple sclerosis (30), tai chi improved balance and reduced risk of falls. It was also found to be more cost-effective for patients with mild-to-moderate Parkinson’s disease than resistance training or stretching, with better fall reduction outcomes (31). Tai chi produced benefits in pain reduction and QoL similar to conventional neck exercises for participants with chronic neck pain (32).

Studies in younger populations are few. Tai chi programs improved self-concept in adolescents (33) as well as flexibility and balance among college students (34). It is also among the complementary health approaches use in children aged 4–17 years, with higher usage among girls than boys, although overall usage among this age group is still small (35).

In cancer patients, preliminary data suggest that tai chi improves QoL (36) (37) and neuropsychological functioning (38). It was feasible and acceptable among senior cancer survivors as well (39), and may help reduce risk factors for other chronic diseases (19). In a study of breast cancer survivors, tai chi practice resulted in clinically relevant, sustained improvements in insomnia, and was as effective as cognitive behavioral therapy for insomnia (CBT-I) (50). A combination qi gong/tai chi exercise program also improved fatigue, depression, and sleep dysfunction (40). In addition, meta-analyses found significant improvements in cancer-related fatigue, sleep difficulty, depression, and QoL (53) as well as cortisol levels and limb function (56).

Tai chi can be practiced by people of all age groups and has been found to have a good adherence rate (17) (22) as the movements are gentle and there is a low risk for injury. In a meta-analysis of RCTs to assess safety, tai chi was found to be generally safe, with significantly fewer adverse events than with controls among patients with heart failure (57).

The Integrative Medicine Service at MSK offers tai chi and other exercise and mind-body modalities in a new online program, Integrative Medicine at Home, to help support the recovery and well-being of cancer patients everywhere.

Mechanism of Action

Improved postural control and walking ability are due to specific features that characterize the tai chi protocol, in which weight shifting and ankle sway move one’s center of gravity toward the limits of stability (28). Alternating narrow and wide stances continually change the base of support, increase support-leg standing and trailing-leg swing time, and encourage rotation of the torso with an upright posture. Forward heel-to-toe and backward toe-to-heel steps strengthen dorsiflexion and plantar flexion, respectively. Improvements in mobility are attributed to the increased flexibility and balance that may occur with regular tai chi practice (6), and are also the mechanisms by which this modality helps to prevent falls (41). Tai chi particularly appears to alleviate bradykinetic movements associated with Parkinson’s disease by improving gait characteristics such as maximum excursion, while reducing deviation in movement (eg, reaching forward to take objects from a cabinet; transitioning from seated-to-standing / standing-to-seated positions) and markedly increasing gait velocity and stride length (28).

Several studies evaluating biomarker changes with tai chi indicate that the physical aspects of this exercise mediate reductions in both decreased fat mass and IL-2 levels along with increased fat-free mass and IL-6, while the meditative component may also contribute to anti-inflammatory effects (42). Declining pro-inflammatory cytokine IL-2 levels further result in increased bone formation and metabolism levels (43). Other anti-inflammatory effects include increased superoxide dismutase activity with reduced IL-1β (44). Tai chi may also improve health-related QoL by regulating other inflammatory responses and biomarkers (37).

Adverse Reactions
  • Tai chi is generally considered to be safe (19). Adverse events have not yet been reported in studies of tai chi for patients with COPD (15), Parkinson’s disease (29), or cancer (39) (45). Additional studies are further evaluating safety in patients with cardiovascular (46) (47) and Parkinson’s disease (48).
  • It is advisable that patients with musculoskeletal injuries consult their physicians before starting a tai chi program.
Practitioners and Treatments

Tai chi classes are offered in many hospitals, cancer centers, and community and senior centers, generally by experienced instructors. The Integrative Medicine Service at MSK offers tai chi and other exercise and mind-body modalities in a new online program, Integrative Medicine at Home, to help support the recovery and well-being of cancer patients everywhere.

