Journal of Evidence-Based Medicine ISSN 1756-5391

REVIEW ARTICLE

Effects of martial arts on health status: A systematic

review
Bin Bu1,2 , Han Haijun, Liu Yong, Zhang Chaohui2 , Yang Xiaoyuan1 and Maria Fiatarone Singh3
1
Department of Sports Medicine, Chengdu Sport University, Chengdu, Sichuan, 610041 P.R. China
2
Institute of Sports Science, Institute of Public Health & Social Development, Sichuan University, Chengdu, Sichuan, 610041 P.R. China
3
The School of Exercise and Sports Science, Faculty of Health Science, The University of Sydney, NSW Australia 21413

Keywords
Martial arts; health; random; control
Correspondence
Bin Bu, Department of Sports Medicine,
Chengdu Sport University, Chengdu, Sichuan
610041, P.R. China.
Tel: +28-89583618
Email: bubin26@hotmail.com
Maria Fiatarone Singh, The School of
Exercise and Sports Science, Faculty of
Health Science, The University of Sydney,
NSW, Australia 21413.
Tel: 612 9351-9755
Email: m.singh@usyd.edu.au
Received 28 July 2010; accepted for
publication 15 October 2010.
doi: 10.1111/j.1756-5391.2010.01107.x
Abstract
Objective To systematically summarize the evidence for the effects of martial arts
on health and fitness, to show the strengths of different types of martial arts, and
to get a more complete picture of the impacts of martial arts on health, and also
to provide a basis for future research on martial arts as an exercise prescription in
exercise therapy.
Method We searched for “martial arts” “health” and “random” in eight databases
(n = 5432). Randomized controlled trials and controlled clinical trials on the health
effects of martial arts were included in the study.
Results The final analysis included 28 papers (one general martial arts, one kung
fu, sixteen tai chi, six judo, three karate, and one taekwondo). Among the disci-
plines of martial arts, tai chi was the most well-studied, followed by judo, karate,
and taekwondo. Research topics varied widely, and included health, injuries, com-
petition, morals and psychology, and herbal medicine. Most found positive effects
on health. Tai chi is no-contact, low-impact, soft body and mindfulness exercise,
which has been widely adopted by elderly people and proven to be a beneficial
health promotion exercise. Research on judo, karate, and taekwondo mainly fo-
cused on improvements to athletes’ competitive abilities, rather than on health
effects. We did not find any published randomized controlled trials or controlled
clinical trials on aikido, kendo, sumo, kyudo, qi gong, or other disciplines.
Discussion and Conclusion Since martial arts are widely practiced, their effects
on physiology, morphology, immunology, and neurology should be further studied
in order to help people to select the best discipline or style to accomplish their
purposes. This necessitates categorizing and classifying the disciplines and styles
according to their effects on different body systems and levels of contact, as well
as standardizing evaluation criteria for martial arts. Martial arts as an exercise pre-
scription can then move from an experience-based to an evidence-based treatment.

Each style has its own traditions of training and philosophy.

Introduction
Martial arts are body, mind, and spiritual practices that origi-
nated in China. They include Western boxing (1, 2). In ancient
times, martial arts were practiced for self-defense, but now
they are mainly used for self-improvement (3, 4).
There are about 200 distinct disciplines of martial arts, and
each discipline has specific schools called styles or systems.
These styles number are in the thousands Each discipline has
different facets that make them unique. However, all share the
common goal to defend oneself from physical threat. Within
some martial arts there is also a deep sense of spirituality.
In recent years martial arts has evolved into a part of the fit-
ness industry; almost every town boasts martial arts training
schools. It is estimated that various forms of martial arts are

