Is Tai Chi exercise effective in improving sleep quality in older people?
Date of publication of the systematic review: January 2015
Design
Systematic review of 5 randomized controlled trials (RCTs).
Participants
470 community-dwelling older people aged 60 years or above (mean age range: 65.94 to 75.45 years, 40.9% male).
Intervention
Tai Chi exercise was provided with a range from 8 weeks to 6 months. The session of Tai Chi exercise varied between 20 and 60 min each time. The frequency of Tai Chi exercise sessions varied between 2 and 5 times each week. Four of the included trials reported that Tai Chi exercise was guided by experienced and qualified instructors.
Comparator
Comparison: Tai Chi exercise versus control group receiving no treatment, maintaining routine activities, health education or 1-hr low-impact exercise 3 times per week for 24 weeks.
Major Outcomes
Outcome 1: Pittsburgh Sleep Quality Index (PSQI) global score (ranging from 0 to 21). Higher scores indicated poor sleep quality;
Outcome 2: Subjective sleep quality of PQSI;
Outcome 3: Sleep latency of PQSI.
Settings
The reviewers did not state where the trials were conducted and whether the trials were conducted in inpatient or outpatient settings.
Comparison    Tai Chi exercise versus control group receiving no treatment, maintaining routine activities, health education or 1-hr low-impact exercise 3 times per week for 24 weeks
Main Results
Compared to control group receiving no treatment, maintaining routine activities, health education or 1-hr low-impact exercise 3 times per week for 24 weeks, Tai Chi exercise showed significant effect in reducing PSQI global score for older people (pooled standardized mean difference (pooled SMD): -0.87, 95% CI: -1.25 to -0.49). Besides, Tai Chi exercise showed significant effect in improving subjective sleep quality (pooled SMD: -0.83, 95% CI: -1.08 to -0.57) and reducing sleep latency of PQSI (pooled SMD: -0.75, 95% CI: -1.42 to -0.07).
Comparison: Tai Chi exercise versus control group receiving no treatment, maintaining routine activities, health education or 1-hr low-impact exercise 3 times per week for 24 weeks among older people
Outcomes No. of studies (Total no. of participants) Mean value (SD) / No. of participants Heterogeneity test (I2) Pooled SMD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 5 (381) Not reported / 201 Not reported / 180 68% -0.87 (-1.25 to -0.49) <0.00001 Moderate
2 3 (252) Not reported / 135 Not reported / 117 24% -0.83 (-1.08 to -0.57) <0.00001 High
3 3 (252) Not reported / 135 Not reported / 117 84% -0.83 (-1.08 to -0.57) 0.03 Moderate
Keys: SMD = standardized mean difference; SD = standard deviation; CI = confidence interval.
Comparison    Tai Chi exercise versus control group receiving no treatment, maintaining routine activities, health education or 1-hr low-impact exercise 3 times per week for 24 weeks
Main Results
Compared to control group receiving no treatment, maintaining routine activities, health education or 1-hr low-impact exercise 3 times per week for 24 weeks, Tai Chi exercise showed significant effect in reducing PSQI global score for older people (pooled standardized mean difference (pooled SMD): -0.87, 95% CI: -1.25 to -0.49). Besides, Tai Chi exercise showed significant effect in improving subjective sleep quality (pooled SMD: -0.83, 95% CI: -1.08 to -0.57) and reducing sleep latency of PQSI (pooled SMD: -0.75, 95% CI: -1.42 to -0.07).
Comparison: Tai Chi exercise versus control group receiving no treatment, maintaining routine activities, health education or 1-hr low-impact exercise 3 times per week for 24 weeks among older people
Outcomes 1 2 3
No. of studies (Total no. of participants) 5 (381) 3 (252) 3 (252)
Mean value (SD) / No. of participants Intervention Not reported / 201 Not reported / 135 Not reported / 135
Comparator Not reported / 180 Not reported / 117 Not reported / 117
Pooled SMD (95% CI) -0.87 (-1.25 to -0.49) -0.83 (-1.08 to -0.57) -0.83 (-1.08 to -0.57)
p value <0.00001 <0.00001 0.03
Overall quality of evidence* Moderate High Moderate
Keys: SMD = standardized mean difference; SD = standard deviation; CI = confidence interval.
Conclusion
Benefits
Compared to control group receiving no treatment, maintaining routine activities, health education or 1-hr low-impact exercise 3 times per week for 24 weeks, Tai Chi exercise showed significant effect in reducing PSQI global score, improving subjective sleep quality and reducing sleep latency among older people. For outcomes 1 and 3, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. For outcomes 2, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported in the included trials.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/24934815
The synopsis is based on the following article:
Du S, Dong J, Zhang H, Jin S, Xu G, Liu Z, et al. Taichi exercise for self-rated sleep quality in older people: A systematic review and meta-analysis. International Journal of Nursing Studies. 2015 Jan;52(1), 368-379.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.