Structural plasticity denotes physical modifications in the nervous system at the microscopic and even macroscopic levels. This includes modifications in the strength and number of connections between neurons (synapses), and the generation of new neurons (neurogenesis) within particular brain regions (La Rosa et al., 2020). A core process potential this mechanism is activity-dependent synaptic pruning: during progression or learning, the nervous system selectively strengthens frequently utilized neural connections while eliminating seldom-utilized or inefficient synapses according to patterns of neural activity, hence refining and increasing the effectiveness of neural circuits (Faust et al., 2021). Such structural improvement constitutes the physical basis for encoding new memories and forming complex skills. For example, a seminal study has reported that aerobic exercise training can directly increase hippocampal volume and promote spatial memory in older adults, exemplifying the capacity of experience to drive positive structural modifications in the brain (Erickson et al., 2011).

Functional plasticity displays the brain’s ability to adapt and recover following injury (e.g., stroke, traumatic brain injury) via functional reorganization (Nakamura et al., 2009). When a particular brain region is damaged, its functions are not necessarily permanently lost (Nudo, 2013). Instead, the brain can compensate through two main approaches: (1) redistributing functions from the damaged area to undamaged regions within the ipsilateral or contralateral hemisphere, and (2) increasing the functional effectiveness of remaining healthy neural circuits (Chen et al., 2010). Modern neuroimaging techniques, such as functional magnetic resonance imaging (fMRI), can visually capture this mechanism of post-injury functional reorganization, offering vital evidence for rehabilitation diagnosis and prognostic evaluation (Chen et al., 2010).

Via its unique mind–body combined practice, TC concurrently engages and promotes both structural and functional plasticity in the brain (Cui et al., 2019). In healthy individuals, TC functions as a complex sensorimotor and cognitive challenge that continuously induces the improvement of neural circuits. For instance, it can improve the functional specialization of brain networks; increased brain functional specialization driven by TC practice is a significant predictor of greater cognitive flexibility (Cui et al., 2021). Under the backdrop of neurological rehabilitation, TC can cause the brain toward advantageous functional reorganization. For example, in patients with Parkinson’s disease, TC training has been displayed to significantly promote postural stability, walking capacity, and overall motor function, with impacts even surpassing those of conventional resistance or stretching exercises (Li et al., 2012). This reveals that TC, as a behavioral intervention, can effectively cause adaptive modifications in the brain, hence encouraging the nervous system in obtaining maintained enhancements in both function and structure over the long term.

The hippocampus, a core component of the limbic system, is vital in learning, memory consolidation, and spatial navigation (Voss et al., 2011). Cross-sectional studies suggest that older women with long-term TC practice exhibit significantly better episodic memory performance in comparison to their peers took part in brisk walking. It is worth noting that magnetic resonance imaging (MRI) data determine that the TC group displays higher gray matter density in the medial temporal lobe (including the hippocampus) and significantly enhanced regional homogeneity in the hippocampus, implying greater synchronization of neural activity within this structure (Yue et al., 2020). These structural and functional modifications are effectively linked to superior memory performance, strongly implying that TC may promote memory by remodeling the structure and function of the hippocampus (Yue et al., 2020). This finding is further encouraged by interventional research: a 12-week RCT displayed that both TC and Baduanjin practice significantly enhanced gray matter volume in memory-associated brain regions (such as the medial temporal lobe and hippocampus) in older adults, together with enhancements in Wechsler Memory Scale scores (Tao et al., 2017). Collectively, these findings determine that TC, as a mind–body exercise, can effectively counteract age-associated hippocampal atrophy, hence decreasing memory decline.

Beyond the hippocampus, the prefrontal cortex—a higher-order center for executive function, decision-making, and emotion regulation—also displays important structural and functional adaptive modifications in response to TC practice (Yao et al., 2021). Review literature has reported that anatomical and functional brain modifications in TC practitioners are mainly centered in the prefrontal cortex (Yao et al., 2021). The prefrontal cortex is responsible for the executive control of behavior and decision arbitration, enabling flexible switching between exploiting recent behavioral patterns and investigating new approaches in altering environments (Domenech and Koechlin, 2015). The maintained attention, complex motor sequence planning, and mind–body coordination needed during TC practice constitute a continuous challenge and training for the prefrontal executive control functions. This similarly drives increased neuroplasticity in this region, offering a neural structural basis for the enhancements in cognitive control and emotional control linked to TC.

