Efficacy and evidence certainty of traditional Chinese exercises for musculoskeletal disorders: an umbrella review of meta-analyses.

OBJECTIVES: To comprehensively evaluate the efficacy and exercise prescription parameters of traditional Chinese exercises (TCEs) on health outcomes in patients with musculoskeletal disorders (MSDs) and rigorously assess the certainty of the evidence. DESIGN: Umbrella review. DATA SOURCES: PubMed, Embase, Cochrane Library, Scopus, Web of Science, PEDro, Ovid Medline, CINAHL and SPORTDiscus databases were searched from inception to 6 March 2026. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Systematic reviews with meta-analyses of randomised controlled trials (RCTs) that investigated TCE interventions for individuals with MSDs. RESULTS: 92 meta-analyses, comprising data from 1744 primary RCTs, were included, yielding 547 unique outcome associations. TCE modalities included mixed/unspecified TCEs (37.3%), Tai Chi (41.5%), Baduanjin (11.0%), Yijinjing (4.2%), Qigong (3.8%), Wuqinxi (1.8%) and Daoyin (0.4%). Targeted MSDs spanned 10 categories, most commonly arthritis (38.8%). Methodological quality was high for 65 (70.7%) meta-analyses (A Measurement Tool to Assess Systematic Reviews). Applying the Grading of Recommendations, Assessment, Development and Evaluations framework, 23 associations (4.2%) were supported by high-certainty evidence and 179 (32.7%) by moderate-certainty evidence. High-certainty evidence demonstrated that TCEs significantly improved physical function in knee osteoarthritis, enhanced mental health in patients with knee osteoarthritis and neck pain and improved sleep quality in fibromyalgia. Tai Chi significantly alleviated chronic MSD-related pain and stiffness while increasing bone mineral density (BMD) in participants with osteopenia/osteoporosis. Subgroup analyses indicated that interventions with longer duration, higher frequency and moderate-to-high weekly volume were associated with greater clinical gains for knee osteoarthritis and osteoporosis. CONCLUSIONS: This umbrella review consolidates high-quality evidence demonstrating that TCEs, especially Tai Chi, provide multidimensional benefits for MSDs, improving function, pain, mental health, sleep and BMD with sustained practice. PROSPERO REGISTRATION NUMBER: CRD420251080573.