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c 2010 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University 205
Effects of martial arts on health status
practiced by more than 100 million people throughout the
world. (John Corcoran, Chairman, Curriculum Committee,
American Council on Martial Arts by Health library, Univer-
sity of Sydney).
Today, martial arts are studied for various reasons, includ-
ing fitness, sport, self-defense, combat skills, self-cultivation
(meditation), mental discipline, character development, self-
confidence, and as a complementary or alternative therapy
for some medical conditions (5).
In the health promotion and fitness field, martial arts is
important exercise prescription that is popular in many co-
horts. For example, elderly persons can benefit from tai chi
(12–14), whereas many younger people prefer taekwondo,
and yoga (a derivative of martial arts) is especially popular
among young women (15, 16).
The greatest advantage of martial arts for healthcare is
that, compared to most drugs, it is a relatively inexpensive,
simple treatment (21, 22) that can improve both physical
and mental capacities. A variety of health-related benefits of
martial arts have been documented for older adults. Tai chi is
the most-studied martial art, with proven benefits including
stress reduction (23), improved agility and balance, posture
control (24), and lower extremity strength. Tai chi also ap-
pears to be an effective sleep enhancer for sleep-disturbed
elderly individuals (25).
Martial arts can impede the decline of the muscular-
skeletal system that occurs with aging, and the associated
deterioration in functional capacity and increased risk of falls
and hip fractures.
Currently, the only systematic reviews of the health effects
of martial arts have focussed on tai chi (26, 27). There have
been no systematic reviews performed on how martial arts in
general can be applied for health and fitness gains in clinical
populations. Martial arts as a subject term it is often mixed
with its sub-branches such as tai chi, karate, taekwondo, or
judo in search engines, making the reviewer’s task harder.
For examples On Sport Discus, Scop Note for Martial Arts
is used for sub-branches: aikido, judo, karate, kung fu, tae
kwon do, martial arts, and taekwondo. On Pub med Martial
arts is used as a MeSH term expression, in its sub-branches
MeSH tree, and Entry Terms: Arts, Martial, Tai ji, aikido,
judo karate, kung Fu, gong fu, fu, gong, gongfu, tae kwon
do, which in different organized using
Since martial arts have been playing an important role
in the health field, research on it is ongoing. The aim of
this review is to systematically summarize the evidence for
the effects of martial arts on health and fitness, to show the
strengths of different types of martial arts, and to get a more
complete picture of the impacts of martial arts on health, in
order to provide a basis for future research into martial arts as
an exercise prescription. We also aim to generate evidence-
based recommendations on the most suitable martial arts
programs for different populations.
206 JEBM 3 (2010) 205–219 
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B Bu et al.
Methods
We undertook a systematic, critical review rather than a meta-
analysis because the diversity of martial arts and the het-
erogeneity exercise modalities, dosages, and outcomes as-
sessed in studies do not lend themselves to the meta-analytic
method. Randomized controlled trials (RCTs) in this field
are very limited, so we included some other study designs as
well. Our criteria for including studies were:
1. Study design RCTs and clinical controlled trials (CCTs)
were included in our analysis. Some uncontrolled trials were
also considered for reference. The searched list of trials was
compared with those references identified from a search of
the Specialized Register of the Cochrane Centre for mar-
tial arts scope, EBM Reviews-Cochrane Central Register of
Controlled Trials.
2. Subjects
Subjects were males and females of any age who prac-
ticed martial arts as an exercise prescription to improve
health or prevent disease. Trials prescribing martial arts
training modalities for health, fitness and well-being were
included (28). Studies investigating the effects of single,
acute bouts of martial arts practice were excluded. Studies
involving multimodal interventions, such as martial arts com-
bined with some nutritional supplementation or other treat-
ments, were also excluded. We did, however, include some
studies on interventions affecting the health of martial arts
athletes.
3. Interventions
We searched for studies with martial arts in the title or
key words. if the studies searching automatically changed
to its scope sub-branch disciplines, such as tai chi, judo,
karate. . . .as interventions, which are included in MeSH tree
and Sport Discus scope note, they were also included for con-
sideration. Only keywords used to describe the intervention
were used. After the search, titles and abstracts of identi-
fied published articles were reviewed for relevance . Next,
the references in relevant reviews, RCTs, and CCTs were
screened.
4. Outcome Measures
We included studies with outcomes relevant to health out-
come, such as cardio respiratory function (our primary out-
come measure), falls, balance (a secondary outcome measure
