Background: Taichi softball was voted as one of the most popular health-promoting exercises in the category of ball games, which is attributed to that Taichi softball is not only beneficial for lower extremity-related physical health (e.g., balance, leg strength, and flexibility), but can also develop manipulative skill and hand-eye coordination (eating, bathing, dressing, bathing required manipulative skills, grips movement and strength). However, the positive effects of Taichi softball on physical health have rarely been investigated. Therefore, the purpose of this systematic review was to evaluate the effect of Taichi softball on physical health. Methods: Five electronic databases were used to conduct literature searches. Two review authors independently extracted data in a standardized manner. The methodological quality of studies included was independently evaluated according to the Cochrane Collaboration’s for Assessing Risk of Bias from the Cochrane Handbook for Systematic Review Interventions. The standard mean difference (SMD) and 95% confidence interval (CI) using more conservative random effects model were calculated. Results: The sample size of 411 participants ranged from 32 to 150 in the RCTs, along with a wide age range from 18 to 75. The length of Taichi softball intervention peri-ods in the eligible studies ranged from 12 weeks to 12 months. The participants in the studies consisted of healthy college students, patients with Type 2 diabe-tes, and older adults from community centers. Six randomized controlled trials were used for the meta-analysis. The aggregated results are in favor of Taichi softball on improving physical health in participants with healthy status and Type 2 Diabetes Mellitus. The improvement on the primary components of the physical health consisted of handgrip strength (SMD, -0.6, 95% CI -0.84 to 0.36, p < 0.00001), trunk flexibility (SMD, -0.4, 95% CI -0.74 to -0.05, p = 0.03), static (SMD, -0.73, 95% CI -0.94 to -0.51, p < 0.00001) and dynamic balance (SMD, -0.68, 95% CI -1.2 to -0.17, p = 0.009). Conclusions: Taichi softball appears to be beneficial for improving physical health (hand strength, physical balance, flexibility, aerobic endurance, resting heart rate, diastolic and systolic pressures) among healthy adults and patients with Type 2 Diabetes. However, because of the low methodological quality of assessment, ill-designed experimental designs, and small study size, a definite conclusion of Taichi softball improving physical health can be confirmed along with high-quality studies with long follow-up.
Physical health is defined as a state of physical well-being in which an individual is physically fit to perform their activities without restriction [
Taichi Quan was extensively approved to promote physical health in adults [
Taichi softball is a novel Chinese health-enhancing exercise invented based on the principle of Taichi Quan (practice slow, gentle, graceful movements along with deep breathing and relaxation for cultivating internal energy) [
This research protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 15 March 2016 (CRD42016036469) [
Five electronic databases (PubMed, GoogleScholar, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, Chinese Biomedical Literature Database [CBM]) were used to conduct literature searches, along with the combination strategy of: Taichi ball, Taichi softball, Taiji ball, or Taichi softball. The studies were included if they met the following criteria: 1) only peer-re- viewed studies in English or Chinese because reviewer authors are proficient in both languages; 2) original randomized controlled studies published from September 2000 to February 2016; 3) Taichi softball as the main intervention in the studies; 4) a minimum of one component relating to handgrip strength, balance, or trunk flexibility as primary outcomes. Except the primary outcomes, other components of the physical health (e.g., systolic and diastolic pressures, resting heart rate, aerobic endurance, shoulder mobility, and bone mineral density and metabolism) were also reported. In addition, because of the limited number of randomized controlled trials carried out, additional study designs investigating the effectiveness of Taichi softball were also displayed to obtain a more comprehensive understanding (
For each included study, two reviewer authors (xx and xx) independently extracted data in a standardized way. The data extraction included the following: the first author, year of publication, sample size, intervention duration and frequency, and details of the control group, sex and age of study participants, study design, and components of the physical health consisting of primary outcome measures (hand-grip strength, balance, or trunk flexibility), secondary outcomes
Author, year | Study design | Sample (F/M) | Age, mean ± SD years | Study groups (n) | Frequency and duration | Outcomes measured and results |
