International Journal of Behavioral Medicine

, Volume 21, Issue 4, pp 605–617 | Cite as

The Effects of Tai Chi on Depression, Anxiety, and Psychological Well-Being: A Systematic Review and Meta-Analysis

  • Fang Wang
  • Eun-Kyoung Othelia Lee
  • Taixiang Wu
  • Herbert Benson
  • Gregory Fricchione
  • Weidong Wang
  • Albert S. Yeung
Article

Abstract

Background

Tai chi, also called taiji or tai chi chuan, is a form of mind–body exercise that originated from China. It combines Chinese martial arts and meditative movements that promote balance and healing of the mind and body, involving a series of slowly performed, dance-like postures that flow into one another. As it comprises mental concentration, physical balance, muscle relaxation, and relaxed breathing, tai chi shows great potential for becoming widely integrated into the prevention and rehabilitation of a number of medical and psychological conditions.

Purpose

A growing body of clinical research has begun to evaluate the efficacy of tai chi as a therapy for a variety of health issues. A systematic review and meta-analysis were carried out on randomized controlled trials (RCTs) and quasi-experimental (Q-E) trials that studied the effects of tai chi on psychological well-being.

Method

Drawn from English and Chinese databases, 37 RCTs and 5 Q-E studies published up to May 31, 2013 were included in the systematic review. The methodological quality of the RCTs was evaluated based on the following criteria: adequate sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting, and other potential biases. Statistical analyses were performed using Review Manager version 5.0.

Results

The studies in this review demonstrated that tai chi interventions have beneficial effects for various populations on a range of psychological well-being measures, including depression, anxiety, general stress management, and exercise self-efficacy. Meta-analysis was performed on three RCTs that used depression as an outcome measure (ES = −5.97; 95 % CI −7.06 to −4.87), with I2 = 0 %.

Conclusion

In spite of the positive outcomes, the studies to date generally had significant methodological limitations. More RCTs with rigorous research design are needed to establish the efficacy of tai chi in improving psychological well-being and its potential to be used in interventions for populations with various clinical conditions.

