Dose-Related Effects of Different Tai Chi Styles Versus Traditional Community-Based Exercises on Cardiometabolic Health and Physical Function in Middle-Aged and Older Adults: Randomized Controlled Trial

Background Age-related declines in metabolic, cardiovascular, and physical function contribute to reduced quality of life in older adults. Although structured exercise is central to healthy aging, the optimal modality remains unclear. Community-based exercise programs in China are heterogeneous, and their comparative effects on health outcomes and cardiovascular safety have not been systematically evaluated. Objective We aimed to compare the effects of 4 common community-based exercise modalities on cardiometabolic health, physical function, and quality of life in middle-aged and older adults, and to assess their relative efficacy and safety across intervention exposure. Methods This single-blind randomized controlled trial included 113 middle-aged and older adults (mean age 62.3, SD 4.25 years). Participants were assigned to one of the 5 groups: 12-form Chen-style Tai Chi (CTC12), 24-form Tai Chi, square dance, walking, or a control group. The 12-week intervention comprised 2 supervised sessions per week, each lasting 90 minutes. Pre- and postintervention assessments included blood pressure, lipid profiles, fasting glucose, interleukin-6 levels, Short Physical Performance Battery (SPPB) scores, activities of daily living, and the World Health Organization Quality of Life (WHOQOL) index. Results The CTC12 and square dance groups showed significant improvements in several outcomes. In the CTC12 group, triglyceride and low-density lipoprotein cholesterol levels significantly decreased (P=.008 and P=.002, respectively), whereas SPPB and WHOQOL scores significantly improved (P=.02 and P=.002, respectively). In the square dance group, total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels significantly decreased (P=.01, P=.002, and P=.002, respectively), whereas SPPB, activities of daily living, and WHOQOL scores significantly improved (P=.04, P=.04, and P=.002, respectively). The walking group showed a significant improvement only in WHOQOL scores (P=.02). No significant changes were observed in the control group for any outcome. Conclusions CTC12 and square dance were associated with significant improvements in cardiometabolic, physical, and psychological health outcomes in middle-aged and older adults. CTC12 demonstrated broader multidimensional benefits, potentially reflecting the integration of physical, respiratory, and cognitive components. These modalities may represent safe and scalable strategies for promoting healthy aging in community settings. Trial Registration Chinese Clinical Trial Registry ChiCTR2400092473; https://www.chictr.org.cn/showprojEN.html?proj=249330