The WHO predicts that by 2050, the worldwide number of people 65 years of age and older will reach 1.6 billion (1, 2). Between 2000 and 2030, the proportion of individuals 65 years of age and older in the United States is expected to rise from 12.4 to 19.6%, while in Europe, it will increase from 15.5 to 24.3% (3). By the close of 2024, the number of people 65 years of age and older in China surpassed 220 million, constituting 15.6% of the national population (4). These statistics highlight the increasingly severe trend of global population aging.

Aging leads to progressive skeletal muscle atrophy and frailty (5), which in turn contribute to declines in lower limb strength, impaired balance, and gait disturbances—primary causes often linked to falls in older adult individuals (6, 7). Around 30% of community-dwelling individuals 65 years of age and older suffer a fall each year (8), while nearly 50% of those aged 80 and above fall more than once annually (9). Falls in the older adult not only cause injuries, disability, and reduced quality of life, but also impose a heavy financial burden on healthcare systems. For instance, in 2019, fall-related incidents among older adults in the Netherlands incurred medical expenses exceeding one billion euros (10). Therefore, enhancing lower limb strength, balance, and gait stability is essential for preventing falls, improving physical function, and promoting independence in daily activities among the older adult.

Key strategies aimed at enhancing or postponing the deterioration of physical abilities in the older adult population include pharmacological treatments, hormone replacement, nutritional supplements, and exercise interventions (11–13). Among the above interventions, exercise is notable for being affordable, widely accessible, and having few to no side effects, making it an increasingly favored approach among the older adult population. Currently, exercise interventions aimed at improving postural stability and leg muscle strength among the older adult primarily include perturbation training, dual- or multi-task balance drill, progressive resistance exercise, Tai Chi, and Qigong exercises (14, 15). Among these, perturbation-based balance training involves the intentional application of external disturbances, such as treadmill-based exercises, mechanical pulling, or manual push and pull forces, to improve an individual’s reactive balance control in response to instability (16, 17). Dual-task balance training combines a balance exercise with either a cognitive or motor task, whereas multi-task balance training integrates both cognitive and motor tasks simultaneously (14, 18). Existing studies have demonstrated that perturbation-based balance training and dual−/multi-task balance training, as forms of exercise intervention, can effectively improve one or more intrinsic factors linked to the likelihood of falling in older adults, particularly lower limb strength, balance capacity, and gait stability. However, some studies have indicated that among community-dwelling older adult individuals, perturbation-based balance training does not demonstrate significantly greater effectiveness than general care (physiotherapy) in enhancing stability control or alleviating fear of falls (10), and its impact on actual fall incidence and other fall-related indicators appears to be limited (19). Additionally, research has shown that although 12 weeks multi-task balance drill can improve response speed in healthy older adults, it does not lead to significant improvements in postural sway (20). Another study found that 6-week multi-task balance training enhanced working memory in healthy older adults, though it did not significantly improve balance performance (21). On the other hand, systematic reviews have also indicated that while progressive resistance training (i.e., strength training involving gradually increasing loads) can significantly enhance muscle strength in older adults, its effectiveness in improving balance remains uncertain or subject to debate (22, 23).

In summary, although each of the aforementioned exercise interventions has its own advantages, Tai Chi and Health Qigong are more suitable for older adults in terms of comfort during exercise and ease of long-term adherence, due to their gentle and moderate movements, low risk, and minimal reliance on specific venues or equipment.

Taiji Stick, along with Tai Chi, Baduanjin, and Wuqinxi, all belong to the domain of Chinese traditional sports. Among these, Taiji Stick, Baduanjin, and Wuqinxi have been officially recognized and promoted by the General Administration of Sport of China as standardized Health Qigong. It is worth emphasizing that Taiji Stick is the only routine among the 11 officially endorsed Health Qigong sets that involves practice with a handheld stick (24). The Taiji Stick shares a common origin and similar movement patterns with Tai Chi, Baduanjin, and Wuqinxi, providing both the theoretical rationale and practical foundation for this study. Numerous studies have demonstrated that mind–body exercises with similar movement mechanics improve functional ability; thus, we hypothesized that Taiji Stick exercise would lead to statistically significant improvements in lower limb strength and dynamic balance ability compared to controls in senior care center-dwelling older adults after 11 weeks. In order to examine this hypothesis, the present research employed a randomized controlled trial design for the first time, using the Taiji stick as an exercise intervention to assess their effects on strength, balance, and daily activity function in the aging population. A gap in the existing literature is being addressed by this study regarding the impact of apparatus-based Health Qigong interventions on physical function in the older adult and holds both exploratory and pioneering significance.

