Table 3 Summary of findings of the health effects of Tai Chi

Adverse events (AE)

Adults, older adults; healthy, obesity, cancer, myocardial infarction, chronic heart failure, osteoarthritis, type 2 diabetes mellitus, chronic pulmonary disease; in community settings; China, South Korea, Australia, USA, Brazil, Israel, France, Italy, Turkey

Cui 2019 [64]

Critically low

Serious AE (15 RCTs)

TC (n = 476) vs physically active interventions (n = 489)

RD 0.0 (− 0.02 to 0.02)

Equivalent risk

LOW

dd

Non-serious AE (15 RCTs)

TC (n = 476) vs physically active interventions (n = 489)

RD 0.01 (− 0.01 to 0.03)

Equivalent risk

MODERATE

d

TC related AE (15 RCTs)

TC (n = 476) vs physically active interventions (n = 489)

RD 0.0 (− 0.01 to 0.02)

Equivalent risk

MODERATE

d

Serious AE (9 RCTs)

TC (n = 421) vs physically inactive interventions (n = 408)

RD − 0.03 (− 0.06 to 0.00)

Equivalent risk

MODERATE

d

Non-serious AE (9 RCTs)

TC (n = 421) vs physically inactive interventions (n = 408)

RD 0.03 (− 0.00 to 0.07)

Equivalent risk

MODERATE

d

TC related AE (9 RCTs)

TC (n = 421) vs physically inactive interventions (n = 408)

RD 0.0 (− 0.01 to 0.02)

Equivalent risk

MODERATE

d

General health and quality of Life

Older adults, with or without chronic diseases (also see cancer, cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, Parkinson’s disease, perimenopause)

Older adults; healthy, low bone mass, chronic obstructive pulmonary disease, chronic heart failure & depression, benign prostate hyperplasia, total knee arthroplasty, highly maladjusted institutionalized; in community settings, intermediate care rehabilitation unit, long-term care institution; China, Hong Kong, South Korea, USA, Spain, Germany, Iran

Wang 2020 [91]

Critically low

QoL—overall (6 RCTs)

TC (n = 277) vs Ucare, Ex (n = 275)

SMD 1.23 (0.56 to 1.89)

Large effect

LOW

a, b

Older adults; with chronic disease—osteopenia, osteoporosis, osteoarthritis, stroke, hypertension, Parkinson’s disease, diabetes; in community settings; China, South Korea, USA, Australia, Turkey

Choo 2020 [62]

Critically low

QoL—physical (6 RCTs: 1 RCT Taylor-Piliae 2020 [90], 1 RCT Wang 2017 [92])

TC (n = 257) vs noRx, ADL, Ucare, HEd, attention control, waitlist (n = 238)

SMD 0.46 (0.13 to 0.80)

Small to moderate effect

MODERATE

a

QoL—mental health (6 RCTs: 1 RCT Wang 2017 [92])

TC (n = 257) vs noRx, ADL, Ucare, HEd, attention control, waitlist (n = 238)

SMD 0.21 (0.03 to 0.39)

Small effect

MODERATE

a

Perimenopause

Female adults and older adults; perimenopause, with or without low bone mineral density; in community settings; China, USA

Wang 2017 [92]

Critically low

QoL—physical function SF-36 (4 RCTs)

TC + / − placebo capsule (n = 154) vs Ucare, ADL, placebo capsule (n = 160)

MD − 1.8 points (− 5.2 to 1.6)

Equivalent effect, MCID − 2 points [50]

LOW

a, d

QoL—bodily pain SF-36 (3 RCTs)

TC + / − placebo capsule (n = 112) vs usual care, ADL, placebo capsule (n = 118)

MD − 3.6 points (− 6.6 to − 0.6)

Moderate effect, MCID − 3 points [50]

MODERATE

a

(†LOW)

QoL—general health SF-36 (3 RCTs)

TC + / − placebo capsule (n = 112) vs ADL, placebo capsule (n = 118)

MD − 5.1 points (− 7.6 to − 2.6)

Large effect, MCID − 2 points [50]

MODERATE

a

(†LOW)

QoL—vitality SF-36 (3 RCTs)

TC + / − placebo capsule (n = 112) vs ADL, placebo capsule (n = 118)

MD − 5.7 points (− 8.5 to − 2.8)

Large effect, MCID − 2 points [50]

MODERATE

a

(†LOW)

