Effects of Tai Chi on physical and psychological outcomes in children and adolescents: a systematic review

Abstract

Introduction Exercise supports the physical, mental, and social development of children and adolescents. Although Tai Chi is a well-documented mind-body exercise with established benefits in adults, its effects in younger populations remain unclear. This systematic review examined the physical, psychological, and safety outcomes of Tai Chi in children and adolescents and explored its potential underlying mechanisms. Methods Electronic searches of randomized controlled trials involving Tai Chi in children and adolescents were conducted from database inception to October 15, 2024, across major English- and Chinese-language databases, including PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), SinoMed, and Wanfang. Two reviewers independently performed the study selection and data extraction. Risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool. Results Fifteen trials involving 1004 participants aged 8‒18 years, both healthy and with chronic conditions were included. Yang-style Tai Chi was the most frequently used intervention, and control groups received either no Tai Chi or alternative exercise programs. Several studies reported positive effects on balance, physical function, mobility, muscle strength, fall risk, kyphosis, stereotypical behavior, and self-concept, suggesting possible mechanisms of benefit. However, safety data were limited. The overall methodological quality was moderate: three studies (20%) had low risk of bias, six (40%) had some concerns, and six (40%) had high risk. Conclusion Tai Chi may improve balance, flexibility, motor skills, physical fitness, and psychological factors such as self-concept in children and adolescents. However, further high-quality research is required to confirm its effectiveness and safety in this population.

Keywords

Tai Chi / children / psychological / adolescents / mind-body

References

[1] Leach MJ, Veziari Y, Flanagan C, Schloss J. Prevalence of complementary medicine use in children and adolescents: a systematic review. J Pediatr Health Care. 2024; 38(4):505-519.

[2] Kappes C, Stein R, Körner A, Merkenschlager A, Kiess W. Stress, stress reduction and obesity in childhood and adolescence. Horm Res Paediatr. 2023; 96(1):88-96.

[3] Aubert S, Barnes JD, Demchenko I, et al. Global matrix 4. 0 physical activity report card grades for children and adolescents: results and analyses from 57 countries. J Phys Act Health. 2022; 19(11):700-728.

[4] Guthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1. 6 million participants. Lancet Child Adolesc Health. 2020; 4(1):23-35.

[5] Suchert V, Hanewinkel R, Isensee B. Sedentary behavior and indicators of mental health in school-aged children and adolescents: a systematic review. Prev Med. 2015; 76:48-57.

[6] Hanifah L, Nasrulloh N, Sufyan DL. Sedentary behavior and lack of physical activity among children in Indonesia. Children (Basel). 2023; 10(8):1283.

[7] Chaput JP, Willumsen J, Bull F, et al. 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5-17 years: summary of the evidence. Int J Behav Nutr Phys Act. 2020; 17(1):141.

[8] Riskowski JL, Almeheyawi R. Effects of Tai Chi and Qigong in children and adolescents: a systematic review of trials. Adolesc Res Rev. 2019; 4(1):73-91.

[9] Wang YT, Huang G, Duke G, Yang Y. Tai Chi, Yoga, and Qigong as mind-body exercises. Evid Based Complement Alternat Med. 2017; 2017:8763915.

[10] Yang FC, Desai AB, Esfahani P, Sokolovskaya TV, Bartlett DJ. Effectiveness of Tai Chi for health promotion of older adults: a scoping review of meta-analyses. Am J Lifestyle Med. 2022; 16(6):700-716.

[11] Wall RB. Tai Chi and mindfulness-based stress reduction in a Boston public middle school. J Pediatr Health Care. 2005; 19(4):230-237.

[12] Heidari T, Sokhanguei Y, HoomanMinonejad. The effect of eight weeks of Tai-Chi exercises on status parameters of Kyphosis and balance among educable mentally retarded children. Int J Med Res Health Sci. 2016; 5(7):370-376.

[13] Kong Z, Sze TM, Yu JJ, et al. Tai Chi as an alternative exercise to improve physical fitness for children and adolescents with intellectual disability. Int J Environ Res Public Health. 2019; 16(7):1152.

[14] Zhang X, Yang H, Zhang K, et al. Effects of exercise or Tai Chi on Internet addiction in college students and the potential role of gut microbiota: a randomized controlled trial. J Affect Disord. 2023; 327:404-415.

[15] Lin HH, Hung YP, Weng SH, Lee PY, Sun WZ. Effects of parent-based social media and moderate exercise on the adherence and pulmonary functions among asthmatic children. Kaohsiung J Med Sci. 2020; 36(1):62-70.