This study found that an 11-week Taiji Stick exercise intervention significantly improved functional performance and the ability to perform everyday tasks in the older adult, thereby confirming the research hypothesis.

After completing an 11-week Taiji Stick exercise intervention, the grip strength of both the left and right hands of the older adult participants in the experimental group increased, but these increases did not reach statistical significance. Nevertheless, earlier investigations have demonstrated that Taijiquan and Qigong exercises can significantly enhance grip strength. For example, older adults who participated in Yang-style Tai Chi sessions twice weekly for 45 min over 16 weeks demonstrated significant improvements in grip strength (39). Another study reported significant increases in grip strength among older adults following an 8-week Tai Chi (Bafa Wubu) program conducted three times per week for 40 min each session (40). Additionally, older adult women engaging in Qigong exercises twice weekly for 50 min over 8 weeks also exhibited significant enhancements in grip strength (41). However, A meta-analysis indicated that older adult individuals with sarcopenia or frailty showed no significant improvement in grip strength after practicing Tai Chi 2–7 times per week, with each session lasting 30–90 min, for a total duration of 8–48 weeks (42). Meanwhile, another study also found that although there was a tendency for grip strength to increase in frail older adult people after practicing Qigong twice a week, with each session lasting 60 min, for a total of 12 weeks, the improvement did not reach a significant level (43). The grip strength findings in this study are consistent with those obtained from interventions involving Tai Chi and Qigong among older adult individuals with sarcopenia or frailty. Relevant studies have shown that approximately 50% of older adult people over 75 years old suffer from sarcopenia, and about 40% of Chinese older adult people over 60 years old have frailty syndrome (44, 45). Based on the above research results and the average age of the older adult in the experimental group of this study (83.71 ± 2.89), this study infers that the reason why the grip strength of the older adult in the experimental group did not improve significantly after the intervention of Taiji Stick exercise may be due to the presence of sarcopenia or frailty syndrome among the older adult in the experimental group. Subsequent studies will assess whether the participants suffer from sarcopenia and frailty syndrome.

After 11 weeks of Taiji Stick exercise intervention, the 5STS completion time among the older adult in the experimental group was significantly reduced. This result aligns with earlier intervention researches focusing on Tai Chi or Baduanjin. For example, a study found that community-dwelling older women who participated in Tai Chi training twice a week for 60 min per session across 12 weeks exhibited a marked drop in the 5STS completion time (46). Another study reported that older adults with chronic stroke showed a similar improvement after engaging in Baduanjin exercise three times per week, 50 min per session, for 8 weeks (47). A shorter 5STS completion time indicates greater lower limb muscle strength. The significant reduction in the 5STS completion time may be associated with the repeated transitions among various stances commonly performed in Tai Chi or Qigong exercise, such as the bow stance, horse stance, empty stance, and resting stance. These movements are thought to enhanced lower limb muscle strength by facilitating muscle activation, balance control, and weight shifting.

Following the intervention, the TUG completion time among older adults was significantly reduced in the experimental group, aligning with previous findings from earlier researches involving Taijiquan, Baduanjin, Wuqinxi exercises. For instance, seniors experiencing cognitive impairment who participated in Tai Chi training twice weekly, each lasting 60 min over a 14-week period, exhibited a significant reduction in the TUG completion time (48). Another study demonstrated that older adults with chronic stroke who engaged in Baduanjin exercise three times weekly, each session lasted 50 min and was held over 8 weeks, showed a significant decrease in the TUG completion time (47). Furthermore, older adults with knee osteoarthritis who undertook Wuqinxi exercise four times weekly, 60 min per session for 12 weeks, also experienced a notable drop in the completion time for TUG (49). The significant reduction in the TUG completion time may be attributed to the frequent stance transitions commonly practiced in Tai Chi and Health Qigong. These dynamic stance transitions are considered to enhance lower limb muscle strength and improve gait stability. Additionally, movements involving head rotation, flexion and extension of the cervical spine, shoulder rotation, waist twisting and sinking, as well as the joint movements of flexing and extending in the knee, ankle, elbow, along with stretching of both upper and lower limbs, may contribute to improved flexibility, postural control, and balance.