QoL—mental health SF-36 (4 RCTs)

TC + / − placebo capsule (n = 154) vs Ucare, ADL, placebo capsule (n = 160)

MD − 2.5 (− 4.8 to − 0.2)

Small effect, MCID − 3 points [50]

MODERATE

a

(†LOW)

QoL—social function SF-36 (3 RCTs)

TC + / − placebo capsule (n = 112) vs ADL, placebo capsule (n = 118)

MD − 2.2 points (− 5.0 to 0.6)

Equivalent effect, MCID − 3 points [50]

LOW

a, d

Cancer

Adults, older adults; cancer; in community settings; China, USA

Ni 2019 [83]

Low

(†Critically low)

QoL—physical, breast cancer or female (9 RCTs)

TC (n = 331) vs Ucare, Rehab, HEd, Psych, Ex, sham Qigong (n = 348)

SMD 0.34 (0.09 to 0.59)

Small effect

LOW

aa

QoL—psychological, breast cancer or female (9 RCTs)

TC (n = 333) vs Ucare, Rehab, HEd, Psych, Ex, sham Qigong (n = 348)

SMD 0.60 (0.12 to 1.08)

Moderate effect

VERY LOW

aa, b

QoL—social relationship, breast cancer or female (8 RCTs)

TC (n = 292) vs Ucare, Rehab, HEd, Psych, Ex, sham Qigong (n = 303)

SMD 0.26 (0.25 to 0.77)

Small effect

VERY LOW

aa, b

Sleep quality, breast or lung cancer (3 RCTs: 2 RCTs Si 2020 [86])

TC (n = 106) vs Ucare, Psych, sham Qigong (n = 112)

SMD 0.26 (− 0.02 to 0.53)

Equivalent effect

VERY LOW

aa, b, d

Adults, older adults; lung cancer, prostate cancer; in community settings; China

Song 2018 [87]

Low

(†Critically low)

Fatigue < 8 weeks, lung cancer (2 RCTs)

TC (n = 77) vs Ucare, Ex (n = 74)

SMD − 0.5 (− 0.83 to − 0.18)

Moderate effect

VERY LOW

aa, d

Fatigue < 8 weeks, prostate cancer (1 RCT)

TC (n = 21) vs Ex (n = 45)

SMD 0.01 (− 0.51 to 0.52) favours control

Equivalent effect

VERY LOW

aa, dd

Adults, older adults; Breast cancer; in community settings; China, Thailand, USA

Liu LZ 2020 [77]

Critically low

Fatigue 3 months (2 RCTs)

TC + Ucare, Rehab (n = 60) vs Ucare, Rehab (n = 56)

SMD − 0.91 (− 1.30 to − 0.53)

Large effect

LOW

a, d

Fatigue 3 months (2 RCTs)

TC (n = 85) vs Psych, sham Qigong (n = 89)

MD − 0.46 points (− 1.09 to 0.17)

Equivalent effect, MCID unknown

LOW

a, d

Fatigue 6 months (2 RCTs)

TC (n = 80) vs Psych, sham Qigong (n = 83)

MD − 0.16 (− 0.98 to 0.67)

Equivalent effect, MCID unknown

LOW

a, d

Female adults; breast cancer; in community settings; China, Thailand, USA

Luo 2020 [79]

Moderate(†Low)

Pain, 3 weeks (2 RCTs)

TC (n = 110) vs Rehab (n = 109)

SMD 0.25 (− 0.02 to 0.51)

Equivalent effect

LOW

a, d

Pain, 3 months (4 RCTs)

TC (n = 169) vs Ucare, Rehab (n = 168)

SMD 0.30 (0.08 to 0.51)

Small effect

MODERATE

a

(†LOW)

Cardiovascular, diabetes, and risk factors

Chronic heart failure

Adults, older adults; chronic heart failure, left ventricular ejection fraction (LVEF) ≤ 45%; in community settings; China, USA, UK, Italy

Gu 2017 [66]

Low

(†Critically low)

6-min walk test—6-MWT (10 RCTs)

TC (n = 344) vs Ucare, HEd, Ex (n = 379)

MD 51 m (30.49 to 71.5)

Moderate effect, MCID 36 m [57]

VERY LOW

aa, b

Left ventricular ejection fraction—LVEF

(7 RCTs)

TC (n = 283) vs Ucare, HEd, Ex (n = 306)

MD 7.7% (3.6 to 11.9)