The potential processes potential TC-driven structural modifications in these brain regions are multifaceted. TC can significantly ameliorate age-associated decline in cerebrovascular function (Li et al., 2021; Zheng et al., 2019). Research displays that long-term TC practitioners exhibit significant enhancements in cerebral hemodynamic indicators, comprising mean blood flow velocity, maximum and minimum blood flow velocities, alongside positive decreases in vascular pulse wave velocity and peripheral resistance. This is equivalent to a “vascular rejuvenation” for the brain, determining adequate blood supply and nutrition to brain tissue, notably to metabolically demanding gray matter regions (Li et al., 2021). Moreover, molecular-level studies implicate core neurotrophic factors. A RCT involving older adults with mild cognitive impairment uncovered that a 6-month TC training regimen not only significantly promoted their memory and executive function, but also concurrently upregulated plasma levels of brain-derived neurotrophic factor (BDNF) (Sungkarat et al., 2018). BDNF is a critical molecule encouraging neuronal survival, synaptic plasticity, and neurogenesis, and its enhanced levels are directly related to enhancements in learning and memory (Azman and Zakaria, 2022). Furthermore, TC can cause a neuroprotective environment by regulating oxidative stress balance. A meta-analysis determined that regular TC practice significantly increases the activity of core antioxidant enzymes, such as superoxide dismutase and catalase, while effectively decreasing levels of lipid peroxidation products (Rosado-Pérez et al., 2021). This helps decrease damage to neurons from reactive oxygen species, hence protecting the structural integrity of the hippocampus and prefrontal cortex via another critical pathway.

The enhancement in motor function via TC is first manifested in the maintenance and improvement of muscle strength. A cross-sectional study comparing lower limb muscle strength between 205 long-term TC practitioners and their non-practicing peers uncovered that the TC group exhibited significantly superior isometric strength in the iliopsoas, quadriceps, tibialis anterior, and hamstring muscles in comparison to the control group (Zhou et al., 2016). Notably, no significant differences in muscle strength were uncovered across various age cohorts (60–69, 70–79, 80–89 years) among the practitioners, and muscle strength effectively linked to practice duration, strongly implying that TC effectively mitigates age-associated decline in muscular strength (Zhou et al., 2016). This improvement in strength directly translates to promoted balance and decreased fall risk. A meta-analysis incorporating 24 RCTs offers robust evidence for this effect. The findings determined that TC significantly decreases the risk of falls (Relative Risk: 0.76) and the number of falls in older adults, while also effectively promoting different balance metrics, comprising Timed Up and Go test performance, Functional Reach Test results, and single-leg stance duration (Chen et al., 2023). Subgroup analysis further suggested that TC is positive for both healthy older adults and those at high risk of falls, with its advantages enhancing with longer session duration and higher frequency of practice. Moreover, Yang-style TC displayed superior impacts in comparison to Sun-style (Chen et al., 2023).

Beyond its physical benefits, TC significantly promotes cognitive function, notably in domains linked to the frontal and temporal lobes. An activation likelihood estimation meta-analysis, combining 18 functional neuroimaging studies, uncovered that TC practitioners exhibited consistent functional activity modifications in the superior frontal gyrus in comparison to other forms of exercise or intervention. This suggests that long-term neuroadaptive modifications driven by TC form the neural basis for its cognitive benefits (Wang et al., 2025). This cognitive improvement is tightly related to the remodeling of particular neural circuits. Research uncovered that after a 12-week intervention of either TC or Baduanjin practice, older participants displayed significant enhancement in memory quotient alongside significantly enhanced resting-state functional connectivity between the bilateral hippocampus and the medial prefrontal cortex (Tao et al., 2016). It is worth noting that the degree of improvement in hippocampo-prefrontal functional connectivity was effectively linked to the extent of memory improvement across all participants, offering direct evidence that TC exerts its cognitive protective impacts by improving this vital memory circuit (Tao et al., 2016). Furthermore, functional near-infrared spectroscopy studies centering on TC Zhan Zhuang—a core meditative component of TC—displayed a significant enhancement in oxyhemoglobin concentration within the bilateral prefrontal cortex (including the dorsolateral and ventrolateral regions) during practice, alongside increased functional connectivity between the left and right prefrontal cortices. The brain’s functional network also exhibited more efficient small-world properties (Qi et al., 2023). This determining that TC increases higher cognitive abilities, such as executive control, by augmenting neural activity within and improving the network organization of the prefrontal cortex.

