SYSTEMATIC REVIEW article
Front. Public Health
Sec. Aging and Public Health
This article is part of the Research TopicNovel Rehabilitation Approaches for Non-Communicable Diseases in the Era of Precision MedicineView all 12 articles
Comparative Effectiveness of Traditional Chinese Exercises for Knee Osteoarthritis: A Systematic Review and Bayesian Network Meta-Analysis
Provisionally accepted
- 1Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
- 2Harbin Sport University, Harbin, China
- 3Xi'an University of Posts and Telecommunications, Xi'an, China
- 4Xi'an Physical Education University, Xi'an, China
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Purpose: This study aims to evaluate the therapeutic effects of various traditional Chinese exercises on knee osteoarthritis (KOA) in middle-aged and elderly individuals through a systematic review and Bayesian network meta-analysis. Methods: Following the PRISMA guidelines, randomized controlled trials (RCTs) were retrieved from six databases: Web of Science, PubMed, Cochrane Library, Scopus, Embase, and Google Scholar. A total of 20 RCTs involving 1,457 middle-aged and elderly KOA patients were included. Interventions included Tai Chi, Baduanjin, Wuqinxi, and Yijinjing. Mean Difference (MD) was used as the effect size for continuous outcomes (WOMAC subscales, SF-36, VAS, 6MWT). A Bayesian network meta-analysis was performed, and interventions were ranked using the Surface Under the Cumulative Ranking Area (SUCRA). Results: The network meta-analysis, based on SUCRA rankings, showed: For pain relief, Yijinjing combined with electroacupuncture (WOMAC Pain SUCRA 0.77) and Tai Chi (SUCRA 0.72) performed best; Tai Chi was also optimal for VAS score (SUCRA 0.97). For improving joint stiffness (WOMAC Stiffness SUCRA 0.90) and physical function (WOMAC Function SUCRA 0.84), Baduanjin was the most effective. Regarding quality of life, Tai Chi ranked highest for physical health (SF-36 PCS SUCRA 0.89), while Yijinjing ranked highest for mental health (SF-36 MCS SUCRA 0.99). Usual care (SUCRA 0.80) and Tai Chi (SUCRA 0.66) performed best on the 6-Minute Walk Test (6MWT). Conclusion: Tai Chi and Baduanjin appear to be highly effective non-pharmacological options for alleviating pain, improving function, and enhancing quality of life in middle-aged and elderly KOA patients. These findings support individualized exercise prescriptions. However, these results should be interpreted with caution. The included studies were overwhelmingly from China, which may introduce regional bias. Future research with more diverse populations is needed to confirm these findings.
Keywords: knee osteoarthritis, Traditional chinese sports, Bayesian network meta-analysis, randomized controlled trial, middle-aged and elderly populations
Received: 22 Sep 2025; Accepted: 04 Dec 2025.
Copyright: © 2025 LI, Zhai, Guo, Liu, An and Zhai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhe Zhai
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