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Does tai chi help knee arthritis, balance and blood pressure?

Trials show tai chi eases knee arthritis pain and cuts falls in older adults, with longer, more frequent practice working best. Blood pressure drops are small.

Published October 2026

Short answer

For knee arthritis and balance a modest yes, from many small trials. Blood pressure falls about 10/5 mmHg in reviews, but the effect is probably overstated. Evidence grade B (Moderate). Several meta-analyses of randomised trials support the knee and balance answers (B; downgraded for unblinded trials and surrogate balance tests); blood pressure gets C because it is a surrogate marker with inconsistent, mostly small trials.

Key takeaways

  • In meta-analyses of 16 and 17 trials, tai chi eased knee arthritis pain by a moderate amount and improved physical function, with no serious side effects reported [1][2].
  • A 2023 meta-analysis of 24 trials found tai chi cut the risk of falls in older adults by about a quarter, and the benefit grew with longer, more frequent practice [3].
  • In a 670-person trial, a balance-focused tai chi program cut falls by 58% versus stretching, but a 503-person trial found no difference [4][5].
  • Blood pressure fell about 10/5 mmHg in a 2024 meta-analysis, but the trials are small and other reviews find less, so the true effect is probably smaller [6][7].
  • Tai chi can be done at home by video, but people cannot be blinded to practising it, and most trials studied Chinese populations [8][9].

The short version

Tai Chi helps knee osteoarthritis a modest amount and reduces falls in older adults, with the clearest results from longer practice, two or three sessions a week [1] [3] [10]. For blood pressure, meta-analyses report drops of roughly 9 to 11 mmHg systolic and 4 to 5 mmHg diastolic, but the trials are small and the true effect is probably smaller [6] [9]. Trials that recorded side effects found no serious ones [1] [8].

What the studies show

Knee osteoarthritis

A 2021 meta-analysis of 16 randomised trials (986 people) found moderately less pain (a standardised mean difference of -0.69), less stiffness and better physical function; the reviewers rated the evidence low to moderate, and no adverse events were reported [1]. A 2022 analysis of 8 of those trials found the pain, stiffness and function gains were large enough to be clinically relevant, with little inconsistency between trials [11]. A 2025 meta-analysis of 17 trials (980 people) found less pain and stiffness and better quality of life [2]. A 2025 review of 13 trials (701 people) found smaller pooled improvements and reported that programs longer than 16 weeks, with three sessions a week, gave the largest pain and function gains [10].

In a 204-person trial, tai chi and standard physical therapy gave similar improvements after 12 weeks, and both held up at 52 weeks; the tai chi group had larger gains in depression and physical quality of life [12]. A 2026 trial found that unsupervised online tai chi reduced knee pain about 1.4 points more than an information-only control on a 0-to-10 scale in 178 adults, and 73% of the tai chi group reached a clinically meaningful improvement in pain [8].

Balance and falls

A 2023 meta-analysis of 24 randomised trials found tai chi lowered the risk of falls in older adults by about a quarter (rate ratio 0.76) and improved balance tests such as the timed up-and-go and functional reach tests [3]. The benefit appeared in both healthy older adults and those at higher risk of falling, and it grew with longer and more frequent practice [3].

The largest single trial enrolled 670 adults aged 70 and over at high risk of falling [4]. Those who did a tailored balance-focused tai chi program twice a week for 24 weeks had 152 falls versus 363 in a stretching control — about 58% fewer (rate ratio 0.42) — and 31% fewer than a standard exercise program [4]. Not every trial agrees: a 503-person trial found no difference in falls after 48 weeks of modified Sun-style tai chi compared with seated flexibility exercise, and more tai chi participants stopped attending classes [5].

A Cochrane review of exercise for preventing falls found tai chi cut the number of people who fell by 20% across 8 trials, while rating the evidence on the rate of falls as low certainty [13]. A 2024 meta-analysis of 22 trials found better scores on the Berg Balance Scale and one-leg standing tests, no clear change on the Tinetti test or the Short Physical Performance Battery, and rated all outcomes low certainty [14].

Blood pressure

A 2024 meta-analysis of people with essential hypertension (average blood pressure about 148/89 mmHg) found tai chi lowered systolic pressure by 10.6 mmHg and diastolic by 4.7 mmHg [6]. An earlier meta-analysis of 31 trials (3,223 middle-aged adults, most with prehypertension) found drops of 11.3 and 4.8 mmHg, but the authors reported that trials published in English showed about half the effect of those published in Chinese, so the pooled number is probably too large [9]. A 2025 review of 17 studies found similar pooled drops (about 9/5 mmHg), largest in the first three months [15].

Smaller, stricter reviews are less confident: a 2024 review of five small trials (568 people) found a significant systolic drop but no clear diastolic effect, with substantial variation between trials [7]. In the largest single trial, 342 adults with prehypertension did tai chi or aerobic exercise four times a week for a year; tai chi came out slightly ahead, with 2.4 mmHg more systolic reduction [16]. A 2024 meta-analysis of 13 trials in adults with weight, cholesterol or blood-sugar problems found a 4.5 mmHg diastolic drop and rated the evidence moderate [17].