Moderate effect, MCID 3.2% [53]

VERY LOW

aa, b

QoL: Minnesota Living with Heart Failure Questionnaire—MLHFQ (8 RCTs)

TC (n = 280) vs Ucare, HEd, Ex (n = 318)

MD − 10.4 points (− 14.4 to − 6.3)

Moderate effect, MCID − 8 to − 19 [46]

VERY LOW

aa, b

Adults, older adults; chronic heart failure; in community settings; USA

Taylor-Piliae 2020 [90]

Critically low

Psychological distress, chronic heart failure (2 RCTs)

TC (n = 58) vs HEd, Ex (n = 58)

SMD − 0.58 (− 0.95 to − 0.22)

Moderate effect

MODERATE

d

Ischaemic heart disease

Older adults; stable angina; in community settings; China, Brazil

Jiang 2018 [74]

Low(†Critically low)

VO₂max (4 RCTs)

TC (n = 148) vs noRx, Ex (n = 88)

SMD 2.2 (0.81 to 3.63)

Large effect

VERY LOW

aa, b

Adults, older adults; myocardial infarction; in community settings; China

Wu 2020 [96]

Low

(†Critically low)

6-min walk time—6MWT (5 RCTs)

TC (n = 234) vs Ucare, HEd, Ex (n = 231)

SMD 1.3 (0.50 to 2.11)

Large effect

LOW

a, b

Left ventricular ejection fraction—LVEF (5 RCTs)

TC (n = 234) vs Ucare, HEd, Ex (n = 231)

SMD 1.0 (0.43 to 1.57)

Large effect

LOW

a, b

Hyperlipidaemia

Adults, older adults; hyperlipidemia, type 2 diabetes mellitus, hypertension, obesity; in community settings; China, Hong Kong, Taiwan, Australia

Pan 2016 [84]

Low

(†Critically low)

Total cholesterol (6 RCTs)

TC (n = 220) vs Ucare, Ex, waitlist (n = 225)

MD − 7.7 mg/dL (− 17.3 to 1.4)

Equivalent effect, MCID 20 mg/dL

(10% reduction from 200 mg/dL)

VERY LOW

a, b, d

Triglycerides (6 RCTs)

TC (n = 220) vs Ucare, Ex, waitlist (n = 225)

MD − 16.8 mg/dL (− 31.3 to − 2.4)

Moderate effect, MCID 15 mg/dL

(10% reduction from 150 mg/dL)

MODERATE

a

High-density lipoprotein cholesterol—HDL-C (5 RCTs)

TC (n = 192) vs Ucare, Ex (n = 200)

MD 0.46 mg/dL (− 0.71 to 1.64)

Equivalenteffect, MCID 4 mg/dL

(10% increase from 40 mg/dL)

MODERATE

a

(†LOW)

Low-density lipoprotein cholesterol—LDL-C (4 RCTs)

TC (n = 136) vs Ucare, Ex (n = 152)

MD − 1.61 mg/dL (− 16.25 to 13.02)

Equivalent effect, MCIS − 10 mg/dL

(10% reduction from 100 mg/dL)

VERY LOW

a, bb, d

Essential hypertension

Adults, older adults; essential hypertension; in community settings; China, Taiwan

Zhong 2020 [105]

High

Systolic blood pressure (9 RCTs)

TC (n = 456) vs noRx, HEd (n = 458)

MD − 14.8 (− 19.6 to − 10.0)

Large effect, MCID − 10 mmHg

LOW

a, b

Diastolic blood pressure (9 RCTs)

TC (n = 456) vs noRx, HEd (n = 458)

MD − 7.0 (− 9.1 to − 5.0)

Large effect, MCID − 5 mmHg

MODERATE

a

Systolic blood pressure (15 RCTs)

TC (n = 406) vs Pharm (n = 348)

MD − 9.1 (− 14.0 to − 4.1)

Moderate effect, MCID − 10 mmHg

LOW

a, b

Diastolic blood pressure (15 RCTs)

TC (n = 406) vs Pharm (n = 348)

MD − 5.6 (− 14.0 to − 4.1)

Moderate effect, MCID − 5 mmHg

LOW

a, b

Systolic blood pressure (5 RCTs)

TC (n = 123) vs Ex (n = 123)

MD − 7.9 (− 14.2 to − 1.7)

Small effect, MCID − 10 mmHg

LOW

a, b

(†VERY LOW)

