Baduanjin Exercise for Frailty Management in Frail or Prefrail Older Adults: A Systematic Review and Meta-Analysis

  • Jiaqi Zhao Centre for Nursing Studies, Faculty of Health Sciences UiTM Puncak Alam Campus, Universiti Teknologi MARA (UiTM), 42300, Selangor, Malaysia. School of Nursing, Jinzhou Medical University, 121001, Jinzhou, China
  • Sharifah Shafinaz Sh Abdullah Centre for Nursing Studies, Faculty of Health Sciences UiTM Puncak Alam Campus, Universiti Teknologi MARA (UiTM), 42300, Selangor, Malaysia
  • Bing Liang Centre for Nursing Studies, Faculty of Health Sciences UiTM Puncak Alam Campus, Universiti Teknologi MARA (UiTM), 42300, Selangor, Malaysia
  • Ye Gao School of Nursing, Jinzhou Medical University, 121001, Jinzhou, China
  • Gufeng Wu Faculty of Education, Puncak Alam Campus, Universiti Teknologi MARA (UiTM), 42300, Selangor, Malaysia
  • Zhicui Lu College of Computing, Informatics and Mathematics, Universiti Teknologi MARA (UiTM), Shah Alam, 40450, Selangor, Malaysia
DOI: https://doi.org/10.56338/mppki.v9i3.9000
Keywords: Baduanjin, Older Adults, Frailty, Traditional Chinese Exercise, Meta-analysis

Abstract

Introduction: This systematic review and meta-analysis evaluated the effects of Baduanjin, a traditional Chinese mind-body exercise, on frailty and multidimensional health outcomes in older adults.

Methods: Following PRISMA guidelines, we systematically searched multiple databases for RCTs on Baduanjin in frail adults aged ?60 years. Data were pooled using fixed- or random-effects models to calculate MDs or SMDs with 95% CIs. Heterogeneity was quantified by the I² statistic, with random-effects models applied if I² > 50%. Publication bias was assessed by funnel plots and Egger’s test, with the trim-and-fill method used for adjustment when indicated.

Results: Fifteen RCTs (n = 1,044) were included. Baduanjin significantly reduced frailty severity (SMD = -1.12; 95% CI: -1.59 to -0.65) and improved physical function outcomes, including grip strength (MD = 2.39 kg, 95% CI: 2.17 to 2.62, P < 0.001), 6-minute walking distance (MD = 33.72 m; 95% CI: 12.47 to 54.97), and short-distance walk time, although the pooled effect (MD = -0.31 s; 95% CI: -0.57 to -0.06) was moderated by test distance with significant heterogeneity. Mental health improvements encompassed reduced anxiety/depression (SMD = -0.73; 95% CI: -1.11 to -0.35) and enhanced sleep quality (MD = -2.48; 95% CI: -3.21 to -1.76). Cognitive function (MMSE: MD = 2.81; 95% CI: 0.11 to 5.51) showed a statistically significant improvement, though with wide confidence intervals. Quality of life (SF-12/SF-36: SMD = 0.75; 95% CI: 0.48 to 1.02) also improved significantly.

Conclusion: Despite methodological limitations in the included trials, pooled evidence suggests that Baduanjin may confer clinical benefits for managing frailty in older adults. Given its simplicity, safety, and adaptability, Baduanjin should be considered for integration into standard geriatric care and community health programs.

Downloads

Download data is not yet available.