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Cui et al., 2012 | CSS | 29 (29/0) Healthy | 66.8 ± 4.36 (T) 65.6 ± 3.92 (C) | T (15) No training (14) | T group: Three 60-minute Taiji softball sessions for more than one year C: no active sport participation | Primary outcome (handgrip strength test, p < 0.05) Additional outcomes (reaction time for red and green lights, p < 0.01 and p < 0.05, respectively; right hand stability, p < 0.01) |
Lam et al., 2011a, b | NRCT | 66 (39/27) Sedentary | Mean age between 65 and 75 | T (32) Routine activities (32) | Two 60-minute Taiji softball sessions per week for 10 weeks | Primary outcomes (flexibility using sit-and-reach test, p < 0.01; handgrip strength test, p < 0.05) Secondary outcomes (2-minute step test, p < 0.01; time up and go, p < 0.01) Additional outcomes (arm curls test for arm muscle strength, p < 0.01; AAPERD Soda Po test for hand eye coordination, p < .01; chair sand test for lower body strength, p < 0.01; back scratch test, p < 0.01; BMI, p < 0.05) |
Li et al., 2010 | RCT | 64 (32/32) Healthy college students | 19.5 ± 2.6 (T) 19.5 ± 2.3 (C) | T (32) C (32) no training | Six 120-minute sessions per week for 12 weeks | Primary outcomes (handgrip strength, p < 0.05; flexibility using sit-and-reach test, p < 0.05; and stock balance test, p < 0.05 |
Lai, 2010 | NOT | 17 (9/8) Healthy older adults | Aged between 60 and 69 | T (17) | Seven 60-to-90-minute taiji softball sessions for three and half months | Primary outcomes (flexibility using sit-and-reach test, p < 0.05; handgrip strength, p < 0.01; static balance, < 0.01) Additional outcomes (BMI, p < 0.01; waist-and-hip ratio, p < 0.0; shoulder skinfold, p < 0.05 abdomen skinfold, p < 0.01, waist skinfold, p < 0.5; reaction time p < 0.05) |
Qiu et al., 2014 | RCT | 150 (150/0) Healthy college students | Aged between 18 and 25 | T (50) BaDuanJin (50) C (50) | Five 50-minute Taiji softball sessions per week for 18 weeks | Primary outcomes (handgrip strength, p < 0.01; flexibility using sit-and-reach test, p < 0.5; stock balance test, p < 0.01) Secondary outcomes (systolic and diastolic pressures, p > 0.05; resting heart rate, p < 0.05; step test, p < 0.01) Additional outcomes (weight, p < 0.05; waist and abdomen circumferences, p < 0.05; arm and shoulder skinfolds, p < 0.01; abdomen skinfold, p < 0.01; broad long jump, p < 0.05) |
Wang, 2007 | NRCT | 40 (40/0) Postmenopausal women | 60 ± 8 (T) 61 ± 5 (C) | T (20); Walking (20) | Three 50-minute Taiji softball sessions per week for 24 weeks | Additional outcomes (bone mineral density on lumbar 2-4, p < 0.05]; bone mineral content on lumbar 2 and femoral neck, p < 0.001), and bone metabolism index (bone glaprolein [BGP] and serum alkaline phosphatase [ALP], p < 0.001) |
Wei, 2012 | RCT | 52(22/30) Patients with Type 2 diabetes | 56.0 ± 7.2 | T (26) Routine drug treatment (26) | Six 60-minute Taiji softball sessions for 12 weeks | Primary outcomes (handgrip strength, p < 0.01; flexibility using sit-and-reach test, p < 0.01) Secondary outcomes (p < 0.01; resting heart rate, p < 0.01; systolic and diastolic pressures, p < 0.05) Additional outcomes (BMI, BMI, p < 0.01; pulmonary function index, p < 0.05; waist-to-hip ratio) |
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Xiao et al., 2015 | RCT | 32 Patients with Type 2 diabetes Mellitus | Mean age 65.5 | T (16) No intervention (16) | Three 60-to-120 minute Taiji softball sessions per week for three months | Primary outcomes (static and dynamic balance using Berg balance scale, p = 0.008 and Timed Up-and-Go, p = 0.02; Handgrip strength, p = 0.03; flexibility using chair sit-and-reach, p = 0.009) Secondary outcomes (Time Up-and-Go, p = 0.02; 6-minute walk test) Additional outcome (right shoulder mobility using back scratch test, p = 0.046 |
Xiao, 2014 | RCT | 72 (unclear) Healthy community dwellers | 65.4 ± 6.9 | T (36) Other exercise program (36) | Three 60-to-120 minute Taiji softball sessions per week for 12 months | Primary outcomes (unipedal and tandem stance, p = 0.009; Time Up-and-Go, p = 0.03) |
Yao, 2008 | RCT | 41 (41/0) Healthy older adults | 64.2 ± 3.58 (T) 65.4 ± 3.60 (C) | T (21) C (20) no training | Five 60-minute Taiji softball sessions per week for 6 months | Primary outcome (Stork balance test, p < 0.05) |
Zhang et al., 2012 | NOT | 19(19/0) Patients with arteriosclerosis | 57.4 ± 3.78 (T) | T (19) | Seven 30-minute Taiji softball sessions for 24 weeks | Primary outcomes (handgrip strength test, p < 0.05; sit-and-reach test for flexibility, p < 0.05; stock balance test, p < 0.05) Additional outcomes (supine leg raise test for leg strength, p < 0.05; shoulder mobility using back scratch test, p < 0.05; hip flexibility, p < 0.05; agility T- test, p < 0.01) |
T = Taichi softball group; C = control group; RCT = Randomized controlled trial; CSS = Cross-sectional trial; NRCT = non-randomized controlled trial; NOT = non-controlled observational trial.