Diastolic blood pressure (5 RCTs)

TC (n = 123) vs Ex (n = 123)

MD − 3.9 (− 6.5 to − 1.2)

Small effect, MCID − 5 mmHg

MODERATE

a

(†LOW)

Adults, older adults; hypertension; in community settings; China, Hong Kong, USA

Taylor-Piliae 2020 [90]

Critically low

QoL—mental health (3 RCTs)

TC (n = 311) vs Ucare (n = 311)

SMD 0.13 (NI) p = 0.13

Equivalent effect

MODERATE

d

QoL—physical (3 RCTs)

TC (n = 311) vs Ucare (n = 311)

SMD 0.47 (NI) p < 0.001

Small effect

HIGH

Diabetes mellitus

Adults, older adults; type 2 diabetes mellitus; in community settings; China, South Korea, Thailand, Australia

Zhou 2019 [106]

Critically low

Glycosylated haemoglobin—HbA1c % (14 RCTs)

TC (n = 466) vs Ucare, Ucare + TCM, HEd, sham exercise (n = 395)

MD − 0.88% (− 1.45 to − 0.31)

Small effect, MCID 1% [56]

LOW

a, b

Systolic blood pressure—SBP (5 RCTs)

TC (n = 151) vs Ucare, ADL, noEx (n = 139)

MD − 10.0 mmHg (− 15.8 to − 4.3)

Moderate effect, MCID 10 mmHg

MODERATE

a

(†LOW)

Diastolic blood pressure—DBP (5 RCTs)

TC (n = 151) vs Ucare, ADL, noEx (n = 139)

MD − 4.9 mmHg (− 8.2 to − 1.5)

Moderate effect, MCID 5 mmHg

MODERATE

a

(†LOW)

QoL physical function – SF36 (5 RCTs)

TC (n = 151) vs Ucare, ADL, noEx (n = 139)

MD 7.1 (0.79 to 13.4)

Large effect, MCID 3 points [50]

LOW

a, b

(†VERY LOW)

QoL bodily pain – SF36 (5 RCTs)

TC (n = 151) vs Ucare, ADL, noEx (n = 139)

MD 4.3 (0.8 to 7.8)

Moderate effect, MCID 3 points [50]

MODERATE

a

(†LOW)

Chronic obstructive pulmonary disease

Adults, older adults; chronic obstructive pulmonary disease; in community settings; China, Hong Kong, USA

Guo 2020 [67]

Low

Forced expiratory volume in 1 s—FEV₁, ≤ 3 months (3 RCTs)

TC (n = 111) vs noEx (n = 108)

MD 0.13L (0.06 to 0.20)

Moderate effect, MCID 0.1L [43]

MODERATE

a

(†LOW)

FEV₁, ≤ 3 months (5 RCTs)

TC (n = 272) vs Ex + /or breathing Ex (n = 275)

MD 0.06L (− 0.01 to 0.14)

Equivalent effect, MCID 0.1L [43]

LOW

a, d

6-min walk time—6MWT, ≤ 3 months (6 RCTs)

TC (n = 182) vs noEx (n = 181)

MD 24.3 m (6.3 to 42.3)

Small effect, MCID 30–80 m [55, 59]

LOW

a, b

(†VERY LOW)

6MWT, ≤ 3 months (6 RCTs)

TC (n = 308) vs Ex + /or breathing Ex (n = 313)

MD 7.5 m (2.1 to 12.3)

Very small effect, MCID 30–80 m [55, 59]

MODERATE

a

QoL—St George Respiratory Questionnaire—SGRQ, ≤ 3 months (3 RCTs)

TC (n = 129) vs noEx (n = 128)

MD − 8.7 points (− 14.6 to − 2.7)

Large effect, MCID − 2.8 to − 7.6 points [40, 49]

MODERATE

a

(†LOW)

QoL—SGRQ, ≤ 3 months (4 RCTs)

TC (n = 260) v Ex + /or breathing Ex (n = 265)

MD − 1.9 points (− 4.6 to 0.7)

Equivalent effect, MCID − 2.8 to − 7.6 points [40, 49]

MODERATE

a

Cognitive function and impairment

Older adults; no cognitive impairment; in in community settings; China, Hong Kong, Japan, France

Wayne 2014 [94]

Critically low

Executive function (4 RCTs)

TC (n = 151) vs noEx (n = 270)