References

  1. Kim DH, Rockwood K. Frailty in older adults. New England Journal of Medicine. 2024;391(6):538-48. https://doi.org/10.1056/NEJMra2301292
  2. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. The Lancet. 2019;394(10206):1365-75. https://doi.org/10.1016/S0140-6736(19)31786-6
  3. Bai G, Szwajda A, Wang Y, Li X, Bower H, Karlsson IK, et al. Frailty trajectories in three longitudinal studies of aging: Is the level or the rate of change more predictive of mortality? Age and Ageing. 2021;50(6):2174-82. https://doi.org/10.1093/ageing/afab106
  4. Yang Z-C, Lin H, Jiang G-H, Chu Y-H, Gao J-H, Tong Z-J, et al. Frailty is a risk factor for falls in the older adults: a systematic review and meta-analysis. The journal of nutrition, health & aging. 2023;27(6):487-95. https://doi.org/10.1007/s12603-023-1935-8
  5. Dent E, Daly RM, Hoogendijk EO, Scott D. Exercise to prevent and manage frailty and fragility fractures. Current osteoporosis reports. 2023;21(2):205-15. https://doi.org/10.1007/s11914-023-00777-8
  6. TL R, MA G, LS M. Frailty and Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis of Cross-Sectional Studies - PubMed. Neuropsychology review. 2022;32(2). https://doi.org/10.1007/s11065021-09497-1
  7. Tang KF, Teh P-L, Lee SWH. Cognitive Frailty and Functional Disability Among Community-Dwelling Older Adults: A Systematic Review. Innovation in Aging. 2023;7(2). https://doi.org/10.1093/geroni/igad005
  8. Santamaría-Ulloa C, Lehning AJ, Cortés-Ortiz MV, Méndez-Chacón E. Frailty as a predictor of mortality: a comparative cohort study of older adults in Costa Rica and the United States. BMC public health. 2023;23(1):1960. https://doi.org/10.1186/s12889-023-16900-4
  9. Xu L, Lan X, Lou Y, Engström M. Associations between frailty, sociodemographic characteristics and quality?of?life among community?dwelling older adults: A cross?sectional study. Nursing Open. 2023;10(4):2392-405. https://doi.org/10.1002/nop2.149
  10. Bhattarai U, Bashyal B, Shrestha A, Koirala B, Sharma SK. Frailty and chronic diseases: A bi?directional relationship. Aging Medicine. 2024;7(4):510-5. https://doi.org/10.1002/agm2.12349
  11. Randles MA, O’Mahony D, Gallagher PF. Frailty and potentially inappropriate prescribing in older people with polypharmacy: a bi-directional relationship? Drugs & aging. 2022;39(8):597-606. https://doi.org/10.1007/s40266-022-00952-z
  12. Deng M-G, Liu F, Liang Y, Wang K, Nie J-Q, Liu J. Association between frailty and depression: A bidirectional Mendelian randomization study. Science advances. 2023;9(38):eadi3902. https://doi.org/10.1126/sciadv.adi3902
  13. Kojima G, Taniguchi Y, Aoyama R, Tanabe M. Associations between loneliness and physical frailty in community-dwelling older adults: A systematic review and meta-analysis. Ageing research reviews. 2022;81:101705. https://doi.org/10.1016/j.arr.2022.101705
  14. Carvalhas-Almeida C, Cavadas C, Álvaro AR. The impact of insomnia on frailty and the hallmarks of aging. Aging Clinical and Experimental Research. 2023;35(2):253-69. https://doi.org/10.1007/s40520-022-02310-w
  15. Kolle AT, Lewis KB, Lalonde M, Backman C. Reversing frailty in older adults: a scoping review. BMC geriatrics. 2023;23(1):751. https://doi.org/10.1186/s12877-023-04309-y
  16. Zhou J, Yu Y, Cao B, Li X, Wu M, Wen T, et al. Characteristic of clinical studies on Baduanjin during 2000–2019: a comprehensive review. Evidence?Based Complementary and Alternative Medicine. 2020;2020(1):4783915. https://doi.org/10.1155/2020/4783915