Keywords

Tai chi Taiji Depression Anxiety Psychological well-being Meta-analysis 

References

  1. 1.
    Wayne PM, Kaptchuk TJ. Challenges inherent to t'ai chi research: part II—defining the intervention and optimal study design. J Altern Complement Med. 2008;14:191–7. doi:10.1089/acm.2007.7170B.PubMedCrossRefGoogle Scholar
  2. 2.
    Birdee GS, Wayne PM, Davis RB, Phillips RS, Yeh GY. T'ai chi and qigong for health: patterns of use in the United States. J Altern Complement Med. 2009;15:969–73. doi:10.1089/acm.2009.0174.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Hartman CA, Manos TM, Winter C, Hartman DM, Li B, Smith JC. Effects of t'ai chi training on function and quality of life indicators in older adults with osteoarthritis. J Am Geriatr Soc. 2000;48:1553–9.PubMedGoogle Scholar
  4. 4.
    Yeh GY, Wood MJ, Lorell BH, Stevenson LW, Eisenberg DM, Wayne PM, et al. Effects of tai chi mind-body movement therapy on functional status and exercise capacity in patients with chronic heart failure: a randomized controlled trial. Am J Med. 2004;117:541–8. doi:10.1016/j.amjmed.2004.04.016.PubMedCrossRefGoogle Scholar
  5. 5.
    Irwin MR, Olmstead R, Oxman MN. Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of tai chi. J Am Geriatr Soc. 2007;55:511–7. doi:10.1111/j.1532-5415.2007.01109.x.PubMedCrossRefGoogle Scholar
  6. 6.
    Hammond A, Freeman K. Community patient education and exercise for people with fibromyalgia: a parallel group randomized controlled trial. Clin Rehabil. 2006;20:835–46. doi:10.1177/0269215506072173.PubMedGoogle Scholar
  7. 7.
    Orr R, Tsang T, Lam P, Comino E, Singh MF. Mobility impairment in type 2 diabetes: association with muscle power and effect of tai chi intervention. Diabetes Care. 2006;29:2120–2. doi:10.2337/dc06-1130.PubMedCrossRefGoogle Scholar
  8. 8.
    Wang C, Schmid CH, Rones R, Kalish R, Yinh J, Goldenberg DL, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010;363:743–54. doi:10.1056/NEJMoa0912611.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Mustian KM, Katula JA, Gill DL, Roscoe JA, Lang D, Murphy K. Tai chi chuan, health-related quality of life and self-esteem: a randomized trial with breast cancer survivors. Support Care Cancer. 2004;12:871–6. doi:10.1007/s00520-004-0682-6.PubMedCrossRefGoogle Scholar
  10. 10.
    Wang C, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R, et al. Tai chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis Care Res. 2009;61:1545–53. doi:10.1002/art.24832.CrossRefGoogle Scholar
  11. 11.
    Yeh GY, Wang C, Wayne PM, Phillips R. Tai chi exercise for patients with cardiovascular conditions and risk factors: a systematic review. J Cardpulm Rehabil Prev. 2009;29:152–60. doi:10.1097/HCR.0b013e3181a33379.CrossRefGoogle Scholar
  12. 12.
    Wang C, Roubenoff R, Lau J, Kalish R, Schmid CH, Tighiouart H, et al. Effect of tai chi in adults with rheumatoid arthritis. Rheumatol. 2005;44:685–7. doi:10.1093/rheumatology/keh572.CrossRefGoogle Scholar
  13. 13.
    Galantino ML, Shepard K, Krafft L, LaPerriere A, Ducette J, Sorbello A, et al. The effect of group aerobic exercise and t'ai chi on functional outcomes and quality of life for persons living with acquired immunodeficiency syndrome. J Altern Complement Med. 2005;11:1085–92. doi:10.1089/acm.2005.11.1085.PubMedCrossRefGoogle Scholar
  14. 14.
    Lee MS, Pittler MH, Ernst E. Tai chi for rheumatoid arthritis: systematic review. Rheumatol. 2007;46:1648–51. doi:10.1093/rheumatology/kem151.CrossRefGoogle Scholar
  15. 15.
    Wang CW, Chan CLW, Ho RTH, Tsang H, Chan CHY, Ng SM. The effect of qigong on depressive and anxiety symptoms: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2013. doi:10.1155/2013/716094, 2013.
  16. 16.
    Wang WC, Zhang AL, Rasmussen B, Lin L, Dunning T, Kang S, et al. The effect of tai chi on psychosocial well-being: a systematic review of randomized controlled trials. J Acupunct Meridian Stud. 2009;2:171–81. doi:10.1002/art.24832.PubMedCrossRefGoogle Scholar
  17. 17.
    Wang CR, Ramel J, Kupelnick B, Scott T, Schmid CH. Tai chi on psychological well-being: systematic review and meta-analysis. BMC Complement Alternat Med. 2010;10:23. doi:10.1186/1472-6882-10-23.CrossRefGoogle Scholar
