{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:26:07Z","timestamp":1787199967014,"version":"build-2736575974"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background and objective<\/jats:title>\n                    <jats:p>Sarcopenia and frailty involve declines in muscle strength, muscle mass, and physical performance, and single Tai Chi may be insufficient to cover all functional needs. Tai Chi-based combined interventions have emerged, but their overall effects remain unclear. This study evaluated their effects in older adults with sarcopenia, frailty, or risk of functional decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We systematically searched PubMed, Embase, CENTRAL, Web of Science, Scopus, CINAHL,\n                      <jats:uri>ClinicalTrials.gov<\/jats:uri>\n                      , CNKI, Wanfang, and VIP from database inception to May 12, 2026. Randomized controlled trials and cluster-randomized controlled trials comparing Tai Chi-based combined interventions with non-exercise, active-exercise, or single Tai Chi controls were included. Risk-domain composite standardized mean differences (SMDs) were used for the primary analysis, assuming rho\u202f=\u202f0.5. A restricted maximum-likelihood random-effects model with Hartung\u2013Knapp adjustment was applied. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 21 studies (22 reports) were included, of which 16 contributed to quantitative synthesis. In the core layer, compared with active exercise control, combined interventions showed a potentially favorable estimate in the frailty\/overall physical performance domain (SMD\u202f=\u202f0.63, 95% CI: 0.05\u20131.21), whereas muscle function and muscle mass\/quality estimates remained uncertain. Compared with non-exercise control, the muscle function domain (SMD\u202f=\u202f1.00, 95% CI: 0.12\u20131.88) and frailty\/overall physical performance domain (SMD\u202f=\u202f1.35, 95% CI: 0.38\u20132.31) showed favorable estimates, whereas muscle mass\/quality did not improve consistently. Among 14 GRADE bodies of evidence, 2 were Low and 12 Very low, with none Moderate or High.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tai Chi-based combined interventions may improve selected aspects of muscle function and overall physical performance, but the evidence was based on few heterogeneous studies and was of Low or Very low certainty. Additional benefits over active exercise or single Tai Chi, as well as the optimal intervention combination and dose, remain uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      The systematic review was registered in PROSPERO (CRD420261387528)\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261387528<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1891703","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:16:14Z","timestamp":1787199374000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Tai Chi-based combined interventions on muscle function, muscle mass, and physical performance in older adults with sarcopenia, frailty, or risk of functional decline: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Xudong","family":"Jin","sequence":"first","affiliation":[{"name":"School of Physical Education, Yunnan Minzu University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enliang","family":"Hu","sequence":"additional","affiliation":[{"name":"College of Aviation and Sports, Civil Aviation Flight University of China","place":["Deyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caiduo","family":"Shi","sequence":"additional","affiliation":[{"name":"School of Physical Education, Yunnan Minzu University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2131","DOI":"10.3390\/healthcare11152131","article-title":"Perspectives on aging and quality of life","volume":"11","author":"Noto","year":"2023","journal-title":"Healthcare (Basel)"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","article-title":"Frailty in elderly people","volume":"381","author":"Clegg","year":"2013","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: revised European consensus on definition and diagnosis","volume":"48","author":"Cruz-Jentoft","year":"2019","journal-title":"Age Ageing"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1002\/jcsm.12411","article-title":"Sarcopenia and its association with falls and fractures in older adults: a systematic review and meta-analysis","volume":"10","author":"Yeung","year":"2019","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1002\/jcsm.13243","article-title":"Sarcopenia and health-related quality of life: a systematic review and meta-analysis","volume":"14","author":"Beaudart","year":"2023","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1007\/s12603-021-1665-8","article-title":"International exercise recommendations in older adults (ICFSR): expert consensus guidelines","volume":"25","author":"Izquierdo","year":"2021","journal-title":"J Nutr Health Aging"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.2105\/AJPH.2007.120402","article-title":"Translation of an effective tai chi intervention into a community-based falls-prevention program","volume":"98","author":"Li","year":"2008","journal-title":"Am J Public Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1236050","DOI":"10.3389\/fpubh.2023.1236050","article-title":"Tai chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomized controlled trials","volume":"11","author":"Chen","year":"2023","journal-title":"Front Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"101747","DOI":"10.1016\/j.arr.2022.101747","article-title":"The effect of tai chi in elderly individuals with sarcopenia and frailty: a systematic review and meta-analysis of randomized controlled trials","volume":"82","author":"Huang","year":"2022","journal-title":"Ageing Res Rev"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br J Sports Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1093\/ptj\/73.4.254","article-title":"Balance improvements in older women: effects of exercise training","volume":"73","author":"Judge","year":"1993","journal-title":"Phys Ther"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"82","DOI":"10.33607\/rmske.v2i33.1741","article-title":"Effect of the Otago exercise programme combined with