Multiple meta-analyses have confirmed that practicing Tai Chi, Baduanjin, and Qigong can effectively improve lower limb strength (50, 51) and dynamic balance ability (42, 52–54) in the older adult; this study further found that practicing Taiji Stick can also significantly enhance these two aspects. These conclusions provide a clear basis for formulating exercise intervention strategies for the older adult. Accordingly, it is suggested that the older adult take Tai Chi, Baduanjin, Qigong, and Taiji Stick as important ways of their daily exercise, given that regular practice can enhance lower limb strength and improve dynamic balance ability, thus reducing the risk of falls.

After the intervention, significant enhancements in the ADL were observed among older adults in the experimental group. This outcome corresponds with previous studies involving Taijiquan and Baduanjin interventions. For example, one investigation reported that frail older adult individuals who engaged in Taijiquan exercise three times weekly, 30 min each session, over a 12-week period experienced significant improvements in the ADL (55). Similarly, another study reported that frail older adult residents in nursing homes who practiced Baduanjin four times per week, for 35 to 45 min per session over 14 weeks, also showed significant improvements in the ADL (56). All of the aforementioned studies employed the ADL Scale for assessment, which further supports its reliability as a tool for assessing functional status in senior population.

Correlation findings from the present study demonstrated that, following the exercise intervention, strength in the lower extremities and balance performance observed in the intervention group were significantly correlated with the ADL. These findings highlight the value of Focusing on enhancing muscle power in the lower extremities and balance drill in rehabilitation and exercise programs for older adults. Nonetheless, maintaining upper limb strength should not be neglected, so as to better enhance physical functioning and ADL performance in seniors, thereby reducing their risk of falls.

Based on the findings of this study, its results carry significant implications for both clinical practice and public health, as detailed below.

In terms of clinical implications, three key contributions are notable. First, Reducing the risk of falls. Dynamic balance ability and lower limb strength are core elements in fall prevention. Older adults who engage in taiji Stick exercises exhibit significant improvements in lower limb muscle strength and dynamic balance, which in turn reduces their risk of falling. Second, Delaying aging-related functional degradation. Sarcopenia is an age-related, progressive, systemic syndrome characterized by reduced skeletal muscle mass, decreased muscle strength, and impaired function as its core features (44, 57). Through regular stimulation of muscles (especially core muscles and limb muscles), Taiji Stick exercises may play a positive role in delaying the loss of muscle mass and the progression of muscle strength decline, thereby reducing the risk of sarcopenia in older adults. Third, Enhancing activities of daily living and reducing care dependency. Lower limb strength and dynamic balance form the foundation for older adults to independently perform daily activities (e.g., walking, climbing stairs, using the toilet), while upper limb strength is associated with actions like eating and dressing. The findings of this study indicate that Taiji Stick exercise can simultaneously maintain upper limb strength, enhance lower limb strength, and improve dynamic balance ability, thereby promoting older adults’ self-care capacity in daily life.

From a public health perspective, the implications are equally significant. For one thing, Reducing the incidence of accidental injuries. Falls in older adults are likely to result in severe consequences such as fractures, concussions, and intracranial hemorrhage, which not only cause long-term pain and functional impairment but may even be life-threatening. Older adults practicing Taiji Stick can significantly enhance their lower limb muscle strength and dynamic balance ability, thereby reducing the risk of falls and, in turn, decreasing the occurrence of accidental injuries. A reduction in the incidence of accidental injuries among older adults can directly reduce household medical expenditures, alleviate the family’s financial burden and caregiving pressure, and indirectly improve the quality of family life. For another, Enhancing mental health. As a traditional Chinese sport, Taiji Stick uses the stick as a guide and adheres to the practicing essence of “guiding qi to circulate, following with movements, and unifying form and spirit.” Its movement system, which emphasizes waist-centered whole-body movements (e.g., twisting, turning, flexing, extending) integrated with internal activities (such as breathing, mindfulness, and spirit), enables practitioners to achieve physical and mental relaxation during dynamic exercise, thereby mitigating the impact of negative emotions. Additionally, group practice provides a platform for social interaction among older adults, promoting social participation, strengthening their sense of group belonging, and alleviating loneliness through movement communication and experience sharing. These factors altogether form a dual positive effect of “individual emotional regulation combined with group social support,” ultimately contributing to an overall improvement in older adults’ mental health.