The beneficial effects of TC on autonomic nervous system regulation (e.g., increased heart rate variability) and inflammatory profiles are shared with other mind–body practices like yoga (Zou et al., 2018). This suggests common pathways via stress reduction and neuro-immune modulation. However, the specific sensorimotor and attentional demands of TC’s continuous movement may engage brain networks involved in motor planning and executive control more intensely, potentially leading to distinct patterns of neural plasticity. In the realm of emotion regulation, TC has been built as an positive psychological intervention. Review studies determine that TC and Qigong can effectively modulate mood and decrease symptoms of anxiety and depression (Yeung et al., 2018). The potential processes operate at numerous levels: psychologically, the emphasis on “mind–body combination” and mindfulness practice in TC fosters promoted self-awareness and non-judgmental acceptance, hence increasing emotional control capacity; physiologically, its slow, deep breathing and relaxed movement patterns regulate the autonomic nervous system, increasing parasympathetic nervous activity and counteracting stress responses triggered by daily pressures, hence restoring a state of psychosomatic harmony (Yeung et al., 2018).

For the vast elderly population, TC displays a multidimensional facilitating impact on physical and mental health. On a psychological level, its advantages are notably significant. A systematic review and meta-analysis targeting middle-aged and elderly individuals displayed that TC can significantly promote depressive symptoms, and the most ideal effect was obtained when the intervention period exceeded 24 weeks, the total exercise duration exceeded 2,400 min, and the utilization of 24 simplified TC exercises was utilized (Zeng et al., 2023). Another network meta-analysis compared the therapeutic impacts of different types of TC on anxiety and depression symptoms in elderly people, and uncovered that Yang TC had the best effect in relieving anxiety, while integrative TC exercises performed the best in promoting depression symptoms (Kuang et al., 2024). The possible physiological mechanism of its emotional regulation effect is tightly linked to the improvement of autonomic nervous system function. A meta-analysis on mind body exercises (TC/Yoga) uncovered that these exercises significantly improved heart rate variability parameters, manifested as a decrease in normalized low-frequency power and an enhancement in normalized high-frequency power, while effectively decreasing perceived stress levels (Zou et al., 2018). This reveals that TC may increase the body’s ability to cope with stress by regulating the balance between the sympathetic and vagus nerves, hence exerting an emotional enhancement effect (Zou et al., 2018). Overall, TC promotes emotional health from both psychological and physiological perspectives by combining attention anchoring to bodily sensations, deep and slow breathing, and soothing exercises.

TC has been reported to effectively decrease core motor symptoms in PD patients. An early systematic review and meta-analysis displayed that TC significantly promoted motor function, balance, and functional mobility in PD patients in comparison to conventional care or no exercise (Yang et al., 2014). It is worth noting that current studies have suggested the long-term advantages of TC for PD and its potential biological processes. A one-year RCT uncovered that long-term TC training was even better than brisk walking in promoting step width and Berg Balance Scale scores (Li et al., 2022). The mechanism of promoting balance is linked to increasing the visual network function of the brain and downregulating the inflammatory cytokine interleukin-1 β; The overall enhancement in motor function is linked to the improvement of default mode network function, improvement of amino acid and energy metabolism, and the enhancement in mRNA levels of Huntington protein interacting protein 2 in the blood, which may decrease the vulnerability of dopaminergic neurons (Li et al., 2022). Moreover, TC has displayed a positive influence on the cognitive function of PD patients. A meta-analysis reveals that TC can improve overall cognitive function in PD patients and has a trend toward promoting executive function (Yin et al., 2023). It is proposed to experience TC intervention twice a week, for 45–60 min each time, for at least 12 weeks to increase cognitive improvement. The most convincing evidence comes from a 3.5-year cohort study. This study displayed that in comparison to the control group who cannot exercise, PD patients who persisted in TC training had a significantly slower annual deterioration rate of the Unified PD Rating Scale, and the requirement for enhanced anti PD drug treatment was effectively decreased. Furthermore, the annual enhancement in equivalent daily dose of levodopa was also smaller (Li et al., 2024). This determining that TC not only promotes symptoms, but may also have a long-term neuroprotective effect in decreasing disease development.

Oxidative stress is a vital pathological factor causing neuronal damage, accelerated brain aging, and the onset of neurodegenerative diseases (Kong et al., 2024). TC practice increases the body’s endogenous antioxidant defense capacity, effectively decreasing oxidative damage and conferring protection to the nervous system.

