A NEW randomised trial suggests that tai chi may be an effective long-term alternative to cognitive behavioural therapy for insomnia (CBT-I) in middle-aged and older adults. While CBT-I remains the gold-standard treatment for chronic insomnia, the study highlights the potential of tai chi as a safe, accessible, and sustainable approach for managing sleep disturbances in this population.
Mind-Body Exercise Offers Alternative to Standard Sleep Therapy
Chronic insomnia affects a substantial proportion of adults over 50, impacting both physical and mental health. Although CBT-I is highly effective, its availability can be limited due to cost, access to trained therapists, and the need for structured sessions. Tai chi, a mind-body exercise that combines slow, meditative movements with deep breathing, has been explored for various health benefits, including stress reduction and sleep improvement.
The trial, conducted at a single research site in Hong Kong, recruited 200 Chinese participants aged 50 and above with chronic insomnia diagnosed according to the DSM-5 criteria. Participants were randomly assigned in a 1:1 ratio to either tai chi or CBT-I. Both interventions were delivered in a group format over three months, consisting of 24 sessions of one hour each, twice a week.
The primary outcome was the change in the Insomnia Severity Index (ISI), measured at the end of the intervention (month 3) and at 12-month follow-up (month 15). At month 3, CBT-I showed a greater reduction in ISI scores (11.19 points) compared to tai chi (6.67 points). The between-group difference of 4.52 points slightly exceeded the pre-specified non-inferiority margin of four points, meaning tai chi was not considered non-inferior at this early stage.
Tai Chi Shows Comparable Results to CBT-I After 15 Months
However, at month 15, the results shifted. ISI reductions were 10.18 points for CBT-I and 9.51 points for tai chi, with a between-group difference of just 0.68 points. This fell well within the non-inferiority margin, demonstrating that tai chi was comparable to CBT-I for long-term improvement in insomnia severity. The findings were consistent across both per-protocol and intention-to-treat analyses. Importantly, no adverse events were reported during the study.
The study concludes that while CBT-I may provide faster short-term relief, tai chi can serve as a safe and effective alternative for the long-term management of chronic insomnia in older adults. These findings support the integration of mind-body exercises into clinical practice as a complementary or alternative approach for individuals who may not have access to, or prefer not to engage in, traditional CBT-I.
Reference
Siu PM et al.Tai chi or cognitive behavioural therapy for treating insomnia in middle aged and older adults: randomised non-inferiority trial. BMJ.2025; 10.1136/bmj-2025-084320