SMD 0.90 (0.03 to 1.78)

Large effect

MODERATE

b

Executive function (2 RCTs)

TC (n = 67) vs Ex (n = 69)

SMD 0.51 (0.17 to 0.85)

Moderate effect

MODERATE

d

Older adults; Mild cognitive impairment; in community settings; China, Thailand, USA, France

Zhang 2020 [102]

Low

(†Critically low)

Global cognitive function—Mini-Mental State Examination—MMSE (5 RCTs)

TC (n = 325) vs Cognition-action, Ucare, HEd, Ex, other activities (n = 460)

MD 0.29 points (− 0.61 to 0.74)

Equivalent effect, MCID 1 point [41]

HIGH

Memory—Delayed Recall Test (4 RCTs)

TC (n = 297) vs ADL, HEd, Ex (n = 429)

MD 0.37 points (0.13 to 0.61)

A positive effect, MCID unknown

HIGH

Performance—Digit Span Test (4 RCTs)

TC (n = 297) vs ADL, HEd, Ex (n = 429)

MD 0.03 point (− 0.16 to 0.22)

Equivalent effect, MCID unknown

HIGH

Fatigue, fibromyalgia, and sleep quality

Fatigue, any cause

Adults, older adults; fatigue without serious ailments, cancer, multiple sclerosis, chronic obstructive pulmonary disease, insomnia, rheumatoid arthritis; in community settings; China, Hong Kong, USA, Spain, Germany

Xiang 2017 [97]

Moderate

(†Low)

Fatigue (10 RCTs)

TC (n = 356) vs noRx, Ucare, HEd, Ex, sham Qigong (n = 333)

SMD − 0.45 (− 0.70 to − 0.20)

Small effect

MODERATE

a

Vitality (4 RCTs)

TC (n = 115) vs noRx, HEd, Ex (n = 333)

SMD 0.63 (0.20 to 1.07)

Moderate effect

LOW

aa

Depression (7 RCTs)

TC (n = 216) vs noRx, Ucare, HEd, Ex, other control (n = 199)

SMD − 0.58 (− 1.04 to − 0.11)

Moderate effect

VERY LOW

aa, b

Fibromyalgia

Adults; fibromyalgia; in community settings; USA, South Korea, UK, Italy

Cheng 2019 [61]

Low

(†Critically low)

QoL—Fibromyalgia impact questionnaire—FIQ 12–16 weeks (4 RCTs)

TC (n = 158) vs Ucare (n = 149)

SMD − 0.61 (− 0.90 to − 0.31)

Moderate effect

MODERATE

a

(†LOW)

QoL—FIQ 24–32 weeks (2 RCTs)

TC (n = 82) vs Ucare (n = 78)

SMD − 0.49 (− 1.56 to 0.58)

Equivalent effect

VERY LOW

a, b, dd

Pain (3 RCTs)

TC (n = 100) vs noRx, Ucare, HEd, Ex (n = 90)

SMD − 0.88 (− 1.58 to − 0.18)

Large effect

VERY LOW

a, b, d

Sleep quality

Adults, older adults; healthy, stroke, fibromyalgia, cancer, arthritis, depression, chronic kidney disease, heart disease; in community settings; China, Japan, Vietnam, USA, Italy, Iran

Si 2020 [86]

Low

(†Critically low)

Pittsburgh Sleep Quality Index, healthy (10 RCTs)

TC (n = 426) vs noRx, Ex, HEd (n = 401)

SMD − 0.68 (− 1.06 to − 0.31)

Moderate effect

LOW

a, b

Pittsburgh Sleep Quality Index, chronic disease (15 RCTs)

TC (n = 543) vs Ucare, Hed, Psych, Rehab, sham Qigong, acupuncture, waitlist (n = 564)

SMD − 0.39 (− 0.74 to − 0.05)

Small effect

LOW

a, b

Mental health

Depression, anxiety, stress, mood for general populations (also see chronic heart failure, stroke, knee osteoarthritis, fatigue)

Adults, older adults; depression and/or chronic diseases; Asian, North American and European countries

Yin 2014 [98]

Low

Depression (25 RCTs: 1RCT Lyu 2020 [80], 1 RCT Hu 2020 [70])

TC vs noRx, Ex, sham/other

(total sample < 1435)

SMD 0.36 (0.19 to 0.53)

Small effect

HIGH

Anxiety (11 RCTs)