The mechanism of action initially manifests in the maintained upregulation of core antioxidant enzyme activities. A 12-month longitudinal study elucidated the dynamic impacts of TC exercise: at the initial intervention stage (6 months), practitioners exhibited a significant enhancement in glutathione peroxidase (GPx) activity; upon continuation to 12 months, superoxide dismutase (SOD) activity was also markedly elevated, concurrently with significant decreases in plasma concentrations of the lipid peroxidation product malondialdehyde (MDA) and advanced glycation end products (AGEs) (Goon et al., 2009). This mechanism along with the theory of hormesis, wherein TC, as a mild physiological stressor, may initially drive slight oxidative stress, hence activating and potentiating the body’s antioxidant defense system and ultimately obtaining long-term enhancement in redox status (Goon et al., 2009). This finding is robustly encouraged by a systematic review and meta-analysis, the findings of which determined that regular TC practice significantly increases the activities of superoxide dismutase (SOD) and catalase (CAT), while effectively decreasing levels of lipid peroxides in comparison to sedentary behavior (Rosado-Pérez et al., 2021). This displays that the impact of TC in augmenting antioxidant defense and decreasing oxidative damage is robust and reproducible.

Moreover, this systemic antioxidant effect is also significant in elderly populations with metabolic syndrome. Research determined that subjects experiencing 6 months of TC training exhibited a significantly enhanced total antioxidant status and a markedly decreased overall oxidative stress score (Mendoza-Núñez et al., 2018). Basic research offers a potential neurobiological association: the level of oxidative stress in the brain is tightly linked to memory function, and regulating redox balance represents a potential pathway for cognitive improvement (Kruk-Slomka et al., 2016).

Overall, via its slow, rhythmic movements, TC drives a mild physiological stress. This stress, far from being detrimental, initiates and improves the endogenous antioxidant system. By triggering the activities of core enzymes, such as SOD, CAT, and GPx, it effectively scavenges excess free radicals and mitigates oxidative damage, such as lipid peroxidation, ultimately establishing a molecular environment for the brain with decreased oxidative damage, one that is more conducive to neuronal health and functional maintenance.

Chronic inflammation is a core pathological inducer in the onset and progression of different neurodegenerative diseases, such as Alzheimer’s disease (AD) and PD. A persistent inflammatory state disturbs neuronal function and impedes neural repair via the release of numerous pro-inflammatory factors (Li et al., 2021; Chitnis and Weiner, 2017). As a mind–body exercise, TC can regulate the immune system via numerous pathways, effectively decreasing systemic inflammation levels, hence establishing an anti-inflammatory microenvironment for the brain.

The anti-inflammatory impacts of TC are first evident in the precise modulation of core pro-inflammatory and anti-inflammatory cytokines. A systematic review synthesizing 24 studies uncovered that TC practice significantly decreases levels of different pro-inflammatory mediators, comprising interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-12 (IL-12), tumor necrosis factor-alpha (TNF-α), nuclear factor-kappa B (NF-κB), and C-reactive protein (CRP) (Liu et al., 2022). Concurrently, it elevates the expression of cytokines with anti-inflammatory properties, such as interleukin-10 (IL-10) and interleukin-13 (IL-13) (Liu et al., 2022). This bidirectional modulation of inflammatory balance is critical for controlling the vicious cycle of neuroinflammation. The potential process involves complex, multi-level regulation. Firstly, the unique slow stretching movements of TC are hypothesized to transmit mechanical signals directly to immune cells via the fascial network, inhibiting their generation of pro-inflammatory factors (e.g., IL-6, TNF-α) and facilitating the expression of anti-inflammatory factors (e.g., IL-10, TGF-β) (Thelander and Ring, 2025). Secondly, the mind–body combination characteristic of TC enables it to regulate the function of the hypothalamic–pituitary–adrenal (HPA) axis, decreasing chronic stress responses, which are a significant driver of inflammation (Thelander and Ring, 2025). Furthermore, TC may exert long-term immunomodulatory impacts via epigenetic pathways, modulating the expression of inflammation-associated genes (Thelander and Ring, 2025). This alter from a pro-inflammatory toward an anti-inflammatory state holds significant immunological significance. As uncovered in chronic inflammatory diseases, such as rheumatoid arthritis, restoring immune balance and facilitating the resolution of inflammation are core to treatment (Chen et al., 2019). TC obtains this by driving a similar, balance-oriented immune phenotype, counteracting the chronic low-grade inflammation linked to aging and neurodegenerative diseases (Irwin and Olmstead, 2012; Liu et al., 2021).

Overall, TC, via mechanotransduction, neuroendocrine regulation, and potential epigenetic mechanisms, acts synergistically on the immune system to alter the inflammatory milieu from a destructive pro-inflammatory state toward a protective anti-inflammatory state. This systemic immunomodulatory action effectively attenuates neuroinflammation in the brain, offers protection for neurons, and establishes a molecular environment favorable for neuroplasticity and repair.