  18. 18.
    Cai Y, Zhou H. Taijiquan sport to depression patient mood influence. Med J Chin Health Aging. 2010;22:2051, 2112. doi:10.3969/j.issn.1672-0369.2010.16.004.Google Scholar
  19. 19.
    Chou K. Effect of tai chi on depressive symptoms amongst Chinese older patients with major depression: the role of social support. Med Sport Sci. 2008;52:146–54. doi:10.1159/000134295.CrossRefGoogle Scholar
  20. 20.
    Chou K, Lee PWH, Yu ECS, Macfarlane D, Cheng Y, Chan SSC, et al. Effect of tai chi on depressive symptoms amongst Chinese older patients with depressive disorders: a randomized clinical trial. Int J Geriatr Psychiatr. 2004;19:1105–7. doi:10.1002/gps.1178.CrossRefGoogle Scholar
  21. 21.
    Dechamps A, Gatta B, Bourdel-Marchasson I, Tabarin A, Roger P. Pilot study of a 10-week multidisciplinary tai chi intervention in sedentary obese women. Clin J Sport Med. 2009;19:49–53. doi:10.1097/JSM.0b013e318193428f.PubMedCrossRefGoogle Scholar
  22. 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 Rheum. 2007;57:407–14. doi:10.1002/art.22621.PubMedCrossRefGoogle Scholar
  23. 23.
    Gemmell C, Leathem JM. A study investigating the effects of tai chi chuan: individuals with traumatic brain injury compared to controls. Brain Inj. 2006;20:151–6. doi:10.1080/02699050500442998.PubMedCrossRefGoogle Scholar
  24. 24.
    Han Q, Huang X, Li L, Chen L. The effect of shadow boxing exercise on the long-term quality of life in middle-aged and elderly patients with primary hypertension. Chin J Mod Nurs. 2010;16:1617–9.Google Scholar
  25. 25.
    Jin X. The comparison study of body-building among health qigong, tai chi and yangko to the elderly. (Master's thesis). Available from CNKI Dissertations and Theses (No. G852.6); 2010.Google Scholar
  26. 26.
    Lee LYK, Lee DTF, Woo J. Tai chi and health-related quality of life in nursing home residents. J Nurs Scholarsh. 2009;41:35–43. doi:10.1111/j.1547-5069.2009.01249.x.PubMedCrossRefGoogle Scholar
  27. 27.
    Lee LYK, Lee DTF, Woo J. Effect of tai chi on state self-esteem and health-related quality of life in older Chinese residential care home residents. J Clin Nurs. 2007;16:1580–2. doi:10.1111/j.1365-2702.2007.02061.x.PubMedCrossRefGoogle Scholar
  28. 28.
    Li F, Harmer P, Chaumeton NR, Duncan TE, Duncan SC. Tai chi as a means to enhance self-esteem: a randomized controlled trial. J Appl Gerontol. 2002;21:70–89. doi:10.1177/073346480202100105.CrossRefGoogle Scholar
  29. 29.
    Li F, McAuley E, Harmer P, Duncan TE, Chaumeton NR. Tai chi enhances self-efficacy and exercise behavior in older adults. J Aging Phys Act. 2001;9:161–71.Google Scholar
  30. 30.
    Li W, Huang X, Bai M. Impact of Tai Chi exercise on the quality of life of women with osteoporosis in perimenopausal period. J Qilu Nurs. 2010;16:16–7.Google Scholar
  31. 31.
    Mao H, Yuan L, Luo M. The influence of taiji practice to depression and anxiety of female college students. New West. 2008;8:232–9.Google Scholar
  32. 32.
    McCain NL, Gray DP, Elswick RK, Robins JW, Tuck I, Walter JM, et al. A randomized clinical trial of alternative stress management interventions in persons with HIV infection. J Consult Clin Psychol. 2008;76:431–41. doi:10.1037/0022-006X.76.3.431.PubMedCrossRefGoogle Scholar
  33. 33.
    Sattin RW, Easley KA, Wolf SL, Chen Y, Kutner MH. Reduction in fear of falling through intense Tai Chi exercise training in older, transitionally frail adults. J Am Geriatr Soc. 2005;53:1168–78. doi:10.1111/j.1532-5415.2005.53375.x.PubMedCrossRefGoogle Scholar
  34. 34.
    Wolf SL, Sattin RW, Kutner M, O'Grady M, 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.PubMedCrossRefGoogle Scholar
  35. 35.
    Tsai J, Wang W, Chan P, Lin L, Wang C, Tomlinson B, et al. The beneficial effects of tai chi chuan on blood pressure and lipid profile and anxiety status in a randomized controlled trial. J Altern Complement Med. 2003;9:747–54. doi:10.1089/107555303322524599.PubMedCrossRefGoogle Scholar
  36. 36.
    Tsang T, Orr R, Lam P, Comino E, Singh MF. Health benefits of tai chi for older patients with type 2 diabetes: the ''move it for diabetes study''-a randomized controlled trial. Clin Interv Aging. 2007;2:429–39.PubMedCentralPubMedGoogle Scholar
