Performance of Tai Chi Chuan and NF-κB-driven proinflammatory gene expression (IL-6, IL-1β, TNF-α) in adult chronic disease patients: a systematic review and meta-analysis of randomized controlled trials.

Objective: This systematic review and meta-analysis aims to evaluate the effects of Tai Chi Chuan on the expression of pro-inflammatory genes IL-6, IL-1β, and TNF-α-downstream of the NF-κB pathway-in adults with chronic diseases. It further explores potential anti-inflammatory mechanisms and identifies research gaps in the literature regarding these mechanisms. Methods: This study searched seven electronic databases for relevant literature, with language restrictions limited to English and Chinese. The risk of bias in all included trials was assessed using the Cochrane Risk of Bias Assessment Tool (version 2.0) and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. Standardized mean differences (SMD) with 95% confidence intervals (CI) were used to evaluate pooled effect sizes. P values < 0.05 were considered statistically significant. Subgroup analyses were conducted according to disease systems. Results: We retrieved a total of 1,110 relevant studies, with 20 studies ultimately included in the analysis. These covered diseases across multiple systems, including oncology, endocrinology, respiratory, and neurological disorders. To more directly reflect intervention effects, we extracted the mean ± standard deviation of change values post-intervention compared to baseline as the analysis data. After assessing publication bias and minimizing heterogeneity effects, we found that Tai Chi Chuan significantly reduced the expression of downstream target genes (SMD = -0.48, 95% CI: -0.76 to -0.19, p < 0.01), significantly down-regulated IL-6 (SMD = -0.66, 95% CI: -1.27 to -0.06, p = 0.03), and IL-1β (SMD = -0.59, 95% CI: -0.95 to -0.23, p < 0.01). while TNF-α showed a downward trend but without statistical significance (SMD = -0.28, 95% CI: -0.59 to 0.02, p = 0.07). Subgroup analysis revealed that patients with endocrine and respiratory system diseases derived the most significant benefit. Conclusion: Tai Chi can alleviate systemic inflammation in patients with chronic diseases by suppressing NF-κB-driven pro-inflammatory gene expression, demonstrating both safety and feasibility. Furthermore, we identified gaps in existing research on Tai Chi and NF-κB, particularly the lack of randomized controlled trials (RCTs). Future studies should conduct RCTs with NF-κB core proteins and factors as direct outcome measures to directly elucidate Tai Chi's regulatory effects on the NF-κB pathway. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251112908.