We used the updated Arksey and O’Malley five-stage framework [37] to guide the conduct of the scoping review. Specifically, we followed these steps: (1) identifying the research question based on the research team’s experience in conducting Tai Chi–related research and reviewing current literature; (2) identifying relevant studies; (3) selecting the studies; (4) charting the data; and (5) collating, summarizing, and reporting results. Steps 2-5 are described in detail below. Additionally, we used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews) guidelines [38] to draft and report this scoping review. The PRISMA-ScR checklist can be found in Multimedia Appendix 1. We registered this review at the Open Science Framework [39].

We searched the electronic databases PubMed and CINAHL in September 2022. Medical Subject Headings terms “Tai Chi” and “music” were used to build the search strategy on PubMed. The search strategies for PubMed are illustrated in Multimedia Appendix 2. Subsequently, the search terms used on CINAHL were constructed based on the PubMed search strategy. Given that Tai Chi originated in China, where the use of music during Tai Chi is common, we also searched Chinese databases CNKI and Weipu. “太极” (Tai Chi) and “音乐” (music) were used to search through Chinese databases. We did not set language or publishing year restrictions in the database searches as we aimed to comprehensively cover this topic in this scoping review.

Inclusion criteria were (1) studies with comparisons between Tai Chi with music and Tai Chi without music, (2) published journal studies, and (3) at least 1 study group examining Tai Chi with music and 1 group examining Tai Chi without music. Given the broad scope of this scoping review, no age limit was set. Outcomes could encompass any measurements evaluated in the studies such as Tai Chi practice adherence and health outcomes. Exclusion criteria were (1) studies with nonempirical design, such as view paper, review paper, and protocols, and (2) experimental studies without comparisons between Tai Chi with and without music.

First, all search records were merged, and duplicates were removed. The eligibility criteria were then discussed and refined by the study team based on the search processes. YD screened the title and abstract based on the inclusion and exclusion criteria. YD and YH independently screened the full papers according to the eligibility criteria. Any discrepancies were resolved through discussions and consultations with a third researcher (GXW).

YD drafted the data extraction form. YD and YH tested the extraction by charting 2 studies independently and refined the data extraction form accordingly. The form included study location, study design, sample characteristics, Tai Chi selection, music selection, assessed outcomes, and study findings. YD and YH independently extracted data from each study according to the extraction form. Any discrepancies were resolved through discussions and consultations with a third researcher (GXW). Data were extracted in the original published language, and a bilingual researcher translated the Chinese data into English after synthesis, which was then checked by a native English speaker.

We used a narrative approach to summarize, analyze, and assess the evidence in this review. Specifically, one table charted the characteristics of included studies, and another table summarized the use of Tai Chi and music in each study. A thematic analysis approach [40] was adopted to summarize and categorize the findings of included studies. First, YD created a codebook based on the coding of the extracted data and summarized the findings for each code. Second, YH and GXW reviewed the codes and summary findings against the extracted data. Summary quotes are quotes summarized by the authors but not direct quotes from the studies included. Subsequently, YD, YH, and GXW categorized the codes into subthemes. The study team reviewed the themes, subthemes, codes, and summary quotes. Given the scoping nature of this review, no assessment of study quality was conducted.

This scoping review aimed to map out the application of music in Tai Chi practice. We identified 7 studies published in either Chinese or English using controlled trials to compare the differences between practicing Tai Chi with and without music on various outcome measures. Most studies were conducted in China, and the selection and use of music for Tai Chi practice were heterogeneous. There is clear positive evidence supporting the beneficial effects of applying music to Tai Chi practice to improve the perceived quality of Tai Chi instructions and promote Tai Chi learning experience, enjoyment, concentration, adherence, and movement performance. However, further investigations are needed regarding how music should be selected in Western culture, its benefits in beginners versus advanced practitioners, and whether listening to music alone would lead to similar health benefits compared to practicing Tai Chi with music.

The studies included in this review used various types of music for Tai Chi practice, and music was used either throughout the instruction and routine practice or only for routine practice but not during instruction. In general, the music selected was soothing, soft, and relaxing [31,44,45]; aligned well with the soft, gentle, slow, and graceful movements of Tai Chi; and suitable to participant culture [31,45]. The finding is consistent with another study reviewing the psychophysical effects of music in sports and exercise [46]. The review indicated that the keys to selecting music should include considering not only the sociocultural background of the practitioners but also the nature of the physical activity and coordination with the physical activity task [46]. Therefore, music was often used in sports for pre-event preparations, warm-ups, and training sessions. In this review, music was played either throughout the Tai Chi class session or only during practicing the Tai Chi routines, both of which formats showed favorable effects [31,45]. However, since most of the included studies were conducted in China, further investigation is needed to determine the generalizability of these findings to other regions. In addition, Tai Chi has been strongly recommended to improve balance and promote health in the aging populations; while most included studies focused on Chinese college students, studies assessing to what extent the findings may apply to older populations are warranted.

