Many older adults in Hong Kong have heard it said: "Doing tai chi is better than other exercise. It fights sarcopenia and also builds back a body full of muscle." This is only half right, and the wrong half is that it mistakes "works for preventing falls" for "works for building muscle". Tai chi does have clinical evidence behind it for older adults, but its benefit lies in improving balance and preventing falls, and not in building muscle. This article is devoted to tai chi and separates the two ideas out completely.
First the basic medical definition. The European consensus on sarcopenia, EWGSOP2 (Cruz-Jentoft 2019), states that the assessment of sarcopenia covers three independent dimensions: low muscle strength, low muscle mass and low physical performance. An exercise that improves "balance or physical function" does not at the same time increase "muscle mass". This difference is exactly why tai chi and resistance training need to share the work.
The effect of tai chi on increasing muscle mass
The most central point, and the one most often misunderstood, comes first: there is no evidence in medicine that tai chi can increase "muscle mass". Two systematic reviews in older adults with sarcopenia and frailty reached the same conclusion: tai chi does not significantly raise muscle mass.
It has to be added honestly here that the two meta-analyses above are not consistent on grip strength and walking speed. Huang 2022 found no significant difference in grip strength (p=0.95), but Yang 2025 found improvements in grip strength (SMD 0.97, p=0.001) and walking speed (p=0.013). The inconsistency itself shows where the problem lies: what tai chi can reliably improve is the functional performance linked to balance and body coordination (for example the TUG test and fall prevention discussed below), but it cannot reliably increase muscle mass or raise grip strength.
So if the aim is to increase muscle, tai chi alone is not enough. To really increase muscle and strength, progressive resistance training is still the main method. A meta-analysis in older adults with diagnosed sarcopenia (Tan 2026, 25 RCTs) found that resistance training raised strength with an effect size of 0.71, an effect tai chi alone cannot produce. For the specific amount and arrangement of training, see the main article on resistance training, the only core treatment for sarcopenia with evidence behind it.
The role of tai chi in preventing falls
Once the limits of tai chi for building muscle are clear, the next thing to look at is its real strength: preventing falls. Here tai chi has quite solid data from randomised controlled trials (RCTs).
The most representative clinical evidence comes from Li 2018 (published in JAMA Internal Medicine). The study recruited 670 older adults at high risk of falling (average age 77.7, who had fallen or had impaired mobility in the past year), who practised 2 sessions a week for 24 weeks. The results showed that the tai chi group had 58% fewer falls than the stretching control group, and a further 31% fewer than general multimodal exercise. In addition, a small RCT by Zhu 2019 found that tai chi did better than whole-body vibration training for improving balance. The reason is quite clear: tai chi movements are slow and continuous and centre on shifting the body's weight, which trains balance, body coordination and proprioceptionin a targeted way, and these are exactly the basics of "standing steadily and not falling easily" in older adults.
In summary, the benefit of tai chi is training balance, coordination and body sense. Preventing falls does not have to depend on tai chi, however. How to plan balance training and how to choose between different fall-prevention exercises are explained in detail in another article, balance training to prevent falls in older adults.
Telling "building muscle" and "preventing falls" apart
Putting the two parts together gives the core message of this article: building muscle and preventing falls are two different things that need two different kinds of exercise. Tai chi and resistance training each have their own job, and should work together and not replace each other. The yardstick of "whether progressive load is applied" can also be used to measure other popular exercises for older adults besides tai chi. Which of the park pull-rope machine, the exercise bike and the resistance band can really build muscle? See which popular exercises for older adults really build muscle for details.
- The only core treatment with full evidence behind it (Tan 2026, effect size 0.71 for strength)
- Deals with "low strength / low muscle mass", which is sarcopenia itself
- Tai chi cannot do it: the evidence for muscle mass is insufficient (Huang 2022 p=0.14)
- Tai chi has evidence for preventing falls in high-risk older adults (Li 2018, 58% fewer falls)
- Trains balance, coordination and proprioception, which makes up for what resistance training lacks
- But it is low-certainty evidence, and the evidence for balance / multimodal exercise preventing falls is in fact stronger
The limits of the current research evidence also need to be noted. At the level of systematic reviews, the evidence for tai chi preventing falls is of low certainty (Cochrane 2019). The same meta-analysis points out that specific balance or functional exercise can reduce falls by 24% and multimodal exercise by 34%, so the fall-prevention evidence for these two kinds of exercise is in fact stronger and of higher certainty. In other words, tai chi is indeed a good choice, especially because older adults are usually more willing to keep it up in the long term. But it is neither the only nor the best method, and how it is arranged in practice should still be decided by the therapist according to the older adult's own risk of falling.
How to include tai chi in an exercise plan for older adults with sarcopenia
For older adults with sarcopenia, the best arrangement is not a choice between tai chi and resistance training, but to share the work between the two. The order of carrying this out suggested below is a clinical practice consensus in physiotherapy (without a PMID).
- The physiotherapist first assesses the older adult's risk of falling, muscle strength and balance fully, and then sets a suitable exercise programme according to the situation. This is also the main role of home physiotherapy.
- First build the base with resistance training, which is used specifically to increase muscle mass and strength and improves sarcopenia at its root (for the specific amount of training, see the main article).
- At the same time, tai chi can be added to improve balance and coordination. Doing tai chi together with resistance training trains the body's proprioception and lowers the chance of falling in daily life.
- Whether it is tai chi or resistance training, practice has to be regular and the amount slowly increased to have an effect. If the person stops after a few sessions, it is hard to see any improvement.
- If the aim is to increase muscle, do not use tai chi in place of resistance training. If the older adult's risk of falling is high, tai chi alone should not be relied on while a specific balance assessment is skipped.
The biggest difficulty in putting this division of work into practice is that older adults find it hard to judge for themselves. The more practised the tai chi and the steadier the person stands day to day, the easier it is to feel that the muscles have been trained back too, yet "standing steadily" and "having enough muscle" cannot be told apart from everyday feeling alone. A home physiotherapy assessment measures balance and strength separately, and only then can it be seen objectively whether the progress is the balance gain from tai chi or whether strength on the resistance training side has not yet caught up.