Despite the achievements of this study, there are still some limitations. Firstly, only 35 participants were ultimately included in the analysis, which may affect the sample representativeness, stability of the results, and the generalizability of findings. On the one hand, a small-sample experiment may increase the risk of either false negative or false positive results. Specifically, the insufficient statistical power caused by a small sample size makes it harder to detect truly existing effects (i.e., false negatives), particularly when the effect size is small. Conversely, a small sample size may also raise the probability of false positives, as random fluctuations or sampling biases in limited data might be erroneously interpreted as statistically significant effects, thereby distorting the true relationship between variables. On the other hand, the sample of the present study was drawn from a single institution and a specific subgroup (older adult individuals in urban care centers). A small sample size will further exacerbate such “sampling bias,” potentially limiting the generalizability of the research findings to a broader older adult population—including those in urban communities, rural communities, rural care centers, and so forth.

Secondly, failure to implement blinding for participants and assessors can indeed increase the risk of measurement bias. To reduce measurement bias as much as possible, the present study adopted blinding in a specific assessment procedure. Taking the assessment of participants’ activities of daily living (ADL) using the scale as an example, to reduce measurement bias that might arise from assessors’ subjective judgments (e.g., anticipatory bias toward the effectiveness of the intervention group), the following measures were taken in this study: the assessors were professional caregivers from the older adult care center, and they were unaware of both the purpose of this study and the grouping of participants; the assessment was arranged by the leaders of the older adult care center under the pretext of “conducting a routine survey on the ADL of older adult individuals in the center,” thereby helping to mitigate subjective assessment bias that might arise if assessors were aware of the study purpose or grouping information.

Thirdly, This study only adopted gender-stratified randomization for group allocation, which may be subject to interference from other potential confounding factors. To a certain extent, this might affect the comparability between groups and the stability of the study results. Future studies, on the basis of ensuring an adequate sample size, may consider adopting a multi-factor stratified randomization strategy, incorporating key baseline variables such as age, underlying diseases, and exercise capacity into the stratification framework. This would help reduce confounding bias and thereby more accurately reveal the intervention effect of Taiji Stick exercise on older adults.

Fourthly, the study did not examine the persistence of effects following cessation of the Tai Ji Stick exercise intervention. The initial objective of this study was to verify whether Taiji Stick exercise intervention has an improving effect on the strength, balance ability, and activities of daily living (ADL) among older adults immediately after the intervention (i.e., short-term effects), thereby laying a foundation for subsequent studies. In existing Tai Chi intervention studies, an assessment was conducted immediately after the intervention concluded, and if an additional follow-up was scheduled, it was most commonly set at 3 months post-intervention (58, 59). Based on this, we plan to conduct a follow-up assessment at 3 months post-intervention in the subsequent Taiji Stick intervention study to evaluate the maintenance of the effect of Taiji Stick exercise, and thus presenting its exercise benefits more comprehensively.

Lastly, a limitation of this study was that it did not directly assess fall risk, but only inferred from previous findings that improvements in lower limb strength and dynamic balance could help reduce fall risk in older adults, which may limit the persuasiveness of the conclusions. Based on this research, subsequent Taiji Stick intervention studies will directly evaluate fall risk in older adults to enhance the reliability of research conclusions. Future studies will also conduct large-scale, multi-center randomized controlled trials among older adult participants to evaluate the impact of Taiji Stick exercise versus other Chinese traditional exercises, including Taijiquan, Baduanjin, Wuqinxi, and so on. This will not only help further evaluate which intervention produces superior improvements in physical function but also provide reliable evidence to further confirm the stability and generalizability of the results of this study.

This study demonstrates that an 11-week Taiji Stick exercise intervention significantly enhance lower limb strength and dynamic balance, help maintain upper limb strength, show potential to reduce fall-related risks, and improve the older adults’ capacity to carry out daily tasks. These findings also offer empirical support for the advantages of Taiji Stick practice in older adult individuals, and a necessary foundation for its future promotion and widespread adoption.