Stress reduction through taiji: a systematic review and meta-analysis

Abstract

Purpose: In light of the mounting prevalence of stress in contemporary society and the growing interest in stress reduction methods, this review investigates the potential of taiji as a viable strategy for alleviating stress.

Methods: MEDLINE, EMBASE, the Cochrane Controlled Trials Register (CENTRAL), PsycINFO, and Web of Science were searched up to April 2023 to identify randomized controlled trials of taiji. Studies in both patients and healthy populations were considered. They had to provide a measure of perceived stress and include a no treatment or placebo control group. Data were extracted by two reviewers. Pooled standardized mean differences (SMD) were calculated for perceived stress, biological stress markers, anxiety, depression, and quality of life (QoL). Meta-regression analyses were performed to identify sources of heterogeneity.

Results: Eleven trials with a total of 1323 patients comparing taiji to no intervention met the inclusion criteria. The included studies varied strongly with regard to patient characteristics, taiji intervention, and methodological quality. The overall SMD for perceived stress was significant at -0.41 (95% confidence interval, CI, -0.63 to -0.19; I² = 63%). Exclusion of studies with less than 100 participants yielded a diminished SMD at -0.26 (95% CI, -0.45 to -0.06). The SMD for perceived stress at follow-up was significant (-0.25, 95% CI -0.46 to -0.05). Secondary outcomes highlighted improvements in anxiety and physical QoL, while depression, mental QoL, and biological stress markers remained unchanged.

Conclusions: Results underscore taiji's potential in mitigating perceived stress in both patients and healthy populations, paralleled by enhancements in depressive symptoms, anxiety levels, and physical QoL.

Keywords: Evidence-based practice; Mind–body exercise; Relaxation; Stress reduction; Tai Chi.

Fig. 1

Flow diagram

Fig. 2

Risk of bias graph

Fig. 3

Risk of bias summary

Fig. 4

Forest plot for the primary outcome perceived stress (post-intervention)

Fig. 5

Funnel plot for perceived stress (post-intervention)

Fig. 6

Forest plot for perceived stress at follow-up

Fig. 7

Forest plot for perceived stress in comparison to active control groups (post-intervention)

Fig. 8

Forest plot for physiological stress measures (post-intervention)

Fig. 9

Forest plot for depression and anxiety

Fig. 10

Forest plot for the secondary outcome quality of life (post-intervention)