Mitochondria, acting as the cellular powerhouses, play an indispensable role in experiencing the high energy demands of neurons, sustaining calcium homeostasis, and determining cell survival (Walters and Usachev, 2023; Zhang et al., 2025). Their dysfunction is intimately linked to the pathological mechanisms of aging and different neurodegenerative diseases (Walters and Usachev, 2023; Zhang et al., 2025). Literature has determined that TC practice can act as an positive physiological stimulus, encouraging normal neuronal function and increasing resilience against stress and injury by improving mitochondrial function and hence augmenting energy supply to neurons (Zhou et al., 2018).

Its positive influence is first evident in the direct improvement of energy metabolic effectiveness. A pioneering magnetic resonance spectroscopy (MRS) study offered initial evidence: after 12 weeks of TC training, elderly subjects exhibited a significant 16.51% decrease in phosphocreatine (PCr) recovery time in their leg muscles (Zhou et al., 2018). The PCr recovery time is a core indicator of mitochondrial oxidative phosphorylation capacity and ATP resynthesize rate; its shortening clearly reveals that TC training increases mitochondrial energy metabolic effectiveness, enabling cells to replenish their energy reserves more widely after expenditure (Zhou et al., 2018).

The molecular processes potential this improvement of mitochondrial function may involve epigenetic regulation. Reactive oxygen species (ROS) generated by regular exercise are no longer viewed only as harmful byproducts; at physiological levels, they act as critical signaling molecules. Via the modulation of epigenetic mechanisms, such as DNA methylation and histone modifications, they activate gene expression networks linked to mitochondrial biogenesis and antioxidant defense, hence reversing mitochondrial functional decline driven by factors, such as aging (Li et al., 2022). TC, as a moderate-intensity exercise, similarly sustains the health and stability of these cellular power plants by driving this advantageous “epigenetic-mitochondrial” crosstalk (Li et al., 2022). It is worth noting that these energetic benefits similarly extend directly to the brain. The same MRS study also uncovered a significant 5.38% enhancement in the ratio of N-acetylaspartate to creatine (NAA/Cr) in the posterior cingulate cortex of elderly subjects following TC practice (Zhou et al., 2018). NAA is a marker for neuronal mitochondrial integrity and neuronal viability; its elevated level strongly reveals that TC training improves energy metabolism and health status within brain neurons (Moffett et al., 2007). This enrouarges the model of communication between the nervous system and peripheral tissues via “mitochondrial stress signals,” whereby physical interventions, such as TC can produce systemic impacts and ultimately influence brain health and overall organismal aging by regulating core biological mechanisms, such as mitochondrial function (Li et al., 2022).

Overall, TC practice systemically increases cellular energy supply levels from muscle to the brain by promoting mitochondrial energy metabolic effectiveness, potentially consolidating this impact via epigenetic processes. This not only offers more abundant “fuel” for nerve cells to meet daily functional demands and different stresses, but also lays a solid energetic foundation for maintaining long-term neuroplasticity and healthy aging.

Beyond its preventive advantages, TC also exerts significant neuroprotective impacts by directly decreasing nerve cell death and actively facilitating neural repair (Sungkarat et al., 2018; Lin et al., 2024). This protective effect, induced via the modulation of core intracellular signaling pathways, ultimately helps in repairing damaged neural networks and promoting neurological function (Sungkarat et al., 2018; Lin et al., 2024).

The neuroprotective role of TC is first displayed by its capacity to counteract apoptosis and promote neuronal survival. A RCT involving older adults with amnestic Mild Cognitive Impairment (aMCI) offered direct evidence. The study uncovered that subjects who experienced 6 months of TC training exhibited significantly higher plasma levels of BDNF in comparison to the control group receiving health education (Sungkarat et al., 2018). BDNF is a core factor maintaining neuronal survival, facilitating synaptic plasticity, and encouraging neurogenesis. The upregulation of its level represents a core molecular basis for the neuroprotective impacts of TC, tightly linking to the uncovered enhancements in memory and executive function in the study (Sungkarat et al., 2018). Moreover, multi-component training incorporating TC elements has also been displayed to effectively promote functional fitness in patients with neurocognitive disorders, such as lower limb mobility and walking speed, which is critical for maintaining their independence in daily living and quality of life, indirectly implying its protective advantages for neurological function (Ribeiro et al., 2021).