TC vs noRx

(total sample < 1435)

SMD 0.34 (0.02 to 0.66)

Small effect

MODERATE

b

Adults, older adults; healthy, osteoarthritis, rheumatoid arthritis, fibromyalgia, HIV infection, depression, frail; in community settings; China, USA, Australia, UK, Germany, France

Wang 2010 [93]

Critically low

Stress (4 RCTs)

TC vs ADL, Psych, waitlist

(total sample n = 308)

SMD 0.97 (0.06 to 1.87)

Large effect

VERY LOW

aa, bb

Mood / affect (2 RCTs)

TC vs ADL, Psych, waitlist

(total sample n = 191)

SMD 0.25 (− 0.04 to 0.53)

Equivalent effect

VERY LOW

aa, d

Schizophrenia

Adults, older adults; schizophrenia; in hospital, long-stay care, halfway house service; China

Zheng 2016 [104]

Moderate

(†Low)

Negative symptoms—Positive and Negative Syndrome Scale—PANSS (6 RCTs)

TC + Ucare (n = 200) vs Ucare + / − Pharm, HEd, Ex, noEx, waitlist (n = 251)

SMD − 0.87 (− 1.51 to − 0.24)

Large effect

LOW

a, b

Positive symptoms—PANSS (5 RCTs)

TC + Ucare (n = 170) vs Ucare + / − Pharm, HEd, Ex, noEx, waitlist (n = 221)

SMD − 0.09 (− 0.44 to 0.26)

Equivalent effect

MODERATE

a

(†LOW)

Discontinuation rate (4 RCTs)

TC + Ucare (n = 170) vs Ucare + / − Pharm, HEd, Ex, noEx, waitlist (n = 221)

RR 0.06 (0.23 to 1.40)

3 fewer per 100 adults

VERY LOW

a, dd

Musculoskeletal conditions and pain

Osteoarthritis

Older adults; knee osteoarthritis; in community settings; China, South Korea, USA

Hu 2020 [70]

Low

(†Critically low)

WOMAC pain (14 RCTs)

TC (n = 455) vs Ucare, noEx, HEd, PT (n = 422)

SMD − 0.69 (− 0.95 to − 0.44)

Moderate effect

MODERATE

a

WOMAC stiffness (12 RCTs)

TC (n = 396) vs Ucare, noEx, HEd, PT (n = 373)

SMD − 0.65 (− 0.98 to − 0.33)

Moderate effect

LOW

a, b

WOMAC physical function (13 RCTs)

TC (n = 437) vs Ucare, noEx, HEd, PT (n = 407)

SMD − 0.92 (− 1.16 to − 0.69)

Large effect

MODERATE

a

Depression (3 RCTs: 1 RCT in Yin 2014 [98])

TC (n = 167) vs Ucare, noEx, HEd, PT (n = 152)

SMD − 0.46 (− 0.68, − 0.24)

Small effect

MODERATE

a

Arthritis self-efficacy scale (4 RCTs)

TC (n = 185) vs Ucare, noEx, HEd, PT (n = 167)

SMD 0.27 (0.06 to 0.48)

Small effect

MODERATE

a

(†LOW)

Adults, older adults; healthy, osteoarthritis; in in community settings

Su 2020 [88]

Critically low

Knee extensor muscle strength, females (60°/s) (2 RCTs)

TC (n = 40) vs noRx, Ex, Pharm, HEd (n = 45)

MD 17.5 (− 12.0 to 47.0)

Equivalent effect, MCID unknown

VERY LOW

a, b, dd

Knee flexor muscle strength, females (60°/s) (2 RCTs)

TC (n = 40) vs noRx, Ex, Pharm, HEd (n = 45)

MD 22.1 (1.1 to 43.2)

Positive effect, MCID unknown

VERY LOW

a, dd

(†LOW)

Knee flexor muscle strength one maximum strength—1-RM (2 RCTs)

TC (n = 57) vs noRx, HEd (n = 57)

MD 3.3 (2.1 to 4.4)

Positive effect, MCID unknown

LOW

a, d

Knee extensor muscle strength 1-RM

(4 RCTs)

TC (n = 114) vs noRx, HEd, Ex (n = 112)

SMD 0.90 (0.34 to 1.45)

Large effect

MODERATE

a

(†LOW)

Rheumatoid arthritis

Adults, older adults; rheumatoid arthritis; in community settings; China, South Korea, USA

