title: Tai Chi on psychological well-being: systematic review and meta-analysis.
abstract: BACKGROUND
  Physical activity and exercise appear to improve psychological health. However, the quantitative effects of Tai Chi on psychological well-being have rarely been examined. We systematically reviewed the effects of Tai Chi on stress, anxiety, depression and mood disturbance in eastern and western populations.
  
  
  METHODS
  Eight English and 3 Chinese databases were searched through March 2009. Randomized controlled trials, non-randomized controlled studies and observational studies reporting at least 1 psychological health outcome were examined. Data were extracted and verified by 2 reviewers. The randomized trials in each subcategory of health outcomes were meta-analyzed using a random-effects model. The quality of each study was assessed.
  
  
  RESULTS
  Forty studies totaling 3817 subjects were identified. Approximately 29 psychological measurements were assessed. Twenty-one of 33 randomized and nonrandomized trials reported that 1 hour to 1 year of regular Tai Chi significantly increased psychological well-being including reduction of stress (effect size [ES], 0.66; 95% confidence interval [CI], 0.23 to 1.09), anxiety (ES, 0.66; 95% CI, 0.29 to 1.03), and depression (ES, 0.56; 95% CI, 0.31 to 0.80), and enhanced mood (ES, 0.45; 95% CI, 0.20 to 0.69) in community-dwelling healthy participants and in patients with chronic conditions. Seven observational studies with relatively large sample sizes reinforced the beneficial association between Tai Chi practice and psychological health.
  
  
  CONCLUSIONS
  Tai Chi appears to be associated with improvements in psychological well-being including reduced stress, anxiety, depression and mood disturbance, and increased self-esteem. Definitive conclusions were limited due to variation in designs, comparisons, heterogeneous outcomes and inadequate controls. High-quality, well-controlled, longer randomized trials are needed to better inform clinical decisions.
authors.affiliation: Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA. cwang2@tuftsmedicalcenter.org
authors.forename: Chenchen
authors.initials: C
authors.lastname: Wang
authors.forename: Raveendhara
authors.initials: R
authors.lastname: Bannuru
authors.forename: Judith
authors.initials: J
authors.lastname: Ramel
authors.forename: Bruce
authors.initials: B
authors.lastname: Kupelnick
authors.forename: Tammy
authors.initials: T
authors.lastname: Scott
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Schmid
mesh_terms: D000339:Affect; D001007:Anxiety / Q000628:therapy*; D003863:Depression / Q000628:therapy*; D015444:Exercise / Q000523:psychology*; D006801:Humans; D008603:Mental Health; D012649:Self Concept; D013315:Stress, Psychological / Q000628:therapy*; D026302:Tai Ji / Q000523:psychology*; D016896:Treatment Outcome