It is worth noting that the neuroprotective mechanisms of TC may expand to facilitating endogenous neuroregeneration. Research determining that under pathological conditions, such as ischemic stroke, improving the proliferation and differentiation of endogenous neural stem cells to replace damaged nerve cells is a significant future direction for brain repair therapies (Tang et al., 2023). Although more direct evidence is required, therapies within the traditional Chinese medicine system, of which TC is a significant mind–body practice, have been uncovered to specifically regulate the proliferation and differentiation of neural stem cells by regulating numerous signaling pathways and related transcription factors (Qin et al., 2017). This strongly reveals that TC, as a traditional mind–body exercise, may possess similar potential to promote neurogenesis after brain injury by activating endogenous repair processes.

Overall, TC inhibits apoptosis and increases neuronal resilience by upregulating levels of neurotrophic factors, such as BDNF, and may promote neural regeneration and repair by regulating the activity of endogenous neural stem cells. These processes collectively constitute the multi-level neuroprotective strategy of TC, offering a theoretical basis for its potential effectiveness in promoting neurological function and repairing damaged networks under pathological conditions, such as stroke and brain injury.

The most significant advantages of TC for stroke patients are implied in its improvement of motor function, balance ability, and fall risk. A systematic review and meta-analyses have determined that TC training can significantly promote different physical fitness indicators, comprising grip strength, 6 min walking distance, and single leg standing time with eyes open (Wehner et al., 2021). Another large-scale meta-analysis targeting the elderly further determined that TC can effectively decrease the risk of falls and promote balance indicators, such as timed standing and walking tests and functional extension tests (Chen et al., 2023). These advantages are critical for stroke patients with hindered balance function and high risk of falls. Long term practice of TC can continuously promote the motor function of stroke patients and accelerate the recovery of their upper and lower limb functions. A systematic review and meta-analysis specifically targeting the impacts of TC Yunshou on stroke patients displayed that in comparison to conventional rehabilitation training, TC Yunshou training significantly promoted patients’ Berg Balance Scale scores, simplified upper limb function test scores, and displayed greater enhancement in Fugl Meyer exercise evaluation (Zhang et al., 2023). This determining that TC has a unique effect in facilitating movement management and coordination.

For stroke patients in the subacute phase with limited mobility, the promoted sitting style TC is equally positive. A rigorous RCT displayed that a 12 week sitting style TC training can significantly promote upper limb function (assessed by Wolf Motor Function Test), balance control, sitting balance, and decrease depressive symptoms in patients (Zhao et al., 2022). This offers feasible rehabilitation plans for patients with various degrees of functional impairment. Moreover, the advantages of TC go far beyond the range of exercise function, expanding to the improvement of cardiovascular function, emotional stability, and cognitive function, integratively facilitating patients’ return to daily life. A research plan seeks to investigate the impacts of TC on cardiorespiratory adaptation in stroke patients during the recovery period, with a center on evaluating peak oxygen uptake and quality of life, determining the possible role of TC in promoting overall physiological function (Tan et al., 2021). Another randomized feasibility study uncovered that rehabilitation programs according to TC were superior to conventional symptom control programs in promoting flexor muscle strength, walking ability, daily living activity ability, and cognitive function, and displayed significant benefits in the thinking and self-care dimensions of stroke particular quality of life scales (Song et al., 2021).

Overall, TC offers a integrative rehabilitation pathway for stroke patients via its characteristic of both physical and mental cultivation. It can not only effectively increase limb coordination, muscle strength and balance, decrease the risk of falls, but also accelerate the recovery of motor function, and simultaneously promote the patient’s cardiovascular health, emotional state and cognitive ability, ultimately significantly promoting their daily living activities and overall quality of life, aiding patients better reintegrate into society.

For patients with brain injury, notably those with traumatic brain injury (TBI), TC, as a low impact physical and mental exercise, exhibits unique therapeutic value in the rehabilitation process. Although high-quality research directly targeting brain injury patients is still in the accumulation stage, recent systematic evaluations show positive signals. A systematic review specifically evaluating the effectiveness of TC and Qigong in treating traumatic brain injury uncovered that TC consistently promoted patients’ functional, psychological, and/or cognitive outcomes in several included trials (Laskosky et al., 2024). The review indicates that according to these consistent positive findings, it is sufficient to encourage large-scale, high-quality multicenter trials to further validate the effectiveness of TC in traumatic brain injury, determining that TC may turned into a new frontier in the range of brain injury treatment (Laskosky et al., 2024).

