Tai chi, a gentle form of mind–body exercise widely practised within Chinese communities, appears to offer benefits comparable to talking therapy for middle-aged and older adults with chronic insomnia, according to a clinical trial from Hong Kong published today in The BMJ. The findings suggest that tai chi may offer a practical, accessible long-term treatment option for persistent sleep problems in later life. Chronic insomnia is one of the most common sleep disorders among older adults and has been linked to higher risks of cardiovascular disease, mental health conditions, and cognitive decline. Although cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment, access is often restricted due to high costs, limited availability of trained therapists, and long waiting times. While previous studies have indicated that tai chi can improve sleep, direct comparisons with established psychological treatments have been lacking.
To address this gap, researchers investigated whether tai chi could be considered “non-inferior” to CBT-I for managing chronic insomnia in adults aged 50 and over. The trial involved 200 Chinese participants diagnosed with chronic insomnia and recruited between May 2020 and July 2022. All participants were able to walk unassisted, had no primary medical conditions affecting sleep, were not engaged in regular exercise, had not previously received CBT-I, and were not working shifts. They were randomly assigned to receive either tai chi or CBT-I in the form of one-hour group sessions held twice a week over three months, for a total of 24 sessions. Changes in insomnia severity were measured using the Insomnia Severity Index (ISI) immediately after the intervention and again at 12-month follow-up. A four-point margin on the ISI was set as the threshold for determining non-inferiority.
At the start of the study, both groups showed moderate insomnia severity. After three months, ISI scores fell by 6.67 points in the tai chi group and by 11.19 points in the CBT-I group, meaning tai chi did not initially meet the criteria for non-inferiority. However, by month 15, the reductions were 9.51 points for tai chi and 10.18 points for CBT-I, with a between-group difference of just 0.68 points. At this stage, tai chi was considered non-inferior to CBT-I. Both groups also showed similar improvements in subjective sleep quality, quality of life, mental health, and physical activity levels, and no adverse events were reported. The authors note that sustained benefits in the tai chi group may be partly due to continued practice after the intervention ended, and further research is needed to determine whether the findings apply to other populations. Nevertheless, the researchers conclude that tai chi represents a safe and effective alternative approach for the long-term management of chronic insomnia in middle-aged and older adults.
More information: Parco M Siu et al, Tai chi or cognitive behavioural therapy for treating insomnia in middle aged and older adults: randomised non-inferiority trial, The BMJ. DOI: 10.1136/bmj-2025-084320
Journal information: The BMJ Provided by BMJ Group