which can predict risk of falling), strength, and quality of life.
5. Search strategy
A broad computerized literature search of Medline via Ovid,
PubMed in all fields, Sport Discus, CINAHL, CAM, EM-
BASE, EBM Cochrane Database of SR, EBM Reviews-
Cochrane Central Register of Controlled Trials, and Web
of Science was carried out for the period of May 2007 to
December 2008. First, four categorical searches were con-
ducted using the keywords ‘Martial arts’ plus ‘health.’ If
there were no results, we changed the search to ‘martial
B Bu et al.
arts’ plus ‘cardiovascular, hypertension, strength, balance,’
then plus ‘Random.’ Next, all of these keywords were com-
bined in searching, and duplicate results were removed. All
articles in the search results were manually searched for po-
tential inclusion in the review. Articles retrieved, review arti-
cles, and position papers were examined for further relevant
references.
6. Publication language selection
We included only English-language articles.
All criteria were applied independently by two reviewers
(BB and MS) to the full text of the articles that had passed the
first eligibility screening, in order to make a final selection
of studies for the review.
Quality assessment
Two reviewers (BB and MS) performed the methodological
scoring of the trials independently, using the methodolog-
ical quality checklist (the Delphi list, see Table 1) devel-
oped by Verhagen et al. The Delphi list is a comprehensive
criteria list of nine items for assessing the methodological
quality of clinical trials (29). It consists of two items re-
lated to treatment allocation, three items on blinding pro-
cedures, two items on data presentation and analysis, and
two items on the study population and the prognostic com-
parability of the study groups. A pilot assessment of one
RCT, which was not included in the review, was done in
order to test the list of criteria. Differences in scores were
resolved by discussion between the two reviewers, and a
third reviewer was consulted if disagreements could not
be resolved. In cases of multiple publications of one trial,
information on Delphi quality items was derived from all
publications.
Because martial arts is not a simple physical exercise inter-
vention, but a body-mind-spirit practice (30), we designed a
complementary influence factors list for martial arts study in
evaluating the studies, was put forward for further evaluation
(Table 2).
Data extraction
Specific information about subjects’ demography, interven-
tions, and outcome measures was recorded using standard-
ized abstracting forms. Only outcome measures such as car-
dio respiratory function, falls, or balance and so on were
assessed, because they are more relevant health status.
Analysis
The Delphi criteria list consists of 22 items, and our com-
plementary criteria table has 13 items, all with the answer
options ‘yes’/‘no’/‘don’t know’ (Tables 1 and 2). If bias
was unlikely, the criterion was rated positive ‘yes.’ In cases
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Effects of martial arts on health status
where information was lacking or insufficient or if bias was
likely, the criterion was rated ‘no’ or ‘not mentioned.’ All
‘yes’ scores were summed to produce an overall quality
score.
Intervention and setting homogeneity was evaluated by
exploring the differences between the RCTs with regard to
study populations, types of reference treatments, and out-
comes. Whenever studies were heterogeneous, we did not
perform statistical pooling, but summarized the results us-
ing a rating system for ‘levels of evidence’ (31). The rating
system consisted of five levels of scientific evidence which
have been used in previous systematic reviews in the field of
back pain, and which are based on the quality and the out-
come of the studies. In this review, we categorized the quality
of studies as: (A) randomized using an adequate (preferably
concealed) randomization schedule and method of blinding,
(B) a quality score of at least 75% of the maximum available
score, (C) a quality score of at least 50% of the maximum
available score, or (D) less than 50% of the maximum avail-
able score.
Statistical analysis
An effect size (ES) over the intervention time (standardized
mean response) for each of the groups was calculated, if
possible, using the equation:
ES = (Mean POST − Mean PRE)/SD PRE.
The relative ES as a difference between the control and the
intervention group ES is calculated as:
ES RELATIVE = ES INTERVENTION − ES CONTROL.
Ninety-five percent confidence intervals for the relative ef-
fect size were calculated. This method takes into account
differences in baseline values between the groups, as well as
changes over time seen in both the control and the interven-
tion groups.
Results
1. Study inclusion/exclusion
The process of study inclusion/exclusion is presented in
Figure 1. On PubMed, ‘Martial Arts’ yielded 638 papers,
combining the term with ‘health’ yielded 176, and adding
‘random’ to the search terms yielded two results.
On Sport Discus, ‘Martial Arts’ yielded 3006 papers, ex-
pand got 8257, limiting the results to articles and English-
language yielded 480, and combining ‘martial arts’ with
‘health’ and ‘random’ yielded 0.
On CINAHL, ‘Martial Arts’ yielded 179 papers, and com-
bining the term with ‘health’ and ‘random’ yielded 10.
207
208
Table 1 Study quality
Author, Year a b c d e f g h i j k l m