Mudano 2019 [82]

High

Pain, visual analogue scale, 12 weeks (2 RCTs)

TC (n = 42) vs noEx, Ex (n = 39)

SMD − 0.95 (− 1.41 to − 0.49)

Large effect

VERY LOW

aa, dd

Disease activity, DAS-28-ESR, 12 weeks (1 RCT)

TC (n = 29) vs HEd (n = 14)

MD − 0.40 points (− 1.10 to 0.30)

Equivalent effect, MCID − 1.17 points [58]

VERY LOW

aa, dd

Function, Health Assessment Questionnaire – HAQ, 12 weeks (2 RCTs)

TC (n = 39) vs Hed, Ex (n = 24)

MD − 0.33 points (− 0.79 to 0.12)

Equivalent effect, MCID − 0.38 points [58]

VERY LOW

aa, b, dd

Low back pain

Adults, older adults; Low back pain; in community settings; China, Australia

Qin 2019 [85]

Low

(†Critically low)

Pain VAS 1–10 scale (3 RCTs)

TC (n = 123) vs ADL, waitlist (n = 120)

MD − 1.2 points (− 2.3 to − 1.1)

Moderate effect, MCID − 1.2

LOW

a, b

(†VERY LOW)

Pain VAS 1–10 scale (5 RCTs)

TC + Ucare (n = 363) vs Ucare (n = 268)

MD − 1.1 (− 1.3 to − 0.9)

Moderate effect, MCID − 1.2

MODERATE

a

Headache

Adults, older adults; chronic pain from tension headaches; in community settings; USA

Hall 2017 [68]

Low

(†Critically low)

Pain SF-36 15 weeks (1 RCT)

TC (n = 13) vs waitlist (n = 17)

SMD − 1.85 (− 2.73 to − 0.97)

Large effect

VERY LOW

aa, dd

Osteoporosis, osteopenia

Adults, older adults; osteoporosis, osteopenia; in community settings; NI countries

Zhang 2019 [101]

Moderate

(†Low)

Spine Bone mineral density—BMD (6 RCTs)

TC (n = 128) vs noRx (n = 119)

MD 0.04 g/cm² (0.02 to 0.06)

Small effect, MCID ~ 0.05 g/cm² [54]

MODERATE

a

(†LOW)

Femur BMD (3 RCTs)

TC (n = 85) vs noRx (n = 83)

MD 0.04 g/cm² (0.01 to 0.06)

Small effect, MCID ~ 0.05 g/cm² [54]

LOW

a, d

Spine BMD (2 RCTs)

TC (n = 52) vs Ucare (n = 55)

MD 0.16 g/cm² (0.09 to 0.23)

Large effect, MCID ~ 0.05 g/cm² [54]

LOW

a, d

Femur BMD (2 RCTs)

TC (n = 52) vs Ucare (n = 55)

MD 0.16 g/cm² (0.04 to 0.29)

Large effect, MCID ~ 0.05 g/cm² [54]

VERY LOW

a, b, d

Stroke, Parkinson’s disease, and falls

Stroke

Adults, older adults; healthy, type 2 diabetes mellitus, hyperlipidaemia; in community settings; China

Zheng 2015 [103]

Low

(†Critically low)

Incidence of nonfatal stroke over 1–2 years (2 RCTs)

TC + Ucare (n = 62) vs Ucare (n = 58)

RR 0.11 (0.01 to 0.85)

89% reduced risk

LOW

a, d

Incidence of fatal stroke over 1–2 years

(2 RCTs)

TC + Ucare (n = 62) vs Ucare (n = 58)

RR 0.33 (0.05 to 2.05)

77% reduced risk

LOW

a, d

(†VERY LOW)

Adults, older adults; stroke survivors; in community settings; NI countries

Lyu 2018[81]

Moderate

(†Low)

Berg Balance Scale—BBS (2 RCTs)

TC (n = 75) vs Rehab (n = 75)

MD 5.2 points (3.4 to 7.1)

Moderate effect, MCID 4.3 to 7.3 points [47]

LOW

a, d

Fugl-Meyer Assessment FMA—all four limbs

(2 RCTs)

TC + Rehab (n = 51) vs Rehab (n = 49)

MD 4.5 points (1.9 to 7.1)

A positive effect, MCID unknown

LOW

a, d

FMA—upper extremity (2 RCTs)

