Comparative efficacy of different traditional Chinese exercises on bone mineral density in older adults: a systematic...

Osteoporosis is a major public health concern in the aging global population. Traditional Chinese Exercises (TCEs) are promising non-pharmacological interventions, but their comparative efficacy for improving bonemineral density (BMD) at specific skeletal sites remains unclear.

This systematic review and network meta-analysis (NMA) aimed to compare and rank the effects of four common TCEs (Taiji, Baduanjin, Wuqinxi, Yijinjing) on BMD at various sites in older adults.

We systematically searched PubMed, Web of Science, Scopus, CNKI, WanFang, and WeiPu databases from inception to July 31, 2025, for randomized controlled trials (RCTs) investigating TCEs for BMD in older adults. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment using the Cochrane RoB 2 tool. A frequentist NMA was conducted using Stata 17 and R software to estimate pooled mean differences (MDs) with 95% confidence intervals (CIs). Treatments were ranked using the surface under the cumulative ranking curve (SUCRA).

Thirty-one RCTs (n = 2,457 participants) were included. For lumbar spine BMD, Baduanjin (MD = 0.10, 95% CI0.06 to 0.14; SUCRA = 91.6%), Yijinjing (MD = 0.11, 95% CI 0.00 to 0.16; SUCRA = 71.3%), and Taiji (MD = 0.07, 95% CI0.04 to 0.09; SUCRA = 57.4%) were significantly more effective than control. For femoral neck BMD, Yijinjing (SUCRA = 71.6%), Taiji (SUCRA = 67.7%), and Baduanjin (SUCRA = 58.0%) were the most effective. Taiji consistently ranked as the best intervention for both the greater trochanter (SUCRA = 83.1%) and Ward's triangle (SUCRA = 83.5%). Wuqinxi generally showed non-significant effects compared to control across all sites. The overall risk of bias was a concern, but sensitivity analyses excluding high-risk studies reduced heterogeneity and strengthened the results.

The efficacy of TCEs on BMD is site-specific. Baduanjin and Yijinjing appear most beneficial for the lumbar spine, while Taiji demonstrates broad efficacy across hip sites. These findings support the use of tailored TCE prescriptions based on an individual's fracture risk profile, offering valuable non-pharmacological strategies forcommunity-based osteoporosis management in older adults. PROSPERO registration number: CRD420251108373.