Tai Chi for Blood Pressure, Sleep, and Balance: What Trials Show

By Dr. Ryan Kneessi, ND

Tai chi often gets filed under gentle activities that are nice but probably not very powerful. Over the past several years, though, researchers have put it through the same kind of randomized trials used to test medications and conventional exercise programs, and the results have been more interesting than many people expect. I find this research useful because tai chi is low impact, needs no equipment, and appeals to many people who would never set foot in a gym.

In this article, I want to walk through four free, peer-reviewed trials on tai chi, covering blood pressure, sleep, and falls in older adults. For each one, I will explain who was studied, what they did, what the researchers measured, and where the study has limits, so you can judge the findings for yourself.

What tai chi involves

Tai chi is a traditional Chinese practice that combines slow, continuous movements with weight shifting, upright posture, steady breathing, and focused attention. Most of the trials below used the 24-form Yang style, which is a sequence of 24 standard movements and the version most often studied in research. One trial used a program called Tai Ji Quan: Moving for Better Balance, which adapts traditional movements to train balance and stepping in older adults. In every trial, classes were led by trained instructors.

The first study: tai chi and blood pressure

The first trial, published in 2024 in JAMA Network Open, asked whether tai chi could lower blood pressure more effectively than aerobic exercise in people with prehypertension. Prehypertension means a systolic reading of 120 to 139 mm Hg or a diastolic reading of 80 to 89 mm Hg, a range that research has associated with a higher chance of developing high blood pressure and heart disease later on.

The researchers randomly assigned 342 adults aged 18 to 65, with an average age of about 49, to either 24-form Yang-style tai chi or aerobic exercise such as brisk walking, jogging, stair climbing, and cycling. Both groups exercised in 60-minute sessions four times a week for a full year, with at least one supervised group session each week and video-guided sessions on the other days. The main outcome was the change in systolic blood pressure measured in the clinic after 12 months, and the researchers also used 24-hour blood pressure monitors.

After 12 months, systolic blood pressure fell by an average of 7.0 mm Hg in the tai chi group and 4.6 mm Hg in the aerobic exercise group, a difference of 2.4 mm Hg in favor of tai chi. The tai chi group also had larger reductions in 24-hour systolic pressure, by about 2.2 mm Hg, and in nighttime systolic pressure, by about 4.1 mm Hg. Attendance was high in both groups, at around 86 to 87 percent, and no serious adverse events were reported.

There are important limits to keep in mind. About 17 percent of participants dropped out before the final measurement, all participants were in China, and the difference between the two groups, while statistically significant, was modest. It is also worth noticing that both groups improved, which is a good reminder that regular movement of either kind matters for blood pressure.

The second study: tai chi, exercise, and sleep in older adults

The second trial, published in 2021 in JAMA Network Open, studied 320 adults aged 60 and older in Hong Kong who had lived with insomnia for an average of about 10 years. Most of them, about 80 percent, were women. Participants were randomly assigned to 12 weeks of 24-form Yang-style tai chi, 12 weeks of conventional exercise such as brisk walking and muscle strengthening, or a control group with no new activity. Both active groups met three times a week for one hour.

A strength of this trial is that the main measurements came from actigraphy, a wrist-worn device that tracks sleep and wake patterns, rather than from questionnaires alone. Compared with the control group, the tai chi group spent about 3.4 percent more of their time in bed asleep, spent about 13 fewer minutes awake after first falling asleep, and woke about two fewer times per night. The conventional exercise group improved by similar amounts, and the two active groups did not differ from each other. These improvements were still present two years after the program ended.

The authors were candid that the absolute changes were modest. The study took place at a single center, and the control group did not receive any comparison activity, so part of the benefit could reflect the social contact and structure of attending classes.

The third study: tai chi compared with cognitive behavioral therapy for insomnia

The third trial, published in 2025 in The BMJ by the same Hong Kong research group, set a higher bar. Cognitive behavioral therapy for insomnia, often called CBT-I, is the first-line nondrug approach recommended for long-standing insomnia, so the researchers asked whether tai chi could hold up against it. They randomly assigned 200 adults aged 50 and older with long-standing insomnia to tai chi or CBT-I, each delivered in one-hour group sessions twice a week for three months.