tai chi exercises on reducing the risk of fall in elderly","volume":"2","author":"Sharma","year":"2025","journal-title":"Reabil Moksl"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"19","DOI":"10.3928\/00989134-20240416-04","article-title":"Effectiveness of resistance band use in conjunction with tai chi among older adults with prefrailty to improve functional fitness, quality of life, and heart rate variability","volume":"50","author":"Woo","year":"2024","journal-title":"J Gerontol Nurs"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1007\/s12603-022-1745-4","article-title":"The effects of an integrated exercise intervention on the attenuation of frailty in elderly nursing homes: a cluster randomized controlled trial","volume":"26","author":"Liu","year":"2022","journal-title":"J Nutr Health Aging"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e18951","DOI":"10.1016\/j.heliyon.2023.e18951","article-title":"Effect of a moderate-intensity comprehensive exercise program on body composition, muscle strength, and physical performance in elderly females with sarcopenia","volume":"9","author":"Chen","year":"2023","journal-title":"Heliyon"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"6988","DOI":"10.3390\/ijerph19126988","article-title":"Effectiveness of a hybrid exercise program on the physical abilities of frail elderly and explainable artificial-intelligence-based clinical assistance","volume":"19","author":"Meng","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e58175","DOI":"10.2196\/58175","article-title":"Quantifying the enhancement of sarcopenic skeletal muscle preservation through a hybrid exercise program: randomized controlled trial","volume":"7","author":"Guo","year":"2024","journal-title":"JMIR Aging"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"131","DOI":"10.2147\/CIA.S56682","article-title":"The effectiveness of a combined exercise intervention on physical fitness factors related to falls in community-dwelling older adults","volume":"9","author":"Zhuang","year":"2014","journal-title":"Clin Interv Aging"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2208","DOI":"10.1111\/jgs.13693","article-title":"Effects of weighted tai chi on leg strength of older adults","volume":"63","author":"Su","year":"2015","journal-title":"J Am Geriatr Soc"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"834","DOI":"10.3760\/cma.j.issn.0254-1424.2021.09.016","article-title":"Effects of aerobic exercise combined with resistance training on limb motor function in older adults practicing tai chi for a long time","volume":"43","author":"Zhang","year":"2021","journal-title":"Chin J Phys Med Rehabil"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1975","DOI":"10.2147\/CIA.S556687","article-title":"Efficacy of tai chi and Roliball exercise on balance, mobility, and cognitive function in community-dwelling older adults: a randomized controlled trial","volume":"20","author":"Yang","year":"2025","journal-title":"Clin Interv Aging"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/2046-4053-1-2","article-title":"The nuts and bolts of PROSPERO: an international prospective register of systematic reviews","volume":"1","author":"Booth","year":"2012","journal-title":"Syst Rev"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1136\/emermed-2020-209567","article-title":"Population, intervention, comparison, outcomes and study design as a framework to formulate eligibility criteria in systematic reviews","volume":"37","author":"Amir-Behghadami","year":"2020","journal-title":"Emerg Med J"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e12033","DOI":"10.1002\/cesm.12033","article-title":"Multiarm studies and how to handle them in a meta-analysis: a tutorial","volume":"1","author":"Axon","year":"2023","journal-title":"Cochrane Evid Synth Methods"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1007\/s11065-019-09415-6","article-title":"A guide to conducting a meta-analysis with non-independent effect sizes","volume":"29","author":"Cheung","year":"2019","journal-title":"Neuropsychol Rev"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"107","DOI":"10.3102\/10769986006002107","article-title":"Distribution theory for glass\u2019s estimator of effect size and related estimators","volume":"6","author":"Hedges","year":"1981","journal-title":"J Educ Stat"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2971","DOI":"10.1002\/sim.1301","article-title":"Issues in the meta-analysis of cluster randomized trials","volume":"21","author":"Donner","year":"2002","journal-title":"Stat Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"261","DOI":"10.3102\/10769986030003261","article-title":"Bias and efficiency of meta-analytic variance estimators in the random-effects model","volume":"30","author":"Viechtbauer","year":"2005","journal-title":"J Educ Behav Stat"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/1471-2288-14-25","article-title":"The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method","volume":"14","author":"IntHout","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"d549","DOI":"10.1136\/bmj.d549","article-title":"Interpretation of random effects meta-analyses","volume":"342","author":"Riley","year":"2011","journal-title":"BMJ"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"d4002","DOI":"10.1136\/bmj.d4002","article-title":"Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials","volume":"343","author":"Sterne","year":"2011","journal-title":"BMJ"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1111\/j.0006-341x.2000.00455.x","article-title":"Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis","volume":"56","author":"Duval","year":"2000","journal-title":"Biometrics"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/j.jclinepi.2010.04.026","article-title":"GRADE guidelines: 1. Introduction\u2014GRADE evidence profiles and summary of findings tables","volume":"64","author":"Guyatt","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.jclinepi.2010.07.015","article-title":"GRADE guidelines: 3. Rating the quality of evidence","volume":"64","author":"Balshem","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1007\/978-3-031-05654-3_21","article-title":"Design of somatosensory interactive balance