Kutner NG 1997, (TC) (38) Yes Yes NM Yes No NM NM Yes NM Yes Covariates, logistic Follow up 71%
regression response 160/200
Wolf SL 1997, (TC) (24) Yes Yes NM Yes No NM NM Yes NM Yes ANOVA t-test No No
Jones MA 1998 (Kung Fu) (52) Yes Yes/part NM Yes No NM NM Yes NM Yes ANOVA Comparison No NM
Pre-post
Ross MC 1999 (TC) (?) Yes NM NM Yes No NM NM Yes NM Yes ANOVA Practise 4/17
Two tailed test <90%
Effects of martial arts on health status

two groups

JEBM 3 (2010) 205–219 

Hong YL 2000 (TC) (42) Yes NM NM Yes No NM NM Yes NM Yes ANOVA F-test, No No
Kruskat-wallis test’
Chi-square test
Wolf SL 2003 (TC) (36) Yes Yes Yes Yes Yes NM Yes Yes NM Yes ANOVA GEE modle Declining 16%
health
Li, F 2001 (TC) (42) Yes Yes NM Yes No NM NM Yes NM Yes ANOVA Traveling NM
Descriptive statistics, family
Paried t-test
Nowalk MP 200 (TC) (44) Yes Yes Yes Yes No NM NM Yes NM Yes ANOVA NM NM
Zivin G 2001 (martial arts -Kata) (9) Yes Yes NM Yes No NM Yes Yes NM Yes Scale rating NM NM
Finaud J 2006 (Judo; diet/weight) (3) Yes Yes NM Yes No NM Yes Yes NM Yes ANOVA NM NM
(0.8–0.85)
Laskowski R 2003 (Judo) (50) Yes NM NM Yes No Yes NM Yes NM Yes ANOVA NM NM
Cottin F 2000 (Judo) (51) Yes NM NM Yes No Yes NM Yes NM Yes ANOVA Two way NM NM
Wolach, B 2000 (Judo) (48) Yes NM NM Yes No Yes NM Yes NM Yes ANOVA Un paired-t NM NM
Palermo, MT 2006 (Karate) (7) Yes Yes Not Yes No Yes Yes Yes NM Yes Fisher’s exact test NM NM
Wetzel, D2002 (Karate) (73) Yes Yes Yes Yes Yes Yes NM Yes NM Yes ANOVA NM NM
Channer KS 1996 (TC) (35) Yes Yes NM Yes No NM NM Yes NM Yes Non-parametric method Yes Yes 18%
Lai JS 1995 (TC) (34) Yes Not NM Yes No NM NM Yes NM Yes ANOVA Paired t-test Not No
Young DR 1999 (TC) (8) Yes Yes Yes Yes No NM NM Yes NM Yes ANOVA Not NM
Wolfson L 1996 (TC) (67) Yes Yes NM Yes No NM NM Yes NM Yes ANOVA Yes missing 106/110
atten-
dance
Wolf SL 1993,2006 TC) (66/76) Yes Yes NM Yes No NM NM Yes NM not ANOVA Not No
Hartman CA 2000 (TC) (41) Yes Yes Yes Yes Yes NM NM Yes NM Yes ANOVA mix-factor Yes missing 16%
atten-
dance
Ryan 2006 (TC) Yes Yes NM Yes Yes NM NM Yes NM Yes Excel t-test Yes n corpo NM