  37. 37.
    Wang W, Sawada M, Noriyama Y, Arita K, Ota T, Sadamatsu M, et al. Tai chi exercise versus rehabilitation for the elderly with cerebral vascular disorder: a single-blinded randomized controlled trial. Psychogeriatrics. 2010;10:160–6. doi:10.1111/j.1479-8301.2010.00334.x.PubMedCrossRefGoogle Scholar
  38. 38.
    Winsmann F. The effect of tai chi chuan meditation on dissociation in a group of veterans. (Doctoral dissertation). Available from ProQuest Dissertations and Theses (UMI No. 3184477; 2005.)Google Scholar
  39. 39.
    Li Y, Hu X, Cui L. Clinical observation on sitting Tai Chi exercise used for 30 cases of patients with depression after stroke. Chin Nurs Res. 2012;26(8):2254–6. doi:10.3969/j.issn.1009-6493.2012.24.022.Google Scholar
  40. 40.
    Lu G. The effect of Tai Chi prescription on college students' health. Martial Art Sci. 2008;5(1):56–8.Google Scholar
  41. 41.
    Liao G. The effect of Tai Chi to depression and quality of life of the aged with empty nest. J Community Health. 2012;10(17):5–6.Google Scholar
  42. 42.
    Wang L, Zhou Q, Xu J, Yang L, Yang B, Du H. Clinical observation on Tai Chi for the recovery of depression after stroke. Chin Community Dr. 2012;18(14):222. doi:10.3969/j.issn.1007-614x.2012.18.199.Google Scholar
  43. 43.
    Li X. Influence of middle-age women's anxiety by Taiji practice. J Sports Adult Educ. 2012;28(2):36-7-48.Google Scholar
  44. 44.
    Li C, Feng H, Xiao S, Huang H. The influence of Tai Ji Quan on the therapeutic effect for irritable bowel syndrome. J Pract Med Tech. 2008;15(11):1384–6.Google Scholar
  45. 45.
    Li Z. The effect of Taiji to depression and anxiety of chronic obstructive pulmonary disease. Chin J Aesthet Med. 2011;20(6):129–30.Google Scholar
  46. 46.
    Li X, Song W. The effect of Taiji to the emotion of freshmen. Acad. 2011;24:37.Google Scholar
  47. 47.
    Wang C. Exercise on health and mood state of the university student's health care class. (Master's thesis). Available from CNKI Dissertations and Theses (No.G807.4); 2006.Google Scholar
  48. 48.
    Yeung A, Lepoutre V, Wayne P, Yeh G, Slipp LE, Fava M, et al. Tai chi treatment for depression in Chinese Americans: a pilot study. Am J Phys Med Rehabil. 2012;91(10):863–70.PubMedCrossRefGoogle Scholar
  49. 49.
    Nedeljkovic M, Ausfeld-Hafter B, Streitberger K, Seiler R, Wirtz PH. Taiji practice attenuates psychobiological stress reactivity—a randomized controlled trial in healthy subjects. J Cancer Surviv. 2012;6(2):146–54. doi:10.1007/s11764-011-0205-7.CrossRefGoogle Scholar
  50. 50.
    Redwine LS, Tsuang M, Rusiewicz A, Pandzic I, Cammarata S, Rutledge T, et al. A pilot study exploring the effects of a 12-week t'ai chi intervention on somatic symptoms of depression in patients with heart failure. Psychoneuroendocrinology. 2012;37(8):1171–80. doi:10.1016/j.psyneuen.2011.12.007.CrossRefGoogle Scholar
  51. 51.
    Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58. doi:10.1002/sim.1186.PubMedCrossRefGoogle Scholar
  52. 52.
    Yang K. How to write a systematic review. Beijing: People's Medical Publishing House; 2010.Google Scholar
  53. 53.
    Yang X. Experimental study of the effect of Taijiquan on psychological health of college students. J Tianjin Inst Phys Educ. 2003;18(1):63–6.Google Scholar
  54. 54.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Br Med J. 2003;327:557–60. doi:10.1136/bmj.327.7414.557.CrossRefGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2013

Authors and Affiliations

  • Fang Wang
    • 1
  • Eun-Kyoung Othelia Lee
    • 2
  • Taixiang Wu
    • 3
  • Herbert Benson
    • 4
  • Gregory Fricchione
    • 4
  • Weidong Wang
    • 1
    • 5
  • Albert S. Yeung
    • 4
    • 6
  1. 1.Guang’an Men HospitalChina Academy of Chinese Medical SciencesBeijingChina
  2. 2.University of North Carolina at CharlotteCharlotteUSA
  3. 3.West China HospitalSichuan UniversityChengduChina
  4. 4.Benson Henry Institute at the Massachusetts General HospitalBostonUSA
  5. 5.BeijingChina
  6. 6.Depression Clinical and Research ProgramMassachusetts General HospitalBostonUSA

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