TC + Rehab (n = 56) vs Rehab (n = 51)

MD 8.3 points (4.7 to 11.8)

Large effect, MCID 5.3 points [51]

LOW

a, d

FMA—lower extremity (3 RCTs)

TC + Rehab (n = 85) vs Rehab (n = 81)

MD 2.8 points (0.95 to 4.56)

Small effect, MCID 6 points [52]

VERY LOW

a, b, d

Timed up and go—TUG (4 RCTs)

TC + Rehab (n = 100) vs Rehab (n = 96)

MD 2.6 s (1.8 to 3.4)

Small effect, MCID 8 s [47]

LOW

a, d

Activities of daily living—Barthel Index

(2 RCTs)

TC (n = 81) vs Rehab (n = 85)

MD 9.9 points (6.8 to 13.0)

Large effect, MCID 6.8 points [44]

LOW

a, d

Adults, older adults; stroke survivors; in community settings; China, South Korea, Japan, USA, Israel

Lyu 2020 [80]

Moderate

(†Low)

Depression (6 RCTs)

TC (n = 278) vs Rehab (n = 280)

SMD 0.36 (0.10 to 0.61)

Small effect

LOW

aa

Parkinson’s disease

Older adults; Parkinson’s disease; in community settings; NI countries

Yu 2018 [100]

Critically low

Unified Parkinson’s Disease Rating III: Motor (8 RCTs)

TC (n = 204) vs noRx, Ucare, Pharm, Ex (n = 262)

MD − 3.7 points (− 5.7 to − 1.7)

Moderate effect, MCID − 3.3 points [48]

MODERATE

b

Timed up and go—TUG (7 RCTs)

TC (n = 188) vs noRx, Ucare, Pharm, Ex (n = 251)

SMD − 0.50 (− 0.88 to − 0.11)

Moderate effect

HIGH

Berg balance scale—BBS (6 RCTs)

TC (n = 144) vs noRx, Ucare, Pharm, Ex (n = 145)

SMD 0.85 (0.44 to 1.27)

Large effect

HIGH

(†MODERATE)

QoL – Parkinson’s Disease Questionnaire—PDQ-39, PDQ-8 (3 RCTs)

TC (n = 104) vs noRx, Ucare, Pharm, Ex (n = 159)

SMD − 0.75 (− 1.45 to − 0.04)

Moderate effect

HIGH

(†MODERATE)

Falls and risk factors

Older adults; with or without a history of falling, stroke, Parkinson’s disease, females with osteopenia; in hospital, in community settings; China, Taiwan, USA, Canada, Australia, New Zealand, Netherlands

Huang 2017 [73]

Low

(†Critically low)

Rate of people who fell (no. of fallers) (16 RCTs)

TC (n = 1889) vs ADL, noRx, PT, Ex (n = 1650)

RR 0.80 (0.72 to 0.88)

20% reduced risk, 9 fewer per 100

MODERATE

e

Incidence of falls (no. falls) (15 RCTs)

TC (n = 1512) vs ADL, noRx, PT, Ex (n = 1542)

RR 0.69 (0.60 to 0.80)

31% reduced risk

MODERATE

e

Older adults; in hospital, nursing home, in community settings; China, USA, Canada, Australia, New Zealand, UK, Netherlands

Huang 2020 [71]

Critically low

Balance – Single Leg Stance (SLS) (8 RCTs)

TC (n = 417) vs ADL, Ex, other activities (n = 419)

MD 5.8 s (0.62 to 10.90)

Small effect, MCID 41 s [45]

VERY LOW

a, bb

Berg balance scale—BBS (4 RCTs)

TC (n = 412) vs ADL, Ex (n = 400)

MD 1.0 points (0.2 to 1.9)

Small effect, MCID 4 points [42]

MODERATE

a

Timed up and go—TUG (6 RCTs)

TC (n = 190) vs ADL, Ex (n = 178)

MD − 0.71 s (− 0.88 to − 0.54)

Probably small effect, MCID unknown

MODERATE

a

(†LOW)

Older adults; with or without a history of falling; in community settings; USA, Canada, China, Vietnam, Iran

Kruisbrink 2020 [75]

Low

(†Critically low)

Fear of falling (6 RCTs)

^§TC with an instructor vs TC with no information about instructor (NI sample size)

SMD.B − 1.05 (− 1.60 to − 0.50)

Large effect

VERY LOW

aa, b, e