Effects of Tai Chi combined with repetitive transcranial magnetic stimulation on sleep and emotional outcomes in older adults: A systematic review and meta-analysis of randomized controlled trials.

Sleep problems are common in older adults and are frequently accompanied by emotional symptoms, including depression, anxiety, and stress. Tai Chi and repetitive transcranial magnetic stimulation (rTMS) have both been applied as non-pharmacological interventions for sleep and mood regulation. However, evidence regarding the effectiveness of their combined use remains limited.

A systematic literature search was conducted in PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, and Scopus from inception to December 16, 2025, to identify randomized controlled trials. The search strategy combined terms related to Tai Chi, repetitive transcranial magnetic stimulation, and randomized controlled trials. Reference lists of relevant articles were also screened to identify additional eligible studies. Pooled mean differences with 95% confidence intervals were generated using RevMan 5.4, with risk of bias and certainty assessed through established tools including GRADE.

Three trials encompassing 211 older adults qualified for analysis. Combined Tai Chi and rTMS was associated with a significant reduction in sleep severity compared with control interventions (SMD = -0.51; 95% CI: -0.90 to -0.12; P = .01; I2 = 43%). Evidence for other sleep-related outcomes and for depression, anxiety, and stress was inconclusive.

The available evidence suggests that the combination of Tai Chi and rTMS may improve overall sleep severity; however, this finding should be interpreted cautiously given the small number of trials and sensitivity to individual studies. Evidence for specific sleep parameters and emotional outcomes remains inconclusive. Further well-designed randomized trials are needed to clarify the potential role of this combined intervention in sleep and mood regulation.