(systolic and diastolic pressures, resting heart rate, aerobic endurance, and mobility), and additional physical health-related components. A third party appeared and had dealt with disagreements between the two reviewers.
With respect to the change scores and standard deviations for the primary and secondary outcomes, if authors did not report the change score data, reviewer (xxx) first tried to contact the authors via email or phone call to obtain the data. In cases where the data was not obtainable, reviewers used one of the following methods: a) if baseline scores between two groups were not significantly different, scores from posttest were used for data analysis; b) if baseline scores were different, reviewers attempted to estimate the change scores and standard deviation through standard formulas provided by Cochrane Handbook for Systematic Reviews of Interventions [
The methodological quality of each study was independently evaluated according to the Cochrane Collaboration’s for Assessing Risk of Bias from the Cochrane Handbook for Systematic Review Interventions [
Revman 5.3 software within the Cochrane Collaboration for data analysis was used to synthesize a subset of the most commonly reported outcomes from the six randomized controlled trials. The standard mean difference (SMD), along with 95% confidence interval (CI) using more conservative random effects model, was used to calculate heterogeneity for the primary and secondary continuous outcomes [
As displayed in
process and study selection). A total of 70 titles were identified using the following databases: PubMed (n = 2), Google Scholar (n = 19), Chinese National Knowledge Infrastructure (n =15), Chinese Scientific Journal Database (n = 16), Chinese Biomedical Literature Database (n = 12), and other sources (n = 6). After removing 38 duplicates, 32 articles were screened. 15 article were excluded based on two reasons (no relevance = 10; not a full text article = 5). Full texts of 17 articles were retrieved, and 11 articles were excluded with the following reasons: no components of the physical health reported (n = 4), no Taichi softball intervention (n = 3), and incomplete data extraction (n = 4). The final number of six RCTs were included for meta-analysis, including two studies in English [
The sample size of 411 participants ranged from 32 to 150 in the RCTs, along with a wide age range from 18 to 75. The participants in the studies consisted of healthy college students [
As shown in
dered to be poor methodological quality [
Outcomes related to physical health were mainly comprised of three primary components with the six RTCs (hand strength, flexibility using sit-and-reach, and balance), along with secondary components (aerobic endurance, resting heart rate, systolic and diastolic pressures) [
Four RCTs (a total of participants = 298) reported handgrip strength with handgrip dynamometer [
Four RCTs (a total of participants = 298) reported flexibility with sit- and-reach test [
Five RCTs (a total of participants = 359) reported static balance [
Two RCTs (a total of participants = 104) reported mobility (dynamic balance) with Timed Up and Go test [
Two RCTs (a total of participants = 182) reported aerobic endurance [
Two RCTs (a total of participants = 202) reported resting heart rate [
Two RCTs (a total of participants = 202) reported systolic pressure [
A funnel plot for the primary outcomes was performed, including handgrip strength (n = 4 RCTs) [
None of RTCs mentioned adverse effects (e.g. fall, hospitalization, side effects of medication, or death) resulting from participating in Taichi softball program.
The purpose of the present meta-analysis was to evaluate the effect of Taichi softball training on physical health in adults. The meta-analysis suggests that Taichi softball training is beneficial for improving physical health (hand strength, physical balance, flexibility, aerobic endurance, resting heart rate, diastolic and diastolic pressures). Taichi softball, as a novel health-enhancing exercise, should be recommended to practice in order to receive physical health benefits, which helps healthy adults to maintain high quality of life [
However, although meta-analysis verified that Taichi softball had a positive impact on physical health, two main factors contained the small sample size and poor methodological qualities of included trials that potentially weakened positive findings. The authors therefore should conservatively interpret the positive findings. The methodological quality of the included randomized controlled trials was evaluated based on five main aspects with seven items [
When compared to TaijiQuan as a low-limb dominant exercise (e.g., balance, and leg strength) [
Although no withdrawals were found in the included studies, weekly session attendances were not reported at all [
The statistical significance in the meta-analysis indicates that Taichi softball participants with healthy status and Type 2 Diabetes Mellitus can obtain physical health benefits. However, because of low methodological quality of assessment and ill-designed experimental designs, definite conclusion of Taichi softball improving physical health can be confirmed along with high-quality studies with long follow-up.
The authors would like to thank the librarians from Springfield College (USA), with use of inter-library loan. The relevant articles were obtained for this first review paper examining the effect of Tai Chi softball for health benefits.
The authors declare that they have no other conflict of interests.
No financial support was received for the conduct of this study or preparation of this manuscript.
Zou, L.Y., Wang, H.R., Zhang, M., Xiao, Z.J. and Fang, Q. (2017) Taichi Softball as a Novel Chinese Health-Promoting Exercise for Physical Health: A Systematic Review and Meta-Analysis. Open Journal of Preventive Medicine, 7, 15-31. https://doi.org/10.4236/ojpm.2017.72002