  17. Guo L, Liu Z, Yuan W. The effect of Baduanjin on the balancing ability of older adults: a systematic review and meta-analysis. Frontiers in medicine. 2022;9:995577. https://doi.org/10.3389/fmed.2022.995577
  18. Cheng M, Wang Y, Wang S, Cao W, Wang X. Network meta-analysis of the efficacy of four traditional Chinese physical exercise therapies on the prevention of falls in the elderly. Frontiers in public health. 2023;10:1096599. https://doi.org/10.3389/fpubh.2022.1096599
  19. Tan TY, Cao BY, Liang WM, Lou S, Han Z, Ji YX, et al. The superiority trial of Baduanjin training on patients chronic low back pain: a study protocol for a randomized controlled trial. BMC Complementary Medicine and Therapies. 2024;24:1. https://doi.org/10.1186/s12906-024-04649-1
  20. Chen J, Zhang M, Wang Y, Zhang Z, Gao S, Zhang Y. The effect of Ba Duan Jin exercise intervention on cardiovascular disease: a meta-analysis of randomized controlled trials. Frontiers in Public Health. 2024;12:1425843. https://doi.org/10.3389/fpubh.2024.1425843
  21. Shuai Z, Xiao Q, Ling Y, Zhang Y, Zhang Y. Efficacy of traditional Chinese exercise (Baduanjin) on patients with stable COPD: A systematic review and meta-analysis. Complementary Therapies in Medicine. 2023;75:102953. https://doi.org/10.1016/j.ctim.2023.102953
  22. Luo X, Zhao M, Zhang Y, Zhang Y. Effects of baduanjin exercise on blood glucose, depression and anxiety among patients with type II diabetes and emotional disorders: A meta-analysis. Complementary Therapies in Clinical Practice. 2023;50:101702. https://doi.org/10.1016/j.ctcp.2022.101702
  23. Guo M, Cai M, Wang H, Hu Z, Feng H, Xie C. Effects of Baduanjin Exercise on Glucose and Lipid Metabolism in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Current Research in Medical Sciences. 2023;2(1):98-123. https://doi.org/10.56397/CRMS.2023.03.15
  24. Zhang Y, Shilko T. Relationship between Qigong Baduanjin and depression in Chinese elderly. ?????????? ???????? ????? ?????? ???????????? ?????????. 2021;6(2):114-7. https://doi.org/10.47475/2500-0365 2021-16218
  25. Lu Y, Li J, Jiang J, Chen C-Y, Zhao X-T. The effect of Baduanjin on depression: a systematic review. Chinese Preventive Medicine. 2021;10.16506/j.1009-6639.2021.06.007:434–44. https://doi.org/10.16506/j.10096639.2021.06.007
  26. Wang X, Wu J, Ye M, Wang L, Zheng G. Effect of Baduanjin exercise on the cognitive function of middle-aged and older adults: a systematic review and meta-analysis. Complementary therapies in medicine. 2021;59:102727. https://doi.org/10.1016/j.ctim.2021.102727
  27. Xie C, Xie F, Ma J, Yue H, You Y, Yao F. Effect of Baduanjin Qigong on Sleep Quality and Hyperarousal State in Adults With Chronic Insomnia: Protocol for a Randomized Controlled Trial. JMIR Research Protocols. 2023;12(1):e53501. https://doi.org/10.2196/53501
  28. Liang Q, Yang L, Wen Z, Liang X, Wang H, Zhang H, et al. The effect of Baduanjin on the insomnia of older adults: A systematic review and meta-analysis. Geriatric Nursing. 2024;60:241-8. https://doi.org/10.1016/j.gerinurse.2024.09.002
  29. Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. The Lancet. 2019;394(10206):1376-86. https://doi.org/10.1016/S01406736(19)31785-4
  30. Sun X, Liu W, Gao Y, Qin L, Feng H, Tan H, et al. Comparative effectiveness of non-pharmacological interventions for frailty: a systematic review and network meta-analysis. Age and Ageing. 2023;52(2):afad004. https://doi.org/10.1093/ageing/afad004