Evidence from many studies suggests that music could promote positive effects during exercise, such as increasing motivation, happiness, confidence, relaxation, and performance levels [47,48]. Similarly, we found that practicing Tai Chi with music could yield higher learning motivation [41], concentration [41], enjoyment [42], confidence [43,45], performance and compliance [31,41,43-45], and lower perceived difficulties in learning Tai Chi [45]. Previous studies reported that many people who do not habitually engage in exercises often find it difficult to initiate an exercise routine, and some well-documented barriers to regular exercise engagement include a lack of motivation and enjoyment and feeling bored and physically uncomfortable [49]. The findings from the included studies may suggest that adding music to Tai Chi practice could help alleviate the barriers to engaging in Tai Chi exercise, especially for beginners. For example, among the included studies, one study found that Tai Chi beginners had a stronger positive influence from music than advanced practitioners assessed by galvanic skin responses (a signal for capturing the autonomic nerve responses) and subjective enjoyment [50]; this may indicate that Tai Chi beginners may benefit more from using music when practicing Tai Chi in comparison to more advanced users [42]. Music could likely help beginners feel relaxed and focused, and promote Tai Chi exercise in those who are new to learning Tai Chi. For more advanced Tai Chi practitioners, this may vary depending on various factors such as the practitioner’s mood and environment [36]. As an exercise that originated in Asian culture, adding music affiliated with Western populations may help promote its instruction, implementation, and dissemination. However, further investigations are needed to confirm this assumption.

The findings differ when assessing improvements in health outcomes through adding music. Balance, as measured by the dynamic gait index, was found to be significantly improved in the study participants incorporating music, but not in their counterparts practicing Tai Chi without music after a 15-week Tai Chi intervention. Balance is a frequently studied measurement of Tai Chi’s effects on health [51], and the Centers for Disease Control and Prevention also highly recommends that older adults practice Tai Chi to improve balance [52]. For other assessed health measurements, although not significant, trends showed better outcomes in the Tai Chi with music group such as physical symptoms and depression. For other health measurements, no significant improvements were detected, which could be due to the relatively short intervention lengths. Further research with longer interventions and a larger sample size is warranted to explore the possible symbiotic effect of Tai Chi and music on health outcomes.

Integrating music into Tai Chi practice may offer a promising avenue for enhancing its benefits on health outcomes in a holistic approach. First, based on the findings of this review, the health benefits could be through the pathway of a positive influence of added music on perceived enjoyment and concentration, improved adherence or compliance, and overall positive experience. In addition, as evidenced in the literature, listening to music alone could improve a variety of health outcomes including but not limited to mental health, cognitive function, and cardiovascular health [53-58]. Therefore, we hypothesized a theoretical framework of adding music to Tai Chi practice to increase its benefits on health outcomes (Figure 2). Future research could focus on whether the application of music to Tai Chi practice leads to synergistic effects on health outcomes. This includes both physical (eg, mobility, balance, and metabolic health), cognitive (eg, orientation and memory), and mental health (eg, stress and depression symptoms). Studies could also aim to quantify these outcomes and understand the underlying mechanisms driving these potential benefits. It is also warranted to investigate which music (such as type of music, its tempo, and rhythm) is appropriate to maximize health benefits, and how these factors might influence different populations such as various age groups and health conditions. These investigations may provide insights into how to improve health through a holistic approach. Last, but not least, qualitative studies to gather in-depth insights from participants on their experiences, preferences, and perceptions of Tai Chi practice with music may provide valuable information to guide the development of tailored and effective Tai Chi exercise programs. Tools and recommendations could be developed to guide interventions using music to Tai Chi practice for health benefits.

The findings of this scoping review should be interpreted with caution due to the majority of included studies being conducted in China among college students. Even though music has been used during Tai Chi practice in other populations as reported in prior studies [26], the mechanisms of using music in Tai Chi practice in various populations have been understudied. Further research is needed to explore the mechanisms and the potential harms or benefits and establish the practicality of using music for Tai Chi practice in other regions and populations. In addition, the heterogeneous interventions, lengths, and frequencies of the included studies may further limit the application of the findings.

Based on the findings of the included studies, Tai Chi style or form selection, the music used during Tai Chi practice, and the studied populations were heterogeneous. Various outcomes, such as differences in Tai Chi practice experience, instruction quality, and health outcomes, were assessed. There is positive evidence supporting the beneficial effects of applying music to Tai Chi practice to improve the perceived quality of Tai Chi instructions and promote Tai Chi learning experience, enjoyment, concentration, adherence, and movement performance. Particularly, including music in Tai Chi practice may promote Tai Chi among individuals new to Tai Chi practice through perceived better instruction and learning experience. Therefore, applying music to Tai Chi learning and practice might help promote the implementation of Tai Chi in the general population. However, further study with a rigorous study design is needed to clarify if there are synergistic effects of Tai Chi and music on health outcomes.