Dosage (OneMSK Only)
References
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  2. Taylor-Piliae RE, Froelicher ES. Effectiveness of Tai Chi exercise in improving aerobic capacity: a meta-analysis. J Cardiovasc Nurs. Jan-Feb 2004;19(1):48-57.
  3. Chan K, Qin L, Lau M, et al. A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women. Arch Phys Med Rehabil. May 2004;85(5):717-722.
  4. Wayne PM, Kiel DP, Buring JE, et al. Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial. BMC Complement Altern Med. 2012;12:7.
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  6. Maris SA, Quintanilla D, Taetzsch A, et al. The combined effects of tai chi, resistance training, and diet on physical function and body composition in obese older women. J Aging Res. 2014;2014:657851.
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  9. Tsai PF, Chang JY, Beck C, et al. A supplemental report to a randomized cluster trial of a 20-week Sun-style Tai Chi for osteoarthritic knee pain in elders with cognitive impairment. Complement Ther Med. Aug 2015;23(4):570-576.
  10. Dogra S, Shah S, Patel M, et al. Effectiveness of a Tai Chi intervention for improving functional fitness and general health among ethnically diverse older adults with self-reported arthritis living in low-income neighborhoods: a cohort study. J Geriatr Phys Ther. Apr-Jun 2015;38(2):71-77.
  11. Zeng R, Lin J, Wu S, et al. A randomized controlled trial: preoperative home-based combined Tai Chi and Strength Training (TCST) to improve balance and aerobic capacity in patients with total hip arthroplasty (THA). Arch Gerontol Geriatr. Mar-Apr 2015;60(2):265-271.
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  17. Yeh GY, McCarthy EP, Wayne PM, et al. Tai chi exercise in patients with chronic heart failure: a randomized clinical trial. Arch Intern Med. Apr 25 2011;171(8):750-757.
  18. Sun J, Buys N. Community-Based Mind-Body Meditative Tai Chi Program and Its Effects on Improvement of Blood Pressure, Weight, Renal Function, Serum Lipoprotein, and Quality of Life in Chinese Adults With Hypertension. Am J Cardiol. Oct 1 2015;116(7):1076-1081.
  19. Campo RA, Light KC, O’Connor K, et al. Blood pressure, salivary cortisol, and inflammatory cytokine outcomes in senior female cancer survivors enrolled in a tai chi chih randomized controlled trial. J Cancer Surviv. Mar 2015;9(1):115-125.
  20. Irwin MR, Olmstead R, Breen EC, et al. Cognitive behavioral therapy and tai chi reverse cellular and genomic markers of inflammation in late-life insomnia: a randomized controlled trial. Biol Psychiatry. Nov 15 2015;78(10):721-729.
  21. Li F, Fisher KJ, Harmer P, et al. Tai chi and self-rated quality of sleep and daytime sleepiness in older adults: a randomized controlled trial. J Am Geriatr Soc. Jun 2004;52(6):892-900.
  22. Manor B, Lough M, Gagnon MM, et al. Functional benefits of tai chi training in senior housing facilities. J Am Geriatr Soc. Aug 2014;62(8):1484-1489.
  23. Carroll JE, Seeman TE, Olmstead R, et al. Improved sleep quality in older adults with insomnia reduces biomarkers of disease risk: pilot results from a randomized controlled comparative efficacy trial. Psychoneuroendocrinology. May 2015;55:184-192.
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  25. Nery RM, Zanini M, de Lima JB, et al. Tai Chi Chuan improves functional capacity after myocardial infarction: A randomized clinical trial. Am Heart J. Jun 2015;169(6):854-860.
  26. Taggart HM, Arslanian CL, Bae S, et al. Effects of T’ai Chi exercise on fibromyalgia symptoms and health-related quality of life. Orthop Nurs. Sep-Oct 2003;22(5):353-360.
  27. Wang C, Schmid CH, Rones R, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. Aug 19 2010;363(8):743-754.
  28. Li F, Harmer P, Fitzgerald K, et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med. Feb 9 2012;366(6):511-519.