The rehabilitation mechanism of TC on patients with brain injury may stem from its positive influence on brain function and structure. Although most neuroimaging study are conducted in healthy populations, the patterns they suggest have enlightening implications for determining brain injury rehabilitation. Research has uncovered that TC training can significantly increase the clustering coefficient and local effectiveness of brain functional networks, facilitating brain functional specialization (Cui et al., 2021). This enhancement in neural plasticity is notably implied in brain regions linked to cognitive processing, such as the thalamus, and has been uncovered to be a predictor of promoted cognitive flexibility. For brain injury patients whose neural network connections are commonly disrupted, TC’s ability to promote brain function reorganization and improvement may be the neural basis for promoting cognitive functions, such as executive function and working memory. Meanwhile, TC has displayed clear benefits in promoting emotional regulation. Research has displayed that practicing TC can significantly decrease valence fluctuations, arousal fluctuations, and dominance fluctuations in emotional responses, determining that it can effectively increase emotional stability (Wang et al., 2023). It is interesting that researchers speculate that the action memory training in TC may increase emotional regulation ability by promoting working memory capacity. This has significant psychological rehabilitation importance for brain injury patients who commonly have emotional instability, difficulty in impulse control, and depressive symptoms.

It is worth noting that the low impact nature of TC makes it a safe and well tolerated rehabilitation option for patients with brain injuries. Systematic assessments have displayed that TC involves several slow, low impact movements that combine breathing, thought, and physical activity, and has good safety (Solloway et al., 2016). A systematic review of traumatic brain injury also indicated that studies displaying adverse events displayed that neither the TC group nor the control group experienced adverse events, preliminarily determining its safety (Laskosky et al., 2024). Moreover, the role of TC in promoting emotional states, decreasing anxiety and depression symptoms has been extensively determined. The system evaluation displays that TC can significantly decrease anxiety and depression levels, and promote the psychological health dimension of quality of life (Yang et al., 2022). This is critical for patients with brain injuries to rebuild their confidence and quality of life. A large-scale systematic review reported that TC has multidimensional advantages, comprising physical, psychological, and quality of life perspectives, and is applicable to different health conditions (Yang et al., 2022). This conclusion also encourages its potential utilization in integrative rehabilitation of brain injuries.

Overall, preliminary evidence reveals that TC can assist cognitive recovery by facilitating brain functional plasticity and promote psychological state by increasing emotional regulation ability for patients with brain injuries. Its low impact features ensure the safety of the rehabilitation process. Via systematic TC training, patients can not only recover in motor function and developed cognitive function, but also receive strong encourage in psychological and emotional perspectives, hence obtaining integrative physical and mental recovery and effectively promoting their quality of life.

The advantageous impacts of TC on cognitive function mainly stem from its positive remodeling of core neural structures and functional networks in the brain (Tao et al., 2016; Chen et al., 2022). Research determining that TC effectively increases different cognitive domains—including attention, memory, and executive function—by specifically augmenting activity and connectivity within brain regions critically involved in higher-order cognitive processing, notably the prefrontal cortex and hippocampus (Tao et al., 2016; Chen et al., 2022).

The neural processes potential these cognitive benefits have been visually elucidated via functional brain imaging studies. A longitudinal study involving older adults uncovered that after 12 weeks of TC or Baduanjin practice, participants displayed a significant enhancement in memory quotient (Tao et al., 2016). It is worth noting that resting-state functional magnetic resonance imaging (fMRI) suggested significantly enhanced functional connectivity between the bilateral hippocampus and the medial prefrontal cortex, and this enhancement in connectivity was effectively linked to the degree of memory improvement (Tao et al., 2016). This finding strongly reveals that TC may counteract age-associated memory decline by improving the functional combination of this core hippocampo-prefrontal memory circuit (Tao et al., 2016). In addition to improving memory circuits, TC also exerts a significant activating impact on the prefrontal cortex itself, which is responsible for executive control. A study using functional near-infrared spectroscopy (fNIRS) uncovered brain activity during TC Zhan Zhuang (a core static meditative practice). The findings displayed that during Zhan Zhuang, practitioners exhibited a significant enhancement in oxyhemoglobin concentration in bilateral prefrontal regions, comprising the dorsolateral and ventrolateral prefrontal cortex, alongside increased functional connectivity between the left and right prefrontal cortices. The brain’s functional network also displayed more efficient small-world properties (Qi et al., 2023). This proves that TC practice directly increases neural activity within the prefrontal cortex and improves its functional organization, offering a direct physiological basis for the enhancements in executive function, working memory, and complex problem-solving abilities linked to TC.