The main outcome was the Insomnia Severity Index, a validated questionnaire scored from 0 to 28 on which higher scores mean more severe insomnia. At the end of the three-month program, scores dropped by about 6.7 points with tai chi and about 11.2 points with CBT-I, so tai chi did not match CBT-I in the short term. By 15 months, however, the tai chi group had continued to improve, with a total reduction of about 9.5 points compared with about 10.2 points for CBT-I. At that point, tai chi met the researchers’ preset definition of being no worse than CBT-I. No adverse events occurred in either group.

This was a single-center study in Chinese adults, and most participants were 60 or older, so the results may not apply equally to younger people. My reading is that CBT-I still works faster, while tai chi appears to be a reasonable long-term option for people who prefer a movement-based approach or who cannot easily access CBT-I.

The fourth study: a balance-focused tai chi program and injurious falls

The fourth trial, published in 2019 in JAMA Network Open, focused on one of the most important issues in healthy aging, which is falling. Researchers in Oregon enrolled 670 community-dwelling adults aged 70 and older, with an average age of about 78, who had fallen in the past year or had impaired mobility on a standard walking test. They were randomly assigned to Tai Ji Quan: Moving for Better Balance, a multimodal exercise program that combined strength, aerobic, balance, and flexibility training, or a stretching program. Each group met twice a week for one hour over 24 weeks, and participants were then followed for another six months.

Over the 12 months of the study, the tai chi group had about half as many moderate injurious falls as the stretching group, and about one quarter as many serious injurious falls, meaning falls that led to an emergency department visit or a hospital admission. The multimodal exercise program also outperformed stretching, but the tai chi program was linked to about half as many serious injurious falls as the multimodal program. The researchers noted that moderate falls were self-reported and that not every serious fall could be confirmed through medical records, which introduces some uncertainty.

How to read these results together

These four studies are randomized trials, which is the strongest kind of evidence for comparing approaches, and each one compared tai chi with an active alternative rather than with doing nothing alone. That makes the results more meaningful, because tai chi was held to the standard of exercise programs and therapies that already have good evidence behind them. In most cases, tai chi matched or modestly outperformed its comparison, with the clear exception that CBT-I worked faster for insomnia.

At the same time, most of the participants came from China or Hong Kong, three of the four trials took place at one or two centers, and the classes were led by experienced instructors with good attendance. Results in everyday life may depend on how consistently someone practices and how well the classes are taught.

Why a gentle practice may have these effects

The trials were not designed to prove how tai chi works, but there are reasonable explanations. The blood pressure researchers pointed to earlier work suggesting that tai chi may have a relaxing effect on the nervous system, shifting the balance away from the stress response. Tai chi combines continuous low-to-moderate movement with slow breathing and focused attention, which may calm the stress response that can keep blood pressure and nighttime arousal elevated. I write more about the breathing side of this in my article on breathwork. The constant weight shifting, single-leg stances, and controlled stepping train balance and leg strength, which helps explain the findings on falls and ties in with my article on strength training for longevity.

How I think about this as a functional medicine doctor

I see tai chi as a practical option for people who want a gentle, social, and sustainable way to move, especially those who are older, deconditioned, recovering from an injury, or simply not drawn to conventional workouts. It is not a replacement for other forms of exercise. Brief bursts of harder effort, which I covered in my article on vigorous intermittent lifestyle physical activity, and building cardiorespiratory fitness each offer something different.

For sleep, I like that tai chi fits naturally alongside the routines I describe in my articles on sleep optimization for longevity and whether a consistent sleep schedule matters. If you have heart disease, poorly controlled blood pressure, joint problems, or a history of falls, talk with your own clinician before starting a new program, and look for an instructor who has experience with beginners and older adults.

Frequently asked questions

Sources

This article is for educational purposes only and is not medical advice. It does not replace an individual evaluation. Talk with your healthcare provider before making changes to your diet, exercise, supplements, or medications, especially if you are pregnant, nursing, or managing a health condition.