Tai chi beats qigong on sleep, but not for everyone

Poor sleep is common, and drug-free ways to improve it are in constant demand. Traditional Chinese exercises such as tai chi and qigong combine gentle movement, breathing and focused attention, and have long been proposed as sleep aids, but the trial evidence has been contested rather than conclusive. This review set out to pool the randomised controlled trials of these practices and ask three questions: do they genuinely improve sleep quality, for whom do they work, and does the specific practice matter?

The authors searched five databases, including Web of Science, Embase, PubMed, Medline and China National Knowledge Infrastructure, for randomised controlled trials published before July 2022, and included 20 studies. Because sleep quality was measured on two very different scales, the Verran and Snyder-Halpern Sleep Scale and the Pittsburgh Sleep Quality Index, the two sets of trials were analysed separately rather than forced into one figure. Effects were pooled with a random-effects model, and subgroups were examined by population, practice type, practice site, duration and age.

Both measures pointed the same way: sleep quality improved, with Pittsburgh Sleep Quality Index scores falling by an average of 2.24 points, where lower scores mean better sleep. The benefit was not universal. Improvements appeared in groups including normal older adults and people with insomnia, fibromyalgia, chronic fatigue syndrome-like illness, knee osteoarthritis and menopause, but not in stroke patients, breast cancer patients, normal college students or people with episodic migraine. Tai chi produced greater improvements than qigong, while practice site, duration and participant age did not change the effects.

The result adds weight to mind-body movement as a sleep intervention, and helps explain the earlier controversy: the effect appears to depend heavily on who is practising. The authors flag large disagreement between the included studies and call for more extensive, rigorously designed trials, so the pooled figure should be held loosely. The finding that tai chi outperformed qigong is a useful lead for future head-to-head comparisons. Why some groups, such as students and stroke patients, saw no benefit remains an open question.

If you sleep badly and prefer movement to medication, this is evidence that gentle practices such as tai chi are worth knowing about, particularly for older adults and people with insomnia, where the pooled trials showed improvement. The same data suggest it is not a universal fix, since several groups saw no significant change at all. The authors themselves advise caution given how much the studies disagreed with each other. This is information about averages in trials, not a prescription for any individual.