The nuances

Blinding is impossible in these trials, and self-reported outcomes may partly reflect expectation: the 204-person knee trial notes that patients knew which treatment they were getting [12]. Where the participants lived also matters: most trials were done in China, and the 3,223-person blood-pressure review found English-language trials reported about half the effect of Chinese-language ones [9]; a separate pooled analysis of 7 blood-pressure trials concluded that more well-designed trials from other countries are needed [18].

Pooled effect sizes differ between reviews: for knee pain, estimates range from small-to-moderate (a standardised mean difference of -0.41) to large (-1.40) across reviews of 13 trials each, and one 2026 review called its larger result moderate-to-high quality evidence [10] [19].

Review quality is uneven: an overview of 14 reviews of tai chi for balance and falls judged 13 of them to be of critically low quality on a standard checklist, with imprecision (small studies) the most common reason for downgrading the evidence [20]. A larger overview of 210 reviews rated only 7% of its effect estimates high certainty, with risk of bias the most common concern [21]. One conflict of interest stands out: the lead author of the positive 670-person falls trial founded the company that licenses the program and receives a licensing fee [4].

How much you do seems to matter: the trial that cut falls most used 60-minute classes twice a week for 24 weeks, and the knee review found longer than 16 weeks with three weekly sessions gave the largest pain gains [4] [10]. The 503-person trial that found no falls benefit also used twice-weekly classes, but for 48 weeks — and more of its tai chi group dropped out early [5].

What this means for you

Tai chi can be done in a class or at home with a video — the online trial found unsupervised practice still helped knee pain [8]. The trials that helped ran for 12 to 48 weeks, usually two or three sessions a week, and the falls benefit grew with longer and more frequent practice [4] [3].

Side effects were rarely reported: the knee review and the online trial found no serious adverse events, adverse-event comparisons in a large overview found a similar risk to comparison groups, and in one falls trial more people in the tai chi group stopped attending [1] [8] [21] [5]. Tai chi is exercise, not a medicine: the blood-pressure reviews compared it with routine care, and the knee trials compared it with physical therapy [7] [12]. If you have knee arthritis, balance problems or high blood pressure, ask a doctor or physiotherapist whether tai chi suits your situation — the full evidence and safety details are on the Tai Chi page.

Go deeper

  • Tai Chi — Tai chi modestly eases knee osteoarthritis pain and is linked to fewer falls in older adults, with the best results from longer, more frequent practice.

References

  1. Tai Chi exercise can ameliorate physical and mental health of patients with knee osteoarthritis: systematic review and meta-analysis.. Clin Rehabil, 2021.
  2. Impact of Tai Chi on Physical and Mental Well-being in Individuals With Knee Osteoarthritis: A Systematic Review and Meta-analysis.. Am J Phys Med Rehabil, 2025.
  3. Tai Chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomized controlled trials.. Front Public Health, 2023.
  4. Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling: A Randomized Clinical Trial.. JAMA Intern Med, 2018.
  5. Impact of tai-chi on falls among preclinically disabled older people. A randomized controlled trial.. J Am Med Dir Assoc, 2015.
  6. The efficacy of Tai Chi for essential hypertension: A systematic review and meta-analysis.. Int J Nurs Pract, 2024.
  7. Efficacy of Tai Chi exercise in patients with hypertension: systematic review and meta-analysis.. Curr Probl Cardiol, 2024.
  8. Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial.. JAMA Intern Med, 2026.
  9. Tai Ji Quan as antihypertensive lifestyle therapy: A systematic review and meta-analysis.. J Sport Health Sci, 2021.
  10. The optimal course and frequency of Tai Chi for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.. Front Public Health, 2025.
  11. Clinical relevance of Tai Chi on pain and physical function in adults with knee osteoarthritis: An ancillary meta-analysis of randomized controlled trials.. Sci Prog, 2022.
  12. Comparative Effectiveness of Tai Chi Versus Physical Therapy for Knee Osteoarthritis: A Randomized Trial.. Ann Intern Med, 2016.
  13. Exercise for preventing falls in older people living in the community.. Cochrane Database Syst Rev, 2019.
  14. Effectiveness of Tai Chi exercise on balance, falls, and motor function in older adults: a meta-analysis.. Front Med (Lausanne), 2024.
  15. An RCT META analysis based on the efficacy of Tai Chi exercise therapy on blood pressure and blood lipids in patients with essential hypertension.. Front Cardiovasc Med, 2025.
  16. Effect of Tai Chi vs Aerobic Exercise on Blood Pressure in Patients With Prehypertension: A Randomized Clinical Trial.. JAMA Netw Open, 2024.
  17. The Effect of Tai Chi on Cardiometabolic Risk Factors: Systematic Review and Meta-Analysis.. J Integr Complement Med, 2025.
  18. Response variation as a result of tai chi on resting blood pressure in hypertensive adults: An aggregate data meta-analysis.. Complement Ther Clin Pract, 2022.
  19. The effect of Tai Chi on knee osteoarthritis: A systematic review and meta-analyses of 13 randomized controlled trials.. J Back Musculoskelet Rehabil, 2026.
  20. Tai Chi for improving balance and reducing falls: An overview of 14 systematic reviews.. Ann Phys Rehabil Med, 2020.
  21. Determining the safety and effectiveness of Tai Chi: a critical overview of 210 systematic reviews of controlled clinical trials.. Syst Rev, 2022.