  31. Pérez-Zepeda MU, Martínez-Velilla N, Kehler DS, Izquierdo M, Rockwood K, Theou O. The impact of an exercise intervention on frailty levels in hospitalised older adults: secondary analysis of a randomised controlled trial. Age and ageing. 2022;51(2):afac028. https://doi.org/10.1093/ageing/afac028
  32. Tou NX, Goh SF, Harding S, Tsao MA, Ng TP, Wee S-L. Effectiveness of community-based Baduanjin exercise intervention for older adults with varying frailty status: a randomized controlled trial. European Review of Aging and Physical Activity. 2024;21(1):28. https://doi.org/10.1186/s11556-024-00363-6
  33. Fang J, Zhang L, Wu F, Ye J, Cai S, Lian X. The safety of Baduanjin exercise: a systematic review. Evidence?Based Complementary and Alternative Medicine. 2021;2021(1):8867098. https://doi.org/10.1155/2021/8867098
  34. Lin H, Wan M, Ye Y, Zheng G. Effects of Baduanjin exercise on the physical function of middle-aged and elderly people: a systematic review and meta-analysis of randomized controlled trials. BMC complementary medicine and therapies. 2023;23(1):38. https://doi.org/10.1186/s12906-023-03866-4
  35. Jones C, Qi M, Xie Z, Moyle W, Weeks B, Li P. Baduanjin exercise for adults aged 65 years and older: a systematic review and meta-analysis of randomized controlled studies. Journal of Applied Gerontology. 2022;41(4):1244-56. https://doi.org/10.1177/07334648211059324
  36. Li L, Li W, Fan T. Baduanjin Exercise Improves Cognitive Function in Older Adults With Mild Cognitive Impairment: A Systematic Review and Meta-analysis. The Journal of Nervous and Mental Disease. 2024;212(9):500-6. https://doi.org/10.1097/NMD.0000000000001796
  37. Higgins Jpt T, Chandler J, Cumpston M, Li T, Page M, Welch V, editors. Cochrane handbook for systematic reviews of interventions version 6.3 (updated February 2022)2022.
  38. Chen YZ, Li YT, Wang W, Zhong RX, Ji GZ. Effect Analysis of Sitting Baduanjin combined with Zusanli Acupressure on Elderly Patients with Asthenia in Community. Progress in Modern Biomedicine. 2023;23(11). https://doi.org/10.13241/j.cnki.pmb.2023.11.013
  39. Wang ZP, Du CF. The Impact of LEARNS Education Model Combined with Baduanjin Intervention on Elderly Hypertensive Patients with Frailty. Clinical Research. 2024;32(08):167-9.
  40. Liu FF, Gao HM, Cui YX. Combined Therapy of Wuxing Music (Five-Element Music Therapy) and Baduanjin for Fatigue and Frailty in Hemodialysis Patients [Title translated by author]. Journal of Qilu Nursing. 2022;28(23):149-51. https://doi.org/10.3969/j.issn.1006-7256.2022.23.048
  41. Zheng L, Fan W, Zou L, Chen F, Rao Y, Fang X. Effect of Baduanjin in elderly hypertensive patients with frailty. Journal of Nursing Science. 2021;36(24):90-3+7. https://doi.org/10.3870/j.issn.10014152.2021.24.090
  42. Hu K, Guan G, Yu H, Wang H, Li Y, Tan C, et al. To explore the influence of Baduanjin method based on the theory of “Producing Yang by moving” on frailty,depression and inflammatory mediators during chemotherapy in elderly patients with malignant tumors. Academic Journal of Guangzhou Medical University. 2024;52(01):35-9. https://doi.org/10.3969/j.issn.2095-9664.2024.01.07
  43. Zhang B. Syndrome Elements of Frailty in Traditional Chinese Medicine and Baduanjin Intervention for Rural Elderly in Bashang Region: A Clinical Study [Title translated by author]: Beijing University of Chinese Medicine; 2023
