Tai Chi Effects on Heart Rate Variability: A Systematic Review and Meta-Analysis

Author: Yujiao Zhou1, Qiuyu Wang2, Linda Larkey3, Dara James3, Hua Cui1,4
1 Department of Wushu, Beijing Sport University, Beijing, China.
2 Department of Foreign Languages, Beijing Sport University, Beijing, China.
3 Center for Health Promotion and Disease Prevention, Edson College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ, USA.
4 Sport Information Research and Teaching Center, Beijing Sport University, Beijing, China.
Conference/Journal: J Integr Complement Med
Date published: 2023 Sep 11
Other: Special Notes: doi: 10.1089/jicm.2022.0682. , Word Count: 405

Background: Tai Chi, originating in China, is a mind-body exercise that integrates mind training, Qi training, and body training. While Tai Chi practice has demonstrated beneficial physical and psychological health benefits, how it achieves effects has been less studied. In recent years, some researchers have begun to explore the potential of heart rate variability (HRV) changes as balancing the autonomic nervous system (ANS) to achieve results, but only a few studies have directly tested how Tai Chi impacts HRV, and results have been mixed. Objective: This study systematically evaluates the effects of Tai Chi on HRV. Methods: Electronic databases including Web of Science, PubMed, Scopus, Cochrane Library, and EBSCOhost direct from inception until December 2020 were searched to obtain eligible studies. The primary outcomes examined were HRV parameters (time domain and frequency domain), and secondary analysis was whether breathing was emphasized during Tai Chi interventions. Results: Based on the 11 randomized controlled trials included comparing Tai Chi with non-active control condition, meta-analyses showed significantly beneficial effects on HRV parameters (low-frequency power [LF], mean difference [MD] = -200.40, 95% confidence interval [CI]: 365.31 to -35.49, p = 0.02; normalized low-frequency power [nLF], MD = -7.39, 95% CI: -12.48 to -2.29, p = 0.004; total power [TP], MD = -649.82, 95% CI: -1180.54 to -119.11, p = 0.02; very low-frequency power [VLF], MD = -200.55, 95% CI: -349.63 to -51.46, p = 0.008; root mean square of the square sum of the difference between adjacent normal heartbeat intervals [RMSSD], MD = 2.59, 95% CI: -7.23 to 12.41, p < 0.0001; standard deviation of the heartbeat interval [SDNN], MD = 8.33, 95% CI: 0.69 to 15.98, p = 0.03). The effect of Tai Chi on certain HRV parameters compared with active control conditions was less favorable (nLF, MD = 6.42, 95% CI: 3.74 to 9.09, p < 0.00001; normalized high-frequency power [nHF], MD: -6.13, 95% CI: -8.76 to -3.50, p < 0.00001; low-frequency/high-frequency power ratio [LF/HF], MD = 1.00, 95% CI: 0.68 to 1.33, p < 0.00001). In addition, studies describing an emphasis on breathing in the Tai Chi intervention showed positive impact on HRV (nLF, MD = -3.22, 95% CI: -5.32 to -1.12, p = 0.003; nHF, MD = 3.80, 95% CI: 0.80 to 6.81, p = 0.01; SDNN, MD = 5.55, 95% CI: 4.85 to 6.25, p < 0.00001). Conclusions: Meta-analysis results showed that Tai Chi compared with non-active control conditions has a positive impact on key HRV parameters associated with the ANS balance. However, active control condition comparisons showed greater HRV improvements than for Tai Chi. Considering the limited number of studies and their heterogeneity, further robust studies are necessary to verify findings and investigate differential effects of Tai Chi on HRV.

Keywords: Tai Chi; heart rate variability; meta-analysis; systematic review; taiji.

PMID: 37695835 DOI: 10.1089/jicm.2022.0682