[16] Lin HC, Lin HP, Yu HH, et al. Tai-Chi-Chuan exercise improves pulmonary function and decreases exhaled nitric oxide level in both asthmatic and nonasthmatic children and improves quality of life in children with asthma. Evid Based Complement Alternat Med. 2017; 2017:6287642.

[17] Huang J, Li X, Chen Z, et al. Effects of mind-body exercises on health-related outcomes in children and adolescents with autism spectrum disorder: a systematic review. Rev J Autism Dev Disord. 2023. doi:10.1007/S40489-023-00412-3.

[18] Liu X, Li R, Cui J, et al. The effects of Tai Chi and Qigong exercise on psychological status in adolescents: a systematic review and meta-analysis. Front Psychol. 2021; 12:746975.

[19] Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021: n71.

[20] Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.

[21] Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Chichester, UK: Wiley-Blackwell; 2008.

[22] Cetin SY, Erel S, Bas Aslan U. The effect of Tai Chi on balance and functional mobility in children with congenital sensorineural hearing loss. Disabil Rehabil. 2020; 42(12):1736-1743.

[23] Chen Y, Cheng L. Effects of Tai Chi exercise on attention deficit hyperactivity disorder tendency in children. J Chengdu Sport Univ. 2016; 42(5):29-32.

[24] Li E. Effects of Bafa Taijiquan on self-regulation in upper-grade primary school students. Youth Sport. 2023; 10:123-126.

[25] Li H, Li P. Effect of Tai Chi practice on alleviating exam stress syndrome among high school students. Contemp Sports Sci Technol. 2017; 7(24):179-181.

[26] Liu F, Wang CT. Study on the intervention of Tai Chi exercise on lower limb stability in middle school students. Station Sports Goods Technol. 2021; 18:3-4.

[27] Ma JF, Sun W. Effects of classic Tai Chi movements on balance in adolescents. Shandong Sports Sci Technol. 2015; 37(2):98-101.

[28] Wu MF. Observation of Young's Sixteen Type Tai Chi on Cervical Spondylosis of Senior Middle School Students [master’s thesis]. Fuzhou, China: Fujian University of Traditional Chinese Medicine; 2014.

[29] Mi SQ. Effect of Tai Chi exercise on balance ability of children aged 10-11 years. Chin Sch Health. 2016; 37(1):43-45.

[30] Zhou XH. The Experimental Research of the Impact of 24 Style Tai Chi on Junior’s Physical Health: Taking the Wuhan Nanhu Middle School for Example [master’s thesis]. Wuhan, China: Central China Normal University; 2015.

[31] Zhang ZS, Ma PY, Zheng W. A Study on the effects of 20-week Tai Chi exercise on physical function and physical fitness in adolescents. J Guangzhou Sport Univ. 2016; 36(3):101-105.

[32] Fong SSM, Chung LMY, Schooling CM, et al. Tai Chi-muscle power training for children with developmental coordination disorder: a randomized controlled trial. Sci Rep. 2022; 12(1):22078.

[33] Sarabzadeh M, Azari BB, Helalizadeh M. The effect of six weeks of Tai Chi Chuan training on the motor skills of children with autism spectrum disorder. J Bodyw Mov Ther. 2019; 23(2):284-290.

[34] Tabeshian R, Nezakat-Alhosseini M, Movahedi A, Zehr EP, Faramarzi S. The effect of Tai Chi Chuan training on stereotypic behavior of children with autism spectrum disorder. J Autism Dev Disord. 2022; 52(5):2180-2186.

[35] Bao X, Jin K. The beneficial effect of Tai Chi on self-concept in adolescents. Int J Psychol. 2015; 50(2):101-105.

[36] Yang GY, Sabag A, Hao WL, et al. Tai Chi for health and well-being: a bibliometric analysis of published clinical studies between 2010 and 2020. Complement Ther Med. 2021; 60:102748.

[37] Yang GY, Wang LQ, Ren J, et al. Evidence base of clinical studies on Tai Chi: a bibliometric analysis. PLoS One. 2015; 10(3):e0120655.

[38] Hopewell S, Chan AW, Collins GS, et al. CONSORT 2025 statement: updated guideline for reporting randomised trials [published online ahead of print April 14, 2025]. Lancet. 2025. doi:10.1016/S0140-6736(25)00672-5. 2025 statement: updated guideline for reporting randomised trials

[39] Yang GY, Wang LQ, Ren J, et al. Proposed reporting of Tai Chi intervention in clinical trials. World Chin Med. 2014; 9(10):1278-1285.

[40] MacPherson H, Altman DG, Hammerschlag R, et al. Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA):extending the CONSORT statement. J Altern Complement Med. 2010; 16(10):ST1-ST14.