  44. Yan Y, Cai Y. Zusanli Acupressure Combined with Baduanjin for Coronary Heart Disease with Frailty in the Elderly: Efficacy Evaluation[Title translated by author]. Tibetan Medicine. 2024;45(04):142-4.
  45. Pang Y, Lin H, Qi LJ, Huang SP, Peng ZL, Tang ML, et al. Clinical Efficacy of Qiangxin Decoction Combined with Baduanjin in Treatment of Elderly Patients with Chronic Heart Failure and Weakness. Chinese Journal of Experimental Traditional Medical Formulae. 2023;29(4):104-9. https://doi.org/10.13422/j.cnki.syfjx.20230497
  46. Fang SL, Yao TQ, Fang CX, Sun AP. The Impact of Baduanjin on the Quality of Life and Exercise Tolerance in Elderly Patients with Heart Failure and Frailty [Title translated by author]. Chinese Journal of Rehabilitation Medicine. 2022;37(1):108-11. https://doi.org/10.3969/j.issn.1001-1242.2022.01.021
  47. Gao ZP. Rehabilitation Effect of Baduanjin on Frailty Status and Lower Extremity Motor Function on Pre-frail Elderly People: North China University of Science and Technology; 2020
  48. Hou XL. Research of the Application of Baduanjin in Institutionalized Elderly Frailty: Chendu university of Chinese medicine; 2018
  49. Cheung DST, Chau PH, Lam T-C, Ng AYM, Kwok TWH, Takemura N, et al. A pilot randomized controlled trial using Baduanjin qigong to reverse frailty status among post-treatment older cancer survivors. Journal of Geriatric Oncology. 2022;13(5):682-90. https://doi.org/10.1016/j.jgo.2022.02.014
  50. Ni RP, Lin XL, Luo YY, Liu Z, Tan J. Impact of Sitting Baduanjin Exercise on Cancer-Related Fatigue and Frailty of Elderly Patients with Primary Liver Cancer Surgery. Clinical Medicine ? Engineering. 2023;30(06):845-6. https://doi.org/10.3969/j.issn.1674-4659.2023.06.0845
  51. Guo P. Application of Chair-Based Baduanjin Training in Frail Elderly Residents of Senior Care Facilities: An Intervention Study [Title translated by author]: Hunan university of Chinese medicine; 2023
  52. Park M, Song R, Ju K, Shin JC, Seo J, Fan X, et al. Effects of Tai Chi and Qigong on cognitive and physical functions in older adults: systematic review, meta-analysis, and meta-regression of randomized clinical trials. BMC geriatrics. 2023;23(1):352. https://doi.org/10.1186/s12877-023-04070-2
  53. Huang C-Y, Mayer PK, Wu M-Y, Liu D-H, Wu P-C, Yen H-R. The effect of Tai Chi in elderly individuals with sarcopenia and frailty: A systematic review and meta-analysis of randomized controlled trials. Ageing research reviews. 2022;82:101747. https://doi.org/10.1016/j.arr.2022.101747
  54. Lee SY, Nyunt MSZ, Gao Q, Gwee X, Chua DQL, Yap KB, et al. Association of Tai Chi exercise with physical and neurocognitive functions, frailty, quality of life and mortality in older adults: Singapore Longitudinal Ageing Study. Age and Ageing. 2022;51(4):afac086. https://doi.org/10.1093/ageing/afac086
  55. Tao J, Chen X, Egorova N, Liu J, Xue X, Wang Q, et al. Tai Chi Chuan and Baduanjin practice modulates functional connectivity of the cognitive control network in older adults. Scientific reports. 2017;7(1):41581. https://doi.org/10.1038/srep41581
  56. Zou H, Lin X, Duan T, Zheng J, Xiao H. Simple Sitting Baduanjin mind-body exercise: randomized controlled trial protocol for advanced cancer patients with the fatigue-sleep disturbance symptom cluster. BMC Complementary Medicine and Therapies. 2024;24(1):348. https://doi.org/10.1186/s12906-024-04652-6
  57. Huang X, Wang X, Shao Y, Lin A, Zhang Z, Qi H, et al. Effects of health qigong exercise on sleep and life quality in patients with drug abuse. Hong Kong Journal of Occupational Therapy. 2023;36(1):13-9. https://doi.org/10.1177/15691861231156002
