BACKGROUND: Self-esteem is a psychological outcome that is positively related to mental and psychological health, one of the most important elements in nursing. Developing strategies for self-esteem promotion is therefore of great importance in nursing practice. Previous reviews suggested that exercise interventions such as Tai Chi practice may confer both mental and physical benefits in humans, but reviews on the effect of Tai Chi exercise on self-esteem of adults are lacking. Thus, this systematic review and meta-analysis was conducted to evaluate the effectiveness of Tai Chi interventions in promoting self-esteem among adults. METHODS: We included randomized controlled trials that investigated Tai Chi interventions in adults, where self-esteem and/or self-confidence were reported as outcomes. The literature search was conducted in ten electronic databases. Two independent reviewers performed abstract and full-text screening using Covidence. These reviewers also independently extracted data from the included studies, and conducted critical appraisal of their methodological quality, using the revised Cochrane risk-of-bias tool for randomized trials (RoB2). RESULTS: Eleven studies were included in the review, of which all were rated as having high risk of bias or some concerns in their methodological quality. Our meta-analysis demonstrated that Tai Chi intervention can significantly improve self-esteem among adults, where the post-intervention self-esteem score was higher among the intervention participants compared to the controls (standardized mean difference: 0.46
95% CI: 0.18-0.74
p = 0.001). Sensitivity analyses by excluding studies not reporting data using means and standard deviations revealed similar findings. One study also showed a positive effect of Tai Chi intervention on self-confidence perception. CONCLUSIONS: Tai Chi interventions have a moderately positive effect on self-esteem among adults. Tai Chi exercise classes could be a potential strategy to implement within communities, especially among individuals in higher need to improve their self-esteem such as older adults and patients having chronic illnesses that have detrimental effects on their psychological well-being. However, given the high risk of bias in most studies, caution is advised before recommending widespread implementation. Further high-quality research, including qualitative studies exploring how Tai Chi can improve self-esteem, is needed to strengthen the evidence base.