Continued

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B Bu et al.
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Table 1 Continued

JEBM 3 (2010) 205–219 

Author, Year n o p q r s t u v w x y z

Kutner NG 1997, (TC) 70, 130/ 70 No NM Yes 95% 130/200 160/200 80% NM p < 0.05 B
200
Wolf SL 1997, (TC) No 72/200 No No Yes 95% p < 0.05 NM NM p < 0.05 B
Jones MA 1998 (Kung Fu) NM NM Yes 95% p < 0.05 NM Moderate p < 0.05 B
intensity
Ross MC 1999 (TC) NM 4/17 NM NM Yes 95% p < 0.05 4/17 4/17 NM p < 0.05 C
Hong YL 2000 (TC) NM No NM NM Yes 95% p < 0.05 100% 28TC v 33 Moderate Positive p < 0.05 C
sedentary intensity
Wolf SL 1996 (TC) 20% 16% NM NM Yes 95% p < 0.05 16% 13%(87%) Moderate Positive p < 0.05 B
(84%) intensity
Li, F 2001 (TC) Yes 23% NM NM Yes 95% p < 0.05 90% 90% average Moderate Positive p < 0.05 B
intensity
Nowalk MP 200 (TC) NM NM NM NM Yes 95% p < 0.05 NM >67% Moderate Positive p < 0.05 B
intensity
Zivin G 2001 (martial arts -Kata) NM NM No NM Yes 95% p < 0.05 NM NM NM p < 0.05 B
Finaud J 2006 (Judo; diet/weight) NM NM No No Yes 95% p < 0.05 NM NM Professional p < 0.05 B
(competi-
tion)
LA skowski R 2003 (Judo) NM NM NM NM Yes 95% p < 0.05 100% 100% not p < 0.05 C
Cottin F 2000 (Judo) NM NM NM NM Yes 95% p < 0.05 100% 100% Yes p < 0.05 C
Wolach, B 2000 (Judo) NM NM NM NM Yes 95% p < 0.05 100% 100% Aerobic/ Positive p < 0.05 C
anaerobic
Palermo, MT 2006 (Karate) NM NM NM NM Yes 95% p < 0.05 100% Yes not Positive p < 0.05 B
Wetzel, D2002 (Karate) NM NM NM NM Yes 95% p < 0.05 not not Impact Positive p < 0.05 B
Channer KS 1996 (TC) Yes 18% No NM Yes 95% p<0.05 82% 82% Soft p < 0.05 B
Lai JS 1995 (TC) No no No No Yes 95% p<0.05 NM Moderate p < 0.05 C
Young DR 1999 (TC) not not NM NM Yes 95% p < 0.05 100% Moderate p<0.05 B
(light)
Wolfson L 1996 (TC) NM 106/110 Yes Yes Yes 95% p < 0.05 96%/89% 72% Repeated p < 0.05 B
measures
Wolf SL 1993 2006(TC) NM No NM NM Yes 95% p < 0.05 96%/89% 28TC v 33 Moderate Positive p < 0.05 B
sedentary intensity

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Continued

209
Effects of martial arts on health status
210
Table 1 Continued
Author, Year n o p q r s t u v w x y z

Hartman CA 2000 (TC) 20% 16% NM NM Yes 95% p < 0.05 16% 13% (87%) Moderate Positive p < 0.05 B
(84%) intensity
Ryan 2006 (TC) Yes 23% NM NM Yes 95% p < 0.05 90% 90% average Moderate Positive p < 0.05 B
intensity

a: Eligibility Criteria Specified.

