A systematic review and meta-analysis of the mechanism of action of Tai Chi on cardiovascular disease: evidence map of aerobic and mind-body exercise pathways

Cardiovascular disease (CVD) remains a leading global health burden, particularly in low- and middle-income countries. Tai Chi is a mind-body exercise with reported cardiovascular benefits, but its mechanistic pathways and comparative effects versus aerobic exercise are not well defined. To synthesize evidence on the effects and proposed mechanisms of Tai Chi on CVD risk factors and related biomarkers, compared with aerobic exercise or standard care. We conducted a systematic review and meta-analysis in accordance with PRISMA. We searched Google Scholar, PubMed, EBSCOhost MEDLINE, Scopus, ScienceDirect, and Web of Science from inception to October 2025. We included studies comparing Tai Chi with aerobic exercise and/or standard care and reporting outcomes related to CVD risk factors, functional capacity, mental health, or mechanistic biomarkers. Random-effects meta-analyses and subgroup analyses were performed where appropriate. Sixty studies were included (39 randomized controlled trials and 21 reviews). Tai Chi significantly reduced systolic blood pressure (MD -6.14 mmHg, 95% CI -8.44 to -3.84) and diastolic blood pressure (MD -3.45 mmHg, 95% CI -4.50 to -2.40). Improvements were also observed in HDL-C (SMD 0.43, 95% CI 0.16 to 0.69) and functional capacity (6-minute walk test, SMD 0.78, 95% CI 0.51 to 1.05). Reported psychosocial outcomes included reductions in fatigue and depression. Evidence mapping suggests Tai Chi may influence autonomic regulation and inflammatory/stress-related pathways (e.g., heart rate variability, IL-6, CRP), alongside improvements in lipid profile and functional performance. Tai Chi may offer clinically meaningful improvements in blood pressure, lipid-related outcomes, functional capacity, and psychosocial health. Mechanistic findings suggest potential effects on autonomic and inflammatory pathways, but comparative advantages over aerobic exercise and biomarker outcomes are supported largely by low- to moderate-certainty evidence and should be interpreted cautiously.