The results of a randomized and controlled non-inferiority trial, published late 2025 in BMJ, compared tai chi to cognitive behavioral therapy for insomnia (CBT-I) for the management of chronic insomnia. Two-hundred eligible participants with chronic insomnia (average age of 64) from a single site in Hong Kong were randomly assigned 1:1 to either tai chi, which comprised 24 one-hour group training sessions over 3 months (two per week) with an instructor of the Yang style of tai chi, or they were assigned to CBT-I. CBT-I, the recognized first-line treatment, also included 24 one-hour group sessions with an instructor for sleep education, stimulus control, cognitive therapy, etc. The primary outcome was the change in perceived insomnia severity measured by the Insomnia Severity Index (ISI), assessed 3 months after the intervention (month 3) and 12 months after the intervention (month 15). The ISI ranges from 0 to 28, with a change of ≥8 established as the minimally important difference to detect moderate improvement.
At baseline, most participants had moderate insomnia. At 3 months, people in the tai chi group experienced a reduction of 6.67 in the ISI, while the CBT-I group had a reduction of 11.19, and tai chi was concluded to be inferior to CBT-I at that point. However, at 15 months, the reductions were 9.51 for tai chi and 10.18 for CBT-I, and tai chi was non-inferior at that point. Similarly, insomnia remission rates were superior for CBT-I at 3 months, but were similar by month 15. Intention-to-treat and per-protocol findings were consistent. Much like a previous study comparing these two interventions among women with breast cancer and insomnia, this study supports the long-term strategy of using tai chi to manage chronic insomnia.