Effects of martial arts on health status

JEBM 3 (2010) 205–219 

b: Randomized.
c: Randomization Concealed.
d: Baseline Characteristics Reported.
e: Blinded Assessment.
f: Subjects Blinded.
g: Power Calculations.
h: Valid Measurement Tools.
i: CV Reported for Tools.
j: Results Reported.
k: Type of Analysis.
l: Missing Data Imputed /Accounted For.
m: Drop-out.
n: Loss to follow-up reported.
o: Drop-out Reported (n, or%).
p: Reported Adverse Events.
q: Type of Adverse Event.
r: Analysis.
s: SD or Confidence Intervals.
t: Compliance.
u: Attendance (%).
v: Intensity.
w: Aim of trial (Hypothesis).
x: Outcome.
y: Rate of score.
z: Effect Size.
Not mentioned: NM.

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Table 2 Study quality Complementary considerations of influence factors for martial arts

JEBM 3 (2010) 205–219 

Author, Year a b c d e f g h i j k l m

Kutner NG 1997, (TC) TC 108 forms/ 10 NM Yes “Chi” internal/ soft NM Experience NM concentration/ NM Yes Yes NM
modified forms concentration/ instructor Calmness
Calm mind-body
mind-body interaction
interaction
Wolf SL 1997, (TC) TC Specified 10 Yes/ Oriental NM soft NM Experience NM NM NM Yes 2x/ Yes 15 NM
modified forms culture instructor week week
Jones MA 1998 (Kung Fu) Kung Fu Kicking Punch NM NM External NM not Yes >3years NM HR, BP NM Yes Yes
Ross MC 1999 (TC) TC TC Yes Yes soft NM Experience Yes NM moderate Yes Yes Yes
instructor
Hong YL 2000 (TC) TC Yang style NM NM Soft (moderate NM Experience 13.2 years +/ - NM moderate Yes Yes Yes
intensity) instructor
Wolf SL 1996 (TC) TC Specified 10 NM not not NM Experience NM NM NM Yes Yes 15 NM
modified forms concentrate? instructor week
Li, F 2001 (TC) Yes TC Yang 24 forms NM Not soft NM Experience NM NM moderate Yes Yes NM
concentrate instructor
Nowalk,MP 2001 (TC)) TC NM NM Yes NM instructor not not not not 24 months NM
Jin, P 1992 (TC) TC NM NM Yes External/ hard not not 6K/ hour
Golomer, E 2005 (Judo) Judo NM NM NM NM not
Su,YC 2001(Judo) Judo NM NM NM NM professional not not not Yes Yes Yes
Zivin G 2001 (martial arts -Kata) Martial arts Kata Yes Not Not Yes master Not NM NM Yes Yes NM
Finaud J 2006 (Judo; diet/ weight) Judo competition Not Not External/ hard Self- professional 14 years NM Yes Old hand
styles determine
diet
Laskowski R 2003 (Judo) Judo competition Not Not External / hard Not professional Yes NM NM Old hand
styles
Cottin F 2000 (Judo) Judo competition Not Not External / hard Not professional NM NM NM Yes Yes National level
Wolach, B 2000 (Judo) Judo competition Not Not External / hard Not professional NM NM NM Yes Yes National level
Palermo, MT 2006 (Karate) Karate Wa Do Ryu Not Not External/ hard Not Yes NM NM NM Yes 3x/ w Yes 10 novice
month
Wetzel, D 2002 (Karate) Karate Not Not Not External/ hard Not Not Not Not Not Not Not Not
styles

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Continued

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212
Table 2 Continued
Author, Year a b c d e f g h i j k l m