  58. Khaleghi M, Ahmadi F. Effect of different exercises on sleep quality in elderly women: a systematic review. Comparative Exercise Physiology. 2024;1(aop):1-12. https://doi.org/10.1163/17552559-00001049
  59. Yao L, Sun G, Wang J, Hai Y. Effects of Baduanjin imagery and exercise on cognitive function in the elderly: A functional near-infrared spectroscopy study. Frontiers in Public Health. 2022;10:968642. https://doi.org/10.3389/fpubh.2022.968642
  60. Yu L, Liu F, Nie P, Shen C, Chen J, Yao L. Systematic review and meta-analysis of randomized controlled trials assessing the impact of Baduanjin exercise on cognition and memory in patients with mild cognitive impairment. Clinical Rehabilitation. 2021;35(4):492-505. https://doi.org/10.1177/0269215520969661
  61. Ma C, Zhou W, Jia Y, Tang Q. Effects of home-based Baduanjin combined with elastic band exercise in patients with chronic heart failure. European journal of cardiovascular nursing. 2022;21(6):587-96. https://doi.org/10.1093/eurjcn/zvab128
  62. Zhang H, Yin L, Peng Y, Zhang G, Chen Q, Liang J, et al. Effect of five-elements music therapy combined with Baduanjin qigong on patients with mild COVID-19. Hong Kong Journal of Occupational Therapy. 2023;36(1):31-8. https://doi.org/10.1177/15691861231167536
  63. Jing L, Jin Y, Zhang X, Wang F, Song Y, Xing F. The effect of Baduanjin qigong combined with CBT on physical fitness and psychological health of elderly housebound. Medicine. 2018;97(51):e13654. https://doi.org/10.1097/MD.0000000000013654
  64. Li N, Ou J, He H, He J, Zhang L, Peng Z, et al. Exploration of a machine learning approach for diagnosing sarcopenia among Chinese community-dwelling older adults using sEMG-based data. Journal of NeuroEngineering and Rehabilitation. 2024;21(1):69. https://doi.org/10.1186/s12984-024-01369-y
  65. Jiang R, Noble S, Sui J, Yoo K, Rosenblatt M, Horien C, et al. Associations of physical frailty with health outcomes and brain structure in 483 033 middle-aged and older adults: a population-based study from the UK Biobank. The Lancet Digital Health. 2023;5(6):e350-e9. https://doi.org/10.1016/S2589-7500(23)00043-2
  66. Lee YH, Lin CH, Wu WR, Chiu HY, Huang HC. Virtual reality exercise programs ameliorate frailty and fall risks in older adults: A meta?analysis. Journal of the American Geriatrics Society. 2023;71(9):2946-55. https://doi.org/10.1111/jgs.18398
  67. Talebisiavashani F, Mohammadi-Sartang M. The effect of mindfulness-based interventions on mental health and cognitive function in older adults: A systematic review and meta-analysis. Journal of Aging and Health. 2024;10.1177/08982643241263882:08982643241263882. https://doi.org/10.1177/08982643241263882
  68. Bao X, Qiu Q-x, Shao Y-J, Quiben M, Liu H. Effect of sitting Ba-Duan-Jin exercises on balance and quality of life among older adults: a preliminary study. Rehabilitation Nursing Journal. 2020;45(5):271-8.
Published
2026-03-03
How to Cite
Zhao, J., Sharifah Shafinaz Sh Abdullah, Liang, B., Gao, Y., Wu, G., & Lu, Z. (2026). Baduanjin Exercise for Frailty Management in Frail or Prefrail Older Adults: A Systematic Review and Meta-Analysis . Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 9(3), 619-638. https://doi.org/10.56338/mppki.v9i3.9000
Issue
Vol. 9 No. 3 (2026)
Section
Article

Copyright (c) 2026 Media Publikasi Promosi Kesehatan Indonesia (MPPKI)

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.