Tai Chi May Help Lower Blood Pressure Better Than Aerobic Exercise

High blood pressure is a serious health risk, says Steven C. Cramer, MD, FAAN, a stroke specialist and a professor of neurology at UCLA. Over time, it can cause a stroke by damaging the arteries that supply blood and oxygen to the brain, says Seemant Chaturvedi, MD, FAAN, endowed professor of neurology at the University of Maryland in College Park. High blood pressure, especially in middle age, also is associated with poorer cognitive function and dementia later in life, according to the National Institutes of Health.

Because high blood pressure often doesn’t have symptoms, many people, including stroke survivors, are surprised to learn they have it. To control it, doctors may prescribe medication and encourage their patients to quit smoking; lose weight, if necessary; reduce their salt intake; eat more fruits and vegetables; limit alcohol; reduce stress; and be more active, among other interventions.

A recent study suggests another way to lower blood pressure that incorporates both stress reduction principles and exercise: tai chi. The ancient martial art has long been studied for its health benefits, which include improving gait and balance and preventing falls. This new research from China, published in JAMA Network Open in February 2024, found that after 12 months tai chi was more effective than aerobic exercise in reducing blood pressure among people with untreated prehypertension. Normal blood pressure is considered to be less than 120/80 mmHg. Prehypertension is 120–139/80–89 mmHg.

The 342 participants ages 18 to 65 were randomly assigned to either a tai chi group or an aerobic exercise group. Both groups met for an hour four times a week for a year. At the end of the study period, people in the tai chi group experienced more significant drops in blood pressure than those assigned to the aerobic exercise group. Nearly 22 percent of the group that did tai chi saw their blood pressure drop to within the normal range without medication, compared with almost 16 percent in the aerobic exercise group. In addition, fewer people in the tai chi group than in the aerobic exercise group developed high blood pressure.

“Many factors affect blood pressure,” says Peter M. Wayne, PhD, associate professor of medicine at Harvard Medical School, director of the Osher Center for Integrative Medicine at Harvard and Brigham and Women’s Hospital, and author of The Harvard Medical School Guide to Tai Chi. “If you’re trying to make your movements easy and flowing, as you are in tai chi, the relaxed muscle tone may reduce strain on the heart. Relaxation also eases the worrying mind, and we know that worrying generates stress and other negative effects for the cardiovascular system.”

While tai chi can be practiced at home alone, most people practice in groups, which may counter isolation and loneliness in stroke survivors, says Dr. Wayne. “There may be a psychosocial piece to this finding as well,” he says.

Mind-body exercises like tai chi and yoga are more meditative than aerobic-based activities and may appeal to people, including stroke survivors and those with high blood pressure, who don’t want to or can’t break a sweat, says Dr. Cramer. “The tai chi folks are saying you don’t have to run a marathon or spend hours in the gym. You just have to start moving, and here’s an appealing way to do that.”

Any activity that gets people moving will improve their health, says Dr. Chaturvedi. “Exercise can contribute to lower blood pressure and a decreased risk of diabetes, sleep apnea, and developing blockage in blood vessels.” Not only does tai chi reduce blood pressure, he says, it also improves balance, which is important for older people. And, Dr. Chaturvedi points out, even small reductions in blood pressure (such as 3 to 5 mmHg) are associated with a lower risk of stroke.

For Edna Brandt, who had a stroke in 2017, tai chi was an integral part of her recovery. The licensed acupuncturist has been practicing the martial art since the late 1970s. As soon as she was transferred to a rehabilitation hospital after her stroke, she began doing some basic tai chi exercises as she lay in bed. One, called Constant Bear, involved turning her torso left and right while rolling an imaginary ball between her hands. This exercise is normally done while standing or sitting, but Brandt adapted it to her supine position. “I felt like I started my rehab right then and there,” she says. Brandt’s blood pressure was documented to be normal in the hospital, but stress from a recent move may have contributed to her stroke.

In addition to physical and occupational therapies four to five hours a day, Brandt practiced tai chi. It was months before she was able to walk normally and feel the right side of her body again, but she credits tai chi with her steady recovery. “My therapist told me I was moving along faster than most,” says the 77-year-old. “And I totally believe it was because of my tai chi.” Brandt continues to do tai chi and takes a baby aspirin and a statin medication (to lower cholesterol) to reduce the risk of a second stroke.

“Tai chi can definitely enhance recovery,” says Dr. Chaturvedi. “Any type of physical activity is beneficial for stroke survivors, and tai chi is excellent for balance and coordination.” It also may improve cognitive function and reduce depression and anxiety, which are common after stroke, says Dr. Cramer. Poor cognitive function and mental health can affect how well someone regains the ability to move, he adds. “Recovery of movement may well be improved with regular tai chi.”

Tai Chi Basics

Tai chi involves slow, flowing movements coordinated with deep breathing and mindfulness techniques. “Classes begin with a warm-up, followed by a series of forms or movements,” says Raymond Li, owner of Manhattan Tai Chi in New York City. Instructors guide students through each movement and provide gentle corrections as needed, Li adds.

Students should inform instructors of any limitations, as classes can be adapted to accommodate various levels of mobility and balance, says Li. Students can use chairs for balance or do movements while seated.

To find instructors and classes, visit Holistic Health Pros’ Find A Pro tool, an online locator provided by the American Tai Chi and Qigong Association. “Users enter a zip code or a city/town name in the search box,” says Mary Wu, director of the association. “The results will display in the Google map with the details for each instructor appearing below the map.”

Beginner videos can be found at the Tai Chi Foundation. Videos of chair tai chi are available on YouTube.