In older populations, the translation of these neural processes manifests as a decrease in cognitive decline, notably the progression toward dementia, such as AD. A systematic literature review noted that for older adults in the early stages of dementia, TC displays possible role for promoting global cognition, visuospatial skills, semantic memory, and verbal learning/memory (Lim et al., 2019). Nevertheless, a scoping review also indicates that recent findings concerning the neurocognitive advantages of TC for individuals with Mild Cognitive Impairment (MCI) and early dementia are inconsistent, necessitating more high-quality clinical trials and mechanistic studies to explain its effectiveness and pathways of action (Jasim et al., 2023). The potential reason for TC’s improvement of brain health lies in its unique integration of aerobic exercise and complex coordinative training. This combined mind–body movement pattern aids sustain an active brain state. Study reveal that physical exercise can improve brain plasticity via mechanisms, such as the modulation of neural oscillations (Li et al., 2024). Overall, exercise training is a critical approach for counteracting the decline in cognition and brain health during aging, with its advantages similarly induced by driving neuroadaptive modifications (Boa Sorte Silva et al., 2024).

Overall, TC encourages and increases cognitive function across numerous levels by enhancing functional activity and connectivity within the prefrontal cortex and hippocampus, and possibly by regulating brain network effectiveness and plasticity. As a mind–body exercise that incorporates both aerobic and coordinative demands, it displays a promising non-pharmacological intervention approach for decreasing age-associated cognitive decline and neurodegeneration.

Similar to yoga and mindfulness-based stress reduction, TC demonstrates efficacy in managing chronic pain conditions like osteoarthritis and low back pain, likely through shared mechanisms including improved physical function, downregulation of systemic inflammation, and enhanced pain coping psychology. The slow, gentle, and continuous movement patterns of TC offer a direct physical basis for its pain-relieving effects. A systematic review and meta-analysis determined that TC training significantly promotes different physical fitness parameters, comprising grip strength, 6-min walk distance, single-leg stance time, and thoracolumbar flexibility (Wehner et al., 2021). By increasing muscle strength, promoting joint flexibility, and improving postural control, TC can effectively correct biomechanical abnormalities caused by negative posture and muscular imbalances, hence decreasing mechanical pain in the musculoskeletal system at its source.

Beyond physical enhancements, the analgesic impact of TC is more significantly implied in its modulation of the biochemical environment linked to pain. A pilot study involving postmenopausal women with knee osteoarthritis suggested the mechanism of TC: after 8 weeks of practice, participants displayed significantly decreased levels of pro-inflammatory oxylipins (e.g., PGE1 and PGE2) in their circulation, alongside corresponding modifications in the levels of endocannabinoids, which are tightly linked to pain perception and neuroinflammation (Shen et al., 2023). These modifications in biochemical markers linked to patients’ pain evaluations and modifications in functional connectivity between the amygdala and prefrontal cortex, implying that TC may exert integrated anti-inflammatory and analgesic impacts both peripherally and centrally by regulating the neuro-immune axis (Shen et al., 2023). Systematic reviews encourage this view, determining that TC practice can decrease levels of different pro-inflammatory cytokines, comprising interleukin-6, tumor necrosis factor-alpha, and C-reactive protein (Liu et al., 2022).

Moreover, the relaxation and meditative components inherent in TC play a core role in decreasing pain triggered by psychological stress. A meta-analysis of mind–body exercises (TC/Yoga) displayed that these practices significantly promote heart rate variability parameters, displayed by reduced low-frequency power and enhanced high-frequency power, while effectively decreasing perceived stress levels (Zou et al., 2018). This determining that TC can decrease stress responses by increasing parasympathetic tone and regulating the sympathetic-vagal balance, hence indirectly decreasing chronic pain conditions tightly related to stress (Zou et al., 2018).

Substantial clinical research evidence enrouarges the utilization of TC for particular chronic pain conditions. A meta-analysis incorporating 18 RCTs displayed that TC has significant immediate impacts on relieving chronic pain triggered by osteoarthritis, low back pain, and osteoporosis (Kong et al., 2016). Review articles further affirm that TC, as an ancient health art combining adapted movement, mind–body interaction, and meditation, displays clear effectiveness in controlling conditions, such as osteoarthritis, fibromyalgia, and low back pain (Peng, 2012).

Overall, the decrease of chronic pain by TC findings from the synergistic action of numerous factors. It relies not only on physical effects, such as promoted physical function and improved blood circulation but, more vitally, exerts integrative impacts across numerous stages of pain—comprising perception, transmission, and regulation—by regulating the nervous system (e.g., autonomic balance) and the immune system (e.g., decreasing systemic inflammation). Hence, TC can be considered an positive complementary and alternative therapy, suitable for combination into integrative control approaches for chronic pain. Table 2 shows Main research achievements on the core effects and key mechanisms of TC in the field of neural rehabilitation applications.