The effects and optimal dosage of traditional Chinese exercises on patients with chronic ankle instability: A systematic review and meta-analysis

Abstract

Background: The effectiveness of Traditional Chinese exercises in promoting functional recovery in patients with chronic ankle instability, as well as the potential impact of variables such as intervention type, duration, frequency, and cycle on treatment outcomes, still requires further investigation.

Methods: Literature searches were conducted in multiple databases including China National Knowledge Infrastructure (CNKI), VIP, Wanfang, China Biomedical Literature Database (CBM), PubMed, EBSCO(Medline、CINAHL、SPORTDiscus), Embase, Cochrane Library, ProQuest, and Web of Science for randomized controlled trials assessing the effects of Traditional Chinese Exercises interventions on patients with Chronic Ankle Instability. The publication timeframe spanned from the inception of each database until January 20, 2025. Meta-analysis was performed using STATA 15 software on the included studies.

Results: Twelve randomized controlled trials (RCTs) involving 323 patients were included in this analysis. Compared with the control group, Traditional Chinese exercises showed the following improvements: CAIT: WMD = 4.02, 95 % CI [3.22, 4.81], z = 9.90, P < 0.001.Balance: ANT: SMD = 0.38, 95 % CI [0.18, 0.59], z = 3.71, P = 0.003.PM: SMD = 0.49, 95 % CI [0.26, 0.70], z = 4.73, P < 0.001.PL: SMD = 0.67, 95 % CI [0.46, 0.88], z = 6.35, P < 0.001.C: SMD = 0.80, 95 % CI [0.35, 1.25], z = 3.51, P < 0.001.JPS:Plantarflexion: SMD = -0.58, 95 % CI [-0.94, -0.21], z = 3.09, P = 0.002.Inversion: SMD = -0.46, 95 % CI [-0.86, -0.06], z = 2.23, P = 0.025.Muscle Strength: Plantarflexion: SMD = 0.81, 95 % CI [0.43, 1.18], z = 4.25, P < 0.001.Inversion: SMD = 0.66, 95 % CI [0.25, 1.07], z = 3.16, P = 0.002.Eversion: SMD = 1.04, 95 % CI [0.62, 1.46], z = 4.82, P < 0.001.Subgroup Analysis: Tai Chi training conducted twice weekly for a 12-week intervention period, with 60-minute sessions, demonstrated the most effective improvements.

Level of evidence: The evidence level for the effects of Traditional Chinese exercises on Balance-ANT, Balance-PM, and Balance-PL balance directions in CAI patients is rated as "moderate."

Conclusion: Traditional Chinese exercise has been shown to significantly improve balance, muscle strength, and joint position sense in CAI patients. Based on the current findings, Tai Chi training appears to provide greater benefits for CAI patients. It is recommended that CAI patients participate in Tai Chi training twice a week, with each session lasting 60 minutes, over a 12-week period.

Systematic review registration: PROSPERO database, CRD42024613359.

Keywords: Balance; Chronic ankle instability; Meta-analysis; Muscle strength; Traditional Chinese exercises.