Effects of tai chi on type 2 diabetes
glycaemic control (65). Furthermore, the bioactivity of
insulin receptors on cytomembrane was also enhanced
through tai chi (53).
In view of the beneficial effects of tai chi on many
outcomes, we recommend that patients with T2DM
should practice tai chi as a complementary rehabilita-
tion therapy, especially those patients who also have
obesity or hypertension. Considering that the effects
of single aerobic exercise last less than 72 h (59), we
also suggest that patients should practice tai chi at least
3 times per week.
This review has several limitations. First, some
studies fulfilling the inclusion criteria might not have
been included in the meta-analysis. Unpublished artic-
les, such as grey literature, were not attainable despite
the exhaustive search strategy. In addition, there was
a possibility of language bias, since only English and
Chinese literature was searched. Furthermore, the
baseline information in some studies was incomplete,
which might result in difficulty in performing further
analysis, with misleading results. In addition, there was
heterogeneity in several results due to different inter-
vention regimens, baseline characteristics of patients,
and duration of follow-up. The heterogeneity across
studies and insufficient sample size might weaken the
strenght of our conclusions for some outcomes; thus,
there is a need for multi-centre, high-quality RCTs
to further investigate the effects of tai chi on T2DM.
The current review also provides additional infor-
mation for further study in related topics. First, tai chi
could be categorized into many types (e.g. Chen style,
Yang style, etc.) but insufficient evidence regarding
differing effects of different types of tai chi makes it
difficult to determine which style of tai chi should be
practiced. Secondly, since the longest follow-up dura-
tion studied was 24 weeks, it is impossible to observe
the long-term effects of tai chi. Thirdly, one needs to
control breath when performing tai chi, and this indi-
cates that tai chi might be associated with respiratory
function, although most studies did not explore the
related outcomes. Other outcomes, such as immune
function, nerve modulation, and survival time, were ra-
rely investigated in these studies. Lastly, most previous
studies focus on the therapeutic effects of tai chi on
T2DM, but whether performing tai chi could reduce the
risk of T2DM in healthy individuals remains unclear.
For the reasons described above, further research is
suggested to investigate the effects of various styles
of tai chi, the long-term effects of tai chi, the impact
on the above outcomes, and the association between
tai chi training and risk of developing T2DM
In conclusion, tai chi may be a suitable mind-body
therapy for individuals with T2DM, since it is benefi-
cial in reducing FPG, decreasing HbA1c and impro-
ving a variety of other outcomes.
415
ACKNOWLEDGEMENTS
The authors are grateful to the authors of the primary studies
and acknowledge the assistance provided by Maowen Li with
statistical analysis.
The authors have no conflicts of interest to declare.
REFERENCES
1. Beidokhti MN, Jäger AK. Review of antidiabetic fruits, ve-
getables, beverages, oils and spices commonly consumed
in the diet. J Ethnopharmacol 2007; 201: 26–41.
2. Lin HC, Su CT, Wang PC. An application of artificial immune
recognition system for prediction of diabetes following
gestational diabetes. J Med Syst 2011; 35: 283–289.
3. Ezuruike UF, Prieto JM. The use of plants in the traditional
management of diabetes in Nigeria: pharmacological and
toxicological considerations. J Ethnopharmacol 2014;
155: 857–924.
4. Ozougwu O. The pathogenesis and pathophysiology of
type 1 and type 2 diabetes mellitus. J Physiol Pathophysiol
2013; 4: 46–57.
5. Cederlund RI, Dahlin LB, Thomsen NO. Activity limitations
before and after surgical carpal tunnel release among
patients with and without diabetes. J Rehabil Med 2012;
44: 261–267.
6. Lan C, Chen SY, Lai JS. Relative exercise intensity of tai chi
chuan is similar in different ages and gender. Am J Chin
Med 2004; 32: 151–160.
7. Lan C, Lai JS, Chen SY. Tai Chi Chuan: an ancient wisdom
on exercise and health promotion. Sports Med 2002; 32:
217–224.
8. Yang AB. [The feasibility study of taijiquan unified sects.]
Yangzhou: Yangzhou University; 2010 (in Chinese).
9. Chen YW, Hunt MA, Campbell KL, Peill K, Reid WD. The
effect of tai chi on four chronic conditions – cancer, osteo-
arthritis, heart failure and chronic obstructive pulmonary
disease: a systematic review and meta-analyses. Br J
Sports Med 2016; 50: 397–407.
10. Huang YT, Wang CH, Wu YF. Adhering to a tai chi chuan
exercise program improves vascular resistance and cardiac
function. Int J Gerontol 2011; 5: 150–154.
11. Li F, Harmer P, Fisher KJ, Mcauley E, Chaumeton N, Eckst-
rom E, et al. Tai chi and fall reductions in older adults: a
randomized controlled trial. J Gerontol 2005; 60: 187–194.
12. Zhao Y, Wang Y. Tai chi as an intervention to reduce falls
and improve balance function in the elderly: a meta-
analysis of randomized controlled trials. Chin Nurs Res
2016; 3: 28–33.
13. Hong Y, Li JX, Robinson PD. Balance control, flexibility, and
cardiorespiratory fitness among older tai chi practitioners.
Br J Sports Med 2000; 34: 29–34.
14. Siu KC, Padilla C, Rajaram SS. The interrelationship bet-
ween balance, tai chi and depression in Latino older adults.
Aging Clin Exp Res 2017; 29: 395–401.
15. Mustian KM, Katula JA, Gill DL, Roscoe JA, Lang D, Murphy
K. Tai chi chuan, health-related quality of life and self-
esteem: a randomized trial with breast cancer survivors.
Support Care Cancer 2004; 12: 871–876.
16. Wang L, Wu K, Chen X, Liu Q. The effects of tai chi on lung
function, exercise capacity and health related quality of life
for patients with chronic obstructive pulmonary disease: a
pilot study. Heart Lung Circ 2018 Aug 2. pii: S1443-9506.
[Epub ahead of print].
17. Li F, Harmer P, Fisher KJ, Xu J, Fitzgerald K, Vongjaturapat
N. Tai chi-based exercise for older adults with Parkinson’s
disease: a pilot-program evaluation. J Aging Phys Act
2007; 15: 139–151.
18. Wang C, Schmid C, Hibberd P, Kalish R, Roubenoff R, Rones
R, et al. Tai chi is effective in treating knee osteoarthritis:
a randomized controlled trial. Arthritis Rheum 2009; 61:
J Rehabil Med 51, 2019