The HKUMed study supports the therapeutic use of tai chi as an alternative for managing chronic insomnia among middle-aged and older adults.
A research team led by the School of Public Health at the LKS Faculty of Medicine, the University of Hong Kong (HKUMed), has discovered that tai chi, a traditional Chinese mind-body exercise, offers long-term benefits for chronic insomnia comparable to cognitive behavioural therapy for insomnia (CBT-I), the current first-line non-pharmacological treatment for chronic insomnia. The study supports the therapeutic use of tai chi as an accessible, culturally relevant, low-cost alternative for managing chronic insomnia among middle-aged and older adults. The findings were published in The BMJ [link to the publication].
Alternative evidence-based approach for insomnia
Insomnia is a common sleep disorder in older adults and is linked to serious disorder risks, including cardiovascular disease, mental illness, and cognitive decline. CBT-I, also known as talking therapy, is a psychological intervention designed to help individuals recognise and alter harmful thought patterns and behaviours that interfere with sleep. CBT-I is considered to be an effective treatment option for chronic insomnia but its accessibility is limited by high costs and a shortage of trained therapists, restricting its availability in the community.
Tai chi is a Chinese martial art and an ancient form of mind-body exercise. As a low-impact, moderate-intensity exercise, tai chi is popular among older adults for regular practice to promote health. While previous studies hinted at its positive effects on sleep, rigorous scientific evidence comparing tai chi to standard clinical treatment was lacking.
Professor Parco Siu Ming-fai, Professor and Head of Division of Kinesiology of the School of Public Health, HKUMed, emphasised the importance of validating tai chi as an evidence-based option. This study was designed to fill this important knowledge gap on the therapeutic role of tai chi in relieving chronic insomnia.
Tai chi delivers positive sleep outcomes comparable to CBT-I
Between May 2020 and July 2022, HKUMed researchers conducted a rigorous trial in Hong Kong involving 200 Chinese adults aged 50 or above who were suffering from chronic insomnia. The participants were randomly assigned to either the tai chi or the CBT-I group. The tai chi group practiced the widely recognised 24-form Yang style in one-hour, instructor-led workout sessions twice a week for three months. To rigorously assess outcomes, insomnia severity was measured using the Insomnia Severity Index (ISI) at three critical points: before the programme (baseline), at three months (post-intervention) and at 15 months (12-month follow-up). Researchers set a benchmark to assess tai chi's potential as an alternative therapy for insomnia. If tai chi's improvement on the ISI fell within four points of the standard CBT-I treatment, it would be recognised as delivering comparable clinical effectiveness.
The results revealed a fascinating dynamic between short and long-term outcomes. At the three-month checkpoint, CBT-I demonstrated a clear advantage, reducing ISI scores by 11.19 points compared to tai chi's 6.67, resulting in a between-group difference of 4.52, underscoring CBT-I's faster impact. However, the picture shifted dramatically over time. By month 15, tai chi had nearly caught up, achieving a reduction of 9.51 points versus CBT-I's 10.18, narrowing the gap to just 0.68 points and meeting the non-inferiority criteria.
'While CBT-I delivers rapid relief, tai chi offers sustained, long-term improvement without the barriers of cost or therapist availability,' said Professor Siu. 'For many middle-aged and older adults struggling with chronic insomnia, access to CBT-I often means long waits and high expenses. Our research provides strong evidence that tai chi can serve as a practical alternative — providing a lifestyle-based intervention that improves sleep while promoting overall physical and mental well-being. This is more than just good news for insomnia sufferers. Instead of relying solely on clinical referrals, patients can integrate lifestyle-based interventions into insomnia care, empowering individuals to take control of their health.'
About the research team
The research was led by Professor Parco Siu Ming-fai, Professor and Head of Division of Kinesiology at the School of Public Health, HKUMed. The co-first authors are Dr Danny Yu and Dr Angus Yu, PhD graduates at the same School.
Acknowledgements
The research was supported by the General Research Fund of the Research Grants Council, the University Grants Committee of Hong Kong, China, and the Seed Fund for Basic Research, HKU.
