The evidence is growing in support of tai chi as an effective, low-impact, enjoyable, and heart-healthy form of exercise.

In a previous meta-analysis of 24 randomized controlled studies, tai chi improved systolic and diastolic blood pressure.^[1] In addition, tai chi led to improvements in quality of life, general health, bodily pain, vitality, social functioning, mental health, physical health, and emotional health. In addition, a 2020 meta-analysis of 126 randomized controlled trials looked at 22 nondrug interventions for reducing blood pressure, and found that tai chi stood out as among the most effective, although the evidence quality was very low.

The research on the specific mechanisms for how tai chi helps reduce blood pressure is still in its early stages, but some studies suggest that the answer lies in the autonomic nervous system. One particular study observed the immediate effects of tai chi on older adults and found that tai chi appeared to tip the balance of their autonomic nervous system. Instead of leaning toward sympathetic modulation (which can raise blood pressure), it leaned more towards parasympathetic modulation (which can help reduce it).^[2]

In another study, the blood-pressure-lowering effects of a 12-week tai chi program were attributed to reductions in a hormone called angiotensin II and increases in nitric oxide (NO).^[3] Angiotensin II causes blood vessels to constrict, causing an increase in blood pressure. In contrast, NO dilates blood vessels, causing a reduction in blood pressure.^[4]

These results add to the growing body of evidence that various types of exercise — not just aerobic exercise — can benefit blood pressure. A recent meta-analysis of exercise trials was reviewed in this Editor’s Pick, in which aerobic exercise, resistance training, high-intensity interval training, and isometric exercise all reduced systolic blood pressure by 5–8 mmHg and diastolic blood pressure by 3–4 mmHg. In fact, isometric exercise was found to be the most effective exercise for reducing blood pressure.

Tai chi has many similarities to isometric exercise: it focuses on static or relatively static postures and use of the body’s own weight through slow, smooth movements to strengthen muscles, tendons, and ligaments and increase flexibility. In light of this, the results of this study aren’t too surprising.

In the tai chi group, 31% of the participants had blood pressure that fell within the recommended range of less than 120 (systolic) and 80 (diastolic) at the end of the study. In the aerobic exercise group, 22% of the participants fell within range. The percentage of participants with hypertension (systolic and diastolic blood pressure above 140 mmHg or 90 mmHg, respectively) was lower in the tai chi group (12%) compared to the aerobic exercise group (18%).

Finally, 35% of the participants in the tai chi group and 28% in the aerobic exercise group experienced a reduction in systolic blood pressure of 10 mmHg or more. In terms of diastolic blood pressure, 44% of the participants in the tai chi group and 37% in the aerobic exercise group had a reduction of 5 mmHg or more. However, the difference in these percentages was not statistically significant.

Ambulatory blood pressure monitoring involves the out-of-office 24-hour measurement of blood pressure using at-home devices, and it’s more closely related to cardiovascular complications than in-office blood pressure measurements.^[5] The improvement in 24-hour and nighttime systolic blood pressure in the tai chi group may be of great clinical significance, though it should be noted that these were exploratory outcomes.

Of note, some parameters related to mental health (measured using the SF-36,) did improve from baseline in the tai chi group: general health increased by 5 points, mental health increased by 4 points, social functioning increased by almost 3 points, role-emotional increased by 5 points, and vitality increased by almost 3 points. There were no changes from baseline in the aerobic exercise group. Although more research needs to be done, these results suggest that tai chi may be an effective intervention for improving cardiovascular health and mental health in adults.

Tai chi seems to represent an effective, zero-cost, and low-barrier alternative to traditional aerobic exercise for blood pressure reduction. This martial art may very well benefit the heart.

A martial art for the heart: tai chi outperforms aerobic exercise for blood pressure reduction Original paper