Exploring the benefits of traditional Chinese exercises (Tai Chi and Qigong) on the anxiety and depression of older adults: A systematic review and meta-analysis

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Abstract

Background:

Research shows that traditional Chinese exercises (TCEs) significantly improve anxiety and depression in older adults. However, studies on the effects of different exercise durations, frequencies, and intensities in this population are limited. This systematic review and meta-analysis evaluate the impact of TCEs on anxiety and depression, and explores the optimal exercise parameters, aiming to provide evidence for nonpharmacological treatment options in clinical practice.

Methods:

As of August 2023, we conducted a literature search through 3 English electronic databases to identify relevant studies. We included studies that met our criteria. During the literature inclusion process, we used Review Manager 5.4 to create flow diagrams, assess the risk of bias, and perform statistical analyses.

Results:

A total of 31 eligible studies involving 2501 participants were included. Compared with the control group, TCEs showed significant improvements in anxiety (standardized mean differences [SMD] = −0.93, 95% confidence interval [CI]: −1.78 to −0.08, P = .03, I ² = 96%) and depression (SMD = −1.14, 95% CI: −1.82 to −0.47, P = .03, I ² = 96%). Subgroup analyses indicated that an intervention duration of 12 to 16 weeks yielded the largest effect size for anxiety (SMD = −1.36, 95% CI: −2.36 to −0.36, P = .008), while the 24-week group showed the largest effect size for depression (SMD = −0.87, 95% CI: −1.43 to −0.30, P = .002). For intervention frequency, a regimen of 3 to 4 times per week produced the largest effect size for anxiety (SMD = −2.34, 95% CI: −4.69 to 0.02, P = .05), whereas a frequency of 5 to 7 times per week demonstrated the largest effect size for depression (SMD = −1.00, 95% CI: −1.83 to −0.17, P = .02). Regarding single-session exercise duration, a group exercising for 40 to 60 minutes showed the largest effect sizes for anxiety (SMD = −1.38, 95% CI: −2.40 to −0.37, P = .007) and depression (SMD = −0.75, 95% CI: −1.07 to −0.42, P < .00001).

Conclusion:

The results indicate that TCEs significantly alleviate anxiety and depression in older adults, with intervention frequency, intensity, and duration potentially influencing the outcomes. However, heterogeneity across studies was observed, primarily due to differences in intervention types and control group designs. These findings offer valuable guidance for future research directions.

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Most cited references 75

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Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

(2022)

Summary Background The mental disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were depressive disorders, anxiety disorders, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, eating disorders, idiopathic developmental intellectual disability, and a residual category of other mental disorders. We aimed to measure the global, regional, and national prevalence, disability-adjusted life-years (DALYS), years lived with disability (YLDs), and years of life lost (YLLs) for mental disorders from 1990 to 2019. Methods In this study, we assessed prevalence and burden estimates from GBD 2019 for 12 mental disorders, males and females, 23 age groups, 204 countries and territories, between 1990 and 2019. DALYs were estimated as the sum of YLDs and YLLs to premature mortality. We systematically reviewed PsycINFO, Embase, PubMed, and the Global Health Data Exchange to obtain data on prevalence, incidence, remission, duration, severity, and excess mortality for each mental disorder. These data informed a Bayesian meta-regression analysis to estimate prevalence by disorder, age, sex, year, and location. Prevalence was multiplied by corresponding disability weights to estimate YLDs. Cause-specific deaths were compiled from mortality surveillance databases. The Cause of Death Ensemble modelling strategy was used to estimate death rate by age, sex, year, and location. The death rates were multiplied by the years of life expected to be remaining at death based on a normative life expectancy to estimate YLLs. Deaths and YLLs could be calculated only for anorexia nervosa and bulimia nervosa, since these were the only mental disorders identified as underlying causes of death in GBD 2019. Findings Between 1990 and 2019, the global number of DALYs due to mental disorders increased from 80·8 million (95% uncertainty interval [UI] 59·5–105·9) to 125·3 million (93·0–163·2), and the proportion of global DALYs attributed to mental disorders increased from 3·1% (95% UI 2·4–3·9) to 4·9% (3·9–6·1). Age-standardised DALY rates remained largely consistent between 1990 (1581·2 DALYs [1170·9–2061·4] per 100 000 people) and 2019 (1566·2 DALYs [1160·1–2042·8] per 100 000 people). YLDs contributed to most of the mental disorder burden, with 125·3 million YLDs (95% UI 93·0–163·2; 14·6% [12·2–16·8] of global YLDs) in 2019 attributable to mental disorders. Eating disorders accounted for 17 361·5 YLLs (95% UI 15 518·5–21 459·8). Globally, the age-standardised DALY rate for mental disorders was 1426·5 (95% UI 1056·4–1869·5) per 100 000 population among males and 1703·3 (1261·5–2237·8) per 100 000 population among females. Age-standardised DALY rates were highest in Australasia, Tropical Latin America, and high-income North America. Interpretation GBD 2019 showed that mental disorders remained among the top ten leading causes of burden worldwide, with no evidence of global reduction in the burden since 1990. The estimated YLLs for mental disorders were extremely low and do not reflect premature mortality in individuals with mental disorders. Research to establish causal pathways between mental disorders and other fatal health outcomes is recommended so that this may be addressed within the GBD study. To reduce the burden of mental disorders, coordinated delivery of effective prevention and treatment programmes by governments and the global health community is imperative. Funding Bill & Melinda Gates Foundation, Australian National Health and Medical Research Council, Queensland Department of Health, Australia.

