Effects of six traditional Chinese mind-body exercises on obesity and cardiovascular risk factors in middle-aged and elderly hypertensive patients: a network Meta-Analysis of 49 RCTs.

BACKGROUND

With the increasing global aging population, the prevalence of hypertension among middle-aged and older adults has significantly risen, with over one-third of individuals aged 40 and above diagnosed with hypertension. Uncontrolled hypertension contributes significantly to cardiovascular morbidity and other health problems, placing a heavy burden on society. Therefore, the prevention and management of hypertension in middle-aged and elderly people has become a public health priority. Traditional Chinese mind-body exercise is gradually gaining attention due to its low damage and high compliance, and is particularly suitable for the middle-aged and elderly.

METHODS

We screened relevant randomized controlled trials (RCTs) published after 2000 by searching five English and three Chinese databases. Study inclusion criteria included hypertensive patients (≥ 45 years old, SBP/DBP > 130/80 mm Hg) receiving at least 8 weeks of Tai Chi, Baduanjin, Liuzijue, Shuxinpingxuegong, Qigong, or Daoyinyangshengshu interventions to assess SBP, DBP, WC, WHR or BMI indicators. Risk of bias and quality of evidence were assessed using the Cochrane tool and the GRADE framework. Effect values and heterogeneity (I² statistic) were calculated by random-effects multivariate Network Meta-Analysis combined with Review Manager and STATA software, and SUCRA values were used to rank intervention effects.

RESULTS

A total of 49 randomized controlled trials covering 4,224 hypertensive patients were included. Risk of bias assessment showed that 77.55% of the studies were low risk, 14.28% were intermediate risk, and 8.16% were high risk. The NMA results showed that in terms of systolic blood pressure reduction, Tai Chi performed best (SMD = -1.10, 95% CI [-1.23, -0.98], SUCRA = 86.9), followed by Daoyinyangshengshu (SMD = -1.00, 95% CI [-1.34, -0.67], SUCRA = 67.4) and Liuzijue (SMD = -0.97, 95% CI [-1.28, -0.66], SUCRA = 62). Daoyinyangshengshu (SMD = -1.26, 95% CI [-1.65, -0.87], SUCRA = 88) and Liuzijue (SMD = -1.06, 95% CI [-1.42, -0.70], SUCRA = 69.2) ranked highly in terms of reducing diastolic blood pressure. In terms of improving waist circumference and waist-to-hip ratio (WHR), Tai Chi had a significant effect (SMD = -0.50, 95% CI [-0.72, -0.28], SUCRA = 90.4; WHR: SMD = -1.75, 95% CI [-2.65, -0.84], SUCRA = 89.8), though the GRADE assessment indicated low-quality evidence for WHR outcomes due to limited studies and potential heterogeneity. Tai Chi (SMD = -0.35, 95% CI [-0.50, -0.20], SUCRA = 80) and Daoyinyangshengshu (SMD = -0.58, 95% CI [-1.14, -0.01], SUCRA = 60.3) outperformed the other interventions in terms of reducing body mass index.

CONCLUSION

This study supports integrating traditional Chinese mind-body exercises like Tai Chi and Baduanjin into hypertension management for middle-aged and elderly patients. Tai Chi effectively lowers blood pressure and reduces abdominal obesity, while Baduanjin improves BMI. Personalized interventions with culturally adapted protocols could optimize adherence and global adoption.