  29. Zhang TY, Hu Y, Nie ZY, et al. Effects of Tai Chi and Multimodal Exercise Training on Movement and Balance Function in Mild to Moderate Idiopathic Parkinson Disease. Am J Phys Med Rehabil. Oct 2015;94(10 Suppl 1):921-929.
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  32. Lauche R, Stumpe C, Fehr J, et al. The Effects of Tai Chi and Neck Exercises in the Treatment of Chronic Nonspecific Neck Pain: A Randomized Controlled Trial. J Pain. Jun 23 2016.
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  34. Zheng G, Lan X, Li M, et al. Effectiveness of Tai Chi on Physical and Psychological Health of College Students: Results of a Randomized Controlled Trial. PLoS One. 2015;10(7):e0132605.
  35. Black LI, Clarke TC, Barnes PM, et al. Use of complementary health approaches among children aged 4-17 years in the United States: National Health Interview Survey, 2007-2012. Natl Health Stat Report. Feb 10 2015(78):1-19.
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  37. Sprod LK, Janelsins MC, Palesh OG, et al. Health-related quality of life and biomarkers in breast cancer survivors participating in tai chi chuan. J Cancer Surviv. Jun 2012;6(2):146-154.
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  39. Campo RA, O’Connor K, Light KC, et al. Feasibility and acceptability of a Tai Chi Chih randomized controlled trial in senior female cancer survivors. Integr Cancer Ther. Nov 2013;12(6):464-474.
  40. Larkey LK, Roe DJ, Weihs KL, et al. Randomized controlled trial of Qigong/Tai Chi Easy on cancer-related fatigue in breast cancer survivors. Ann Behav Med. Apr 2015;49(2):165-176.
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  46. Salmoirago-Blotcher E, Wayne P, Bock BC, et al. Design and methods of the Gentle Cardiac Rehabilitation Study—A behavioral study of tai chi exercise for patients not attending cardiac rehabilitation. Contemp Clin Trials. Jul 2015;43:243-251.
  47. Tao J, Rao T, Lin L, et al. Evaluation of Tai Chi Yunshou exercises on community-based stroke patients with balance dysfunction: a study protocol of a cluster randomized controlled trial. BMC Complement Altern Med. 2015;15:31.
  48. Yang Y, Hao YL, Tian WJ, et al. The effectiveness of Tai Chi for patients with Parkinson’s disease: study protocol for a randomized controlled trial. Trials. 2015;16:111.
  49. Irwin MR, Olmstead R, Breen EC, et al. Cognitive behavioral therapy and tai chi reverse cellular and genomic markers of inflammation in late-life insomnia: a randomized controlled trial. Biol Psychiatry. 2015 Nov 15;78(10):721-9.
  50. Irwin MR, Olmstead R, Carrillo C, et al. Tai Chi Chih Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial. J Clin Oncol. 2017 Aug 10;35(23):2656-2665.
  51. Wang C, Schmid CH, Fielding RA, et al. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ. Mar 21 2018;360:k851.
  52. Wayne PM, Lee MS, Novakowski J, et al. Tai Chi and Qigong for cancer-related symptoms and quality of life: a systematic review and meta-analysis. J Cancer Surviv. Apr 2018;12(2):256-267.
  53. Qin J, Zhang Y, Wu L, et al. Effect of Tai Chi alone or as additional therapy on low back pain: Systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). Sep 2019;98(37):e17099.
  54. Gallant MP, Tartaglia M, Hardman S, et al. Using Tai Chi to Reduce Fall Risk Factors Among Older Adults: An Evaluation of a Community-Based Implementation. J Appl Gerontol. Jul 2019;38(7):983-998.
  55. Chewning B, Hallisy KM, Mahoney JE, et al. Disseminating Tai Chi in the Community: Promoting Home Practice and Improving Balance. Gerontologist. May 15 2020;60(4):765-775.
  56. Ni X, Chan RJ, Yates P, et al. The effects of Tai Chi on quality of life of cancer survivors: a systematic review and meta-analysis. Support Care Cancer. Oct 2019;27(10):3701-3716.
  57. Cui H, Wang Q, Pedersen M, et al. The safety of tai chi: A meta-analysis of adverse events in randomized controlled trials. Contemp Clin Trials. Jul 2019;82:85-92.
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