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No health without mental health.

Martin Prince, Vikram Patel, Shekhar Saxena … (2007)

About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such estimates have drawn attention to the importance of mental disorders for public health. However, because they stress the separate contributions of mental and physical disorders to disability and mortality, they might have entrenched the alienation of mental health from mainstream efforts to improve health and reduce poverty. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Because these interactions are protean, there can be no health without mental health. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Health services are not provided equitably to people with mental disorders, and the quality of care for both mental and physical health conditions for these people could be improved. We need to develop and evaluate psychosocial interventions that can be integrated into management of communicable and non-communicable diseases. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of HIV, tuberculosis, and malaria; gender-based violence; antenatal care; integrated management of childhood illnesses and child nutrition; and innovative management of chronic disease. An explicit mental health budget might need to be allocated for such activities. Mental health affects progress towards the achievement of several Millennium Development Goals, such as promotion of gender equality and empowerment of women, reduction of child mortality, improvement of maternal health, and reversal of the spread of HIV/AIDS. Mental health awareness needs to be integrated into all aspects of health and social policy, health-system planning, and delivery of primary and secondary general health care.

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Mortality associated with sleep duration and insomnia.

Daniel F. Kripke, Lawrence Garfinkel, Deborah L. Wingard … (2002)

Patients often complain about insufficient sleep or chronic insomnia in the belief that they need 8 hours of sleep. Treatment strategies may be guided by what sleep durations predict optimal survival and whether insomnia might signal mortality risks. In 1982, the Cancer Prevention Study II of the American Cancer Society asked participants about their sleep duration and frequency of insomnia. Cox proportional hazards survival models were computed to determine whether sleep duration or frequency of insomnia was associated with excess mortality up to 1988, controlling simultaneously for demographics, habits, health factors, and use of various medications. Participants were more than 1.1 million men and women from 30 to 102 years of age. The best survival was found among those who slept 7 hours per night. Participants who reported sleeping 8 hours or more experienced significantly increased mortality hazard, as did those who slept 6 hours or less. The increased risk exceeded 15% for those reporting more than 8.5 hours sleep or less than 3.5 or 4.5 hours. In contrast, reports of "insomnia" were not associated with excess mortality hazard. As previously described, prescription sleeping pill use was associated with significantly increased mortality after control for reported sleep durations and insomnia. Patients can be reassured that short sleep and insomnia seem associated with little risk distinct from comorbidities. Slight risks associated with 8 or more hours of sleep and sleeping pill use need further study. Causality is unproven.

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Author and article information

Contributors

Yangjian Dong:

ORCID: https://orcid.org/0009-0007-7215-2635

Dan Pang

Jie Xiang

Guodong Chao

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MD

Title: Medicine

Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: 21 March 2025

Publication date (Electronic): 21 March 2025

Volume: 104

Issue: 12

Electronic Location Identifier: e41908

Affiliations

[a ] College of Physical Education, China Three Gorges University, Yichang, China

[b ] College of Physical Education, Hubei Preschool Teachers College, Wuhan, China

[c ] College of Physical Education and Health, Guilin University, Guilin, China.

Author notes

[* ] Correspondence: Xiaoqin Kuang, College of Physical Education and Health, Guilin University, Guilin, China (e-mail: kuangxq2023@ 123456163.com ).

Author information

Yangjian Dong https://orcid.org/0009-0007-7215-2635

Article

Publisher ID: MD-D-24-12087 Accession ID: 00056

DOI: 10.1097/MD.0000000000041908

PMC ID: 11936652

PubMed ID: 40128068

SO-VID: ba627704-6c14-45d6-a3af-bfed4fdb923d

License:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 06 October 2024

Date received : 14 January 2025

Date accepted : 28 February 2025

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Keywords: anxiety,depression,meta-analysis,traditional chinese exercises

Data availability:

Keywords: anxiety, depression, meta-analysis, traditional chinese exercises