Falls have become a major health problem for older adults worldwide, ranking first in incidence and mortality among accidental injuries in older adults.1 Falls not only result in the physical trauma such as soft tissue injury and fractures, but also in psychological problems such as fear of falling, anxiety, depression, and social isolation, which can increase the economic burden on the family and society. Fear of falling (FOF) refers to the negative psychological state of avoiding activities or even refusing to engage in physical behaviour within the limits of one's ability due to excessive concern about falling events.2 The incidence of FOF in older adults is as high as 21–85%,3 which leads to limited mobility, increased hospitalization rate and mortality in older adults. FOF is also a risk factor for repeated falls in older adults,4 which seriously reduces the quality of life in old age. Therefore, the FOF of older adults requires urgent attention.

As a traditional Chinese medicine health exercise, Tai Chi has the effectiveness of strengthening the body, it is economical and is easily accepted by older adults. To date, five mainstream styles of Tai Chi have been developed, including Chen, Yang, Wu, Wu, Sun styles. Of these, Yang style is the most widely practised. After the founding of the People's Republic of China, twenty-four simplified Tai Chi, forty-eight, eighty-eight and forty-two Tai Chi were created. However, these different styles or forms share common elements. The whole set of movements is coherent, uniform, round and natural, covering important parts such as the shoulders, elbows, hips, knees, thighs, ankles, etc. During the exercise process, the load generated by muscle movement stimulates bone cell activity and repairs bone structure, which helps to improve bone density content, joint muscle strength and neuromuscular response,23 improve older adults' postural stability and movement coordination, and maintain joint and ligament flexibility, helping to maintain balance and prevent falls. Existing RCTs have shown that Tai Chi exercise can effectively improve FOF and balance in older adults, but there was no evidence-based medical evidence to support this. Therefore, the aim of this meta-analysis was to evaluate the effectiveness of Tai Chi on FOF and balance in older adults and to provide an evidence-based basis for future work in this area.