Psychological health outcomes of traditional Chinese exercises in older adults: a meta-analysis of randomized controlled trials

TL;DR

Traditional Chinese exercises significantly improve mental health in older adults, reducing depression and anxiety while boosting well-being.

Contribution

This is the first meta-analysis focusing on psychological health outcomes of traditional Chinese exercises in older adults.

Findings

TCEs significantly reduce depression and anxiety in older adults.

TCEs enhance subjective well-being and show positive trends for self-efficacy and self-esteem.

Recommended TCE sessions are group-based, 30-50 minutes long, 3-5 times weekly for at least 24 weeks.

Abstract

In recent years, an increasing number of systematic reviews and meta-analyses have examined the health benefits of traditional Chinese exercises (TCEs). However, most of the reviews and meta-analyses have just focused on their effects on physical function in older adults. This study conducts a meta-analysis of existing randomized controlled trials (RCTs) to investigate the effects of TCEs on psychological health outcomes.

Five Chinese and English databases were searched from their inception to July 2, 2025. RCTs were included if they used TCE interventions to improve psychological health outcomes in older adults, such as depression, anxiety, subjective well-being, general self-efficacy, and self-esteem. Study screening and data extraction were performed independently by two reviewers at all stages. Meta-analyses were conducted using Rev Man 5.4 and Stata 17.0. Pre-determined subgroups included the type of TCEs, mode of the intervention, duration of the intervention, frequency of exercise, duration of the single exercise session, and type of control condition.

This study included 42 RCTs involving 4,317 participants. The meta-analysis revealed that, compared to control groups, TCEs are more effective in improving depression (SMD = −0.51, 95% CI [−0.72 to −0.29], p < 0.00001), anxiety (SMD = −0.39, 95% CI [−0.63 to −0.15], p = 0.002), and subjective well-being among older adults (SMD = 1.07, 95% CI [0.18–1.96], p = 0.02). TCEs also showed positive effects on general self-efficacy (SMD = 0.63, 95% CI [−0.05 to 1.31], p = 0.07) and self-esteem (SMD = 0.54, 95% CI [−0.06 to 1.13], p = 0.08), although these effects are not statistically significant. Despite the high heterogeneity in some outcomes, the studies with heterogeneity did not have a significant effect on the results. None of the included studies reported any injuries or adverse events among the participants.

TCEs represent an effective and safe intervention that can significantly reduce depressive and anxiety symptoms among older adults, while also enhancing their subjective well-being. When implementing TCE interventions, it is recommended to adopt a group-based exercise class, with sessions lasting 30 to 50 minutes, conducted 3 to 5 times per week, for a minimum duration of 24 weeks.

PROSPERO (No. CRD420251067843).

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