Falls in older adults, which often result from decreased balance and mobility, are an important public health issue. The American College of Sports Medicine recommends multidimensional balance and mobility training to prevent falls. In the past 20 years, Tai Chi Chu'an (tai chi) has been found to be effective in improving balance, reducing falls and fear of falling for older adults. Efficient use of time devoted to exercise is critical; therefore, more research is needed into the underlying mechanisms of balance and mobility improvements in older adults as a result of tai chi practice, so that these interventions can be most targeted and efficient. The purpose of this integrative review is twofold. First, evidence is presented to show that balance and mobility have been improved by tai chi in older adults. Second, potential mechanisms of balance improvement from research conducted in longtime tai chi practitioners, and from clinical research conducted in older adults, are offered. A PubMed search with the terms "tai chi" and "balance" entered simultaneously was conducted. Articles were included if they were systematic reviews, pilot or clinical trials, related to both balance and tai chi, and/or specifically related to determining the mechanisms potentially underlying tai chi's effects. The systematic reviews and meta-analyses show that aspects of tai chi research findings remain equivocal. In spite of the inconclusiveness of these review findings, many researchers have considered tai chi worthy of further investigation. Furthermore, practitioners in the clinic and those who deliver exercise in the community have evidently embraced tai chi as an appropriate exercise for older adults. This review, spanning 2 decades, suggests that tai chi has impacted the health and health behaviors of many older adults. Going forward, informing novel balance and mobility rehabilitation by uncovering mechanisms of tai chi's effects definitively may be the most important area of discovery in this field.
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