training exergame for the elderly based on tai chi","volume":"13331","author":"Zhang","year":"2022","journal-title":"Lect Notes Comput Sci"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"afad059","DOI":"10.1093\/ageing\/afad059","article-title":"Effectiveness of exercise on fall prevention in community-dwelling older adults: a 2-year randomized controlled study of 914 women","volume":"52","author":"Rikkonen","year":"2023","journal-title":"Age Ageing"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"afag095","DOI":"10.1093\/ageing\/afag095","article-title":"Effects of tai chi combined with elastic band training on muscle and executive inhibitory function in older adults with sarcopenia: a randomized controlled trial based on fNIRS","volume":"55","author":"Zhan","year":"2026","journal-title":"Age Ageing"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1123\/japa.2024-0123","article-title":"White box modeling of self-determined sequence exercise program among sarcopenic older adults: uncovering a novel strategy overcoming decline of skeletal muscle area","volume":"34","author":"Wei","year":"2026","journal-title":"J Aging Phys Act"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1111\/j.1532-5415.1996.tb01433.x","article-title":"Balance and strength training in older adults: intervention gains and tai chi maintenance","volume":"44","author":"Wolfson","year":"1996","journal-title":"J Am Geriatr Soc"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1186\/s12877-025-06471-x","article-title":"Impact of a functional gait training program as a complementary strategy to improve physical function in older adults: a randomized clinical trial","volume":"25","author":"Alegre-Tamariz","year":"2025","journal-title":"BMC Geriatr"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1123\/japa.2020-0391","article-title":"Feasibility and acceptability of home-based exercise snacking and tai chi snacking delivered remotely to self-isolating older adults during COVID-19","volume":"30","author":"Liang","year":"2022","journal-title":"J Aging Phys Act"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"572","DOI":"10.14283\/jfa.2024.32","article-title":"The efficacy of 12-week progressive home-based strength and tai chi exercise snacking in older adults: a mixed-method exploratory randomised control trial","volume":"13","author":"Liang","year":"2024","journal-title":"J Frailty Aging"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1111\/jocn.12751","article-title":"The effects of tai chi in conjunction with Thera-band resistance exercise on functional fitness and muscle strength among community-based older people","volume":"24","author":"Lin","year":"2015","journal-title":"J Clin Nurs"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1793728","DOI":"10.3389\/fpubh.2026.1793728","article-title":"Effects of digitalized tai chi intervention on muscle function and physical performance in older adults: a systematic review and meta-analysis","volume":"14","author":"Gu","year":"2026","journal-title":"Front Public Health"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"112604","DOI":"10.1016\/j.exger.2024.112604","article-title":"Effects of multicomponent exercise on frailty status and physical function in frail older adults: a meta-analysis and systematic review","volume":"197","author":"Yang","year":"2024","journal-title":"Exp Gerontol"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"863","DOI":"10.14336\/AD.2019.1012","article-title":"Exercise programs for muscle mass, muscle strength and physical performance in older adults with sarcopenia: a systematic review and meta-analysis","volume":"11","author":"Bao","year":"2020","journal-title":"Aging Dis"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"111320","DOI":"10.1016\/j.exger.2021.111320","article-title":"The influence of resistance training on neuromuscular function in middle-aged and older adults: a systematic review and meta-analysis of randomised controlled trials","volume":"149","author":"James","year":"2021","journal-title":"Exp Gerontol"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"1962","DOI":"10.1249\/01.MSS.0000099110.17311.A2","article-title":"Effects of tai chi on joint proprioception and stability limits in elderly subjects","volume":"35","author":"Tsang","year":"2003","journal-title":"Med Sci Sports Exerc"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1016\/j.jesf.2024.02.004","article-title":"Tai chi counteracts age-related somatosensation and postural control declines among older adults","volume":"22","author":"Zhang","year":"2024","journal-title":"J Exerc Sci Fit"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1007\/s10433-021-00679-7","article-title":"A research framework for the United Nations decade of healthy ageing (2021\u20132030)","volume":"19","author":"Keating","year":"2022","journal-title":"Eur J Ageing"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"e5661","DOI":"10.1136\/bmj.e5661","article-title":"CONSORT 2010 statement: extension to cluster randomised trials","volume":"345","author":"Campbell","year":"2012","journal-title":"BMJ"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"237","DOI":"10.13621\/j.1001-5949.2022.03.0237","article-title":"Effects of core strength combined with tai chi exercise on walking ability and fall risk in older adults","volume":"44","author":"Ma","year":"2022","journal-title":"Ningxia Med J"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"1330063","DOI":"10.3389\/fnagi.2024.1330063","article-title":"The effects of tai chi on standing balance control in older adults may be attributed to the improvement of sensory reweighting and complexity rather than reduced sway velocity or amplitude","volume":"16","author":"Cui","year":"2024","journal-title":"Front Aging Neurosci"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1891703\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:16:17Z","timestamp":1787199377000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1891703\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":57,"alternative-id":["10.3389\/fpubh.2026.1891703"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1891703","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]},"article-number":"1891703"}}