BACKGROUND: Tai Chi is beneficial for functional mobility and balance in older adults. However, such benefits of Tai Chi when comparing to conventional exercise (CE) are not well understood due to large variance in study protocols and observations. METHODS: We reviewed publications in five databases. Eligible studies that examined the effects of Tai Chi on the outcomes of functional mobility and balance in healthy older adults as compared to CE were included. Subgroup analyses compared the effects of different types of CE (eg, single and multiple-type exercise) and different intervention designs (eg, Tai Chi types) on those outcomes (Registration number: CRD42022331956). RESULTS: Twelve studies consisting of 2,901 participants were included. Generally, compared to CE, Tai Chi induced greater improvements in the performance of Timed-Up-and-Go (SMD -0.18, (-0.33 to -0.03), p = 0.040, I2 59.57%), 50-foot walking (MD -1.84 s, (-2.62 to -1.07), p < 0.001, I2 0%), one-leg stance with eyes open (MD 6.00s, (2.97 to 9.02), p < 0.001, I2 83.19%), one-leg stance with eyes closed (MD 1.65 s, (1.35 to 1.96), p < 0.001, I2 36.2%), and functional reach (SMD 0.7, (0.32 to 1.08), p < 0.001, I2 86.79%) tests. Subgroup analyses revealed that Tai Chi with relatively short duration (< 20 weeks), low total time (<= 24 h), and/or using Yang-style, can induce significantly greater benefits for functional mobility and balance as compared to CE. Uniquely, Tai Chi only induced significantly greater improvements in Timed-Up-and-Go compared to single- (SMD -0.40, (-0.55 to -0.24), p < 0.001, I2 6.14%), but not multiple-type exercise. A significant difference between the effects of Tai Chi was observed on the performance of one-leg stance with eyes open when compared to CE without balance (MD 3.63 s, (1.02 to 6.24), p = 0.006, I2 74.93%) and CE with balance (MD 13.90s, (10.32 to 17.48), p < 0.001, I2 6.1%). No other significant difference was shown between the influences of different CE types on the observations. CONCLUSION: Tai Chi can induce greater improvement in functional mobility and balance in older adults compared to CE in a more efficient fashion, especially compared to single-type CE. Future studies with more rigorous design are needed to confirm the observations here.

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