Effects of Tai Chi-based combined interventions on muscle function, muscle mass, and physical performance in older adults with sarcopenia, frailty, or risk of functional decline: a systematic review and meta-analysis

Background and objective: Sarcopenia and frailty involve declines in muscle strength, muscle mass, and physical performance, and single Tai Chi may be insufficient to cover all functional needs. Tai Chi-based combined interventions have emerged, but their overall effects remain unclear. This study evaluated their effects in older adults with sarcopenia, frailty, or risk of functional decline. Methods: We systematically searched PubMed, Embase, CENTRAL, Web of Science, Scopus, CINAHL, ClinicalTrials.gov, CNKI, Wanfang, and VIP from database inception to May 12, 2026. Randomized controlled trials and cluster-randomized controlled trials comparing Tai Chi-based combined interventions with non-exercise, active-exercise, or single Tai Chi controls were included. Risk-domain composite standardized mean differences (SMDs) were used for the primary analysis, assuming rho = 0.5. A restricted maximum-likelihood random-effects model with Hartung-Knapp adjustment was applied. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Results: A total of 21 studies (22 reports) were included, of which 16 contributed to quantitative synthesis. In the core layer, compared with active exercise control, combined interventions showed a potentially favorable estimate in the frailty/overall physical performance domain (SMD = 0.63, 95% CI: 0.05-1.21), whereas muscle function and muscle mass/quality estimates remained uncertain. Compared with non-exercise control, the muscle function domain (SMD = 1.00, 95% CI: 0.12-1.88) and frailty/overall physical performance domain (SMD = 1.35, 95% CI: 0.38-2.31) showed favorable estimates, whereas muscle mass/quality did not improve consistently. Among 14 GRADE bodies of evidence, 2 were Low and 12 Very low, with none Moderate or High. Conclusion: Tai Chi-based combined interventions may improve selected aspects of muscle function and overall physical performance, but the evidence was based on few heterogeneous studies and was of Low or Very low certainty. Additional benefits over active exercise or single Tai Chi, as well as the optimal intervention combination and dose, remain uncertain. Systematic review registration: The systematic review was registered in PROSPERO (CRD420261387528) https://www.crd.york.ac.uk/PROSPERO/view/CRD420261387528.