Ferguson, AR 1994 (Karate)(55) Karate Yes Not Not External / hard Not Not Yes Not Not Not Not Yes
styles
Song, KY 2004 Tae kwondo(59) Tae kwondo Yes Tick Not Not External / hard Not Not Yes novice Not Not Yes Yes Yes
Schaller, KJ 1996 (TC) (13) TC Yes modified Yes Yes soft Not master Not Not Not Yes Yes Yes
Channer KS 1996 (TC) (35) TC Wu’s style NM Yes internal/ soft NM master Yes NM Not Yes Yes Yes novice
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Lai JS 1995 (TC) (34) TC Yang’s style NM Yes soft NM master Yes 6.3+/ -3 NM moderate Yes Yes Yes Old hand
year
Young DR 1999 (TC) (8) TC Yes NM not Light intensity NM master novice NM Light intensity Yes Yes novice
Wolfson L 1996 (TC) (67) TC Chang’s Not Yes Low impact Not master novice Not Light intensity Yes Yes novice
Wolf SL 1993 ? (TC) (63) TC 108 forms/ 10 Not Yes soft Not master novice Not Not Yes Yes novice
modified forms
Hartman CA 2000 (TC) (41) TC Yang’s style Not Yes soft Not Master novice Not moderate Yes Yes novice
certificated
Ryan B 2006 (TC) TC Yang’s style Not Yes internal/ soft Not master novice Not Not Yes Yes novice
Yeh S-H 2006 (TC(74) TC Cheng’s style Not Yes internal/ soft Not master Not Not Not Yes Yes novice
Wallsten SM 2006 (TC) TC 10 modified forms Not Not Low impact Not master Not Not Not Yes Yes novice
Thornton EW 2004 (TC) (75) TC Yang’s style Not Not Low impact Not master novice Not Not Yes Yes novice

a: Discipline Specified.
b: Style Specified.
c: Philosophy or religion.
d: Meditation Imagination/visualizing.
e: External/hard styles or internal/soft styles.
f: side-life discipline(life style discipline).
g: Instruction mode.
h: Practice history.
i: Co-aid practice.
j: Intensity/energy consumption (METs or HR).
k: Frequency/Regularity.
l: Duration (weeks).
m: Level of experience (novice or old hand).
Not mentioned: NM.

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B Bu et al. Effects of martial arts on health status

‘Martial arts’ Search Results

(n =3874)

‘‘health’ etc. Database

(n =502409)
Cochran
EBM Central
‘Random’ (n =29337) etc. Cochrane Web Register
Sports Database of Controlled
Terms Pubmed Discus CHINAHL CAM EMBASE of SR Science Trials
Potentially relevant papers retrieved
Martial Arts 638 3006 179 1 20 9 6
(n =5432)
health 176 0 0 0 0 13
Random/CCT 2 0 0/10 0 0 0 0 28
Remove duplicates and Combine all searches cardiovascular 2 2 2/0 0 0 2 0
manually search (n =54) (n =54)
hypertension 0 0 0/0 0 0 0 0
strength 0 0 0/2 0 0 0 (16)/0
balance 0 0 0/0 0 0 0 0

Excluded (n=26)
Not an RCT (n=26)
Training program did not
meet selection criteria (n=26)
Number of papers by martial arts discipline and the Re-
Included Trials (n =28) search Strength in RCT (%)

Martial arts n=1 Tai Chi n=16 Tai chi 16∗ 57.1 RCT
Fung Fu n=1 Judo n=6
(n =2) Karate n=3 Judo 6 21.4 RCT, CCT
Tae Kwando n=1
(n = 26) Karate 3 10.7 RCT, CCT
Taekwondo 1 3.6
Martial Arts 1 3.6
Kung Fu 1 3.6
Figure 1 Searching flow chart
∗
One of trials termed tai chi “mindfulness of movement”
Consensus with EBM Reviews-Cochran Central Register of Con-
On CAM on PubMed, ‘Martial Arts’ searching yielded trolled Trials, 3nd Quarter, Oct., 2007
one paper, and adding ‘health’ and ‘random’ to the search Note: We did not search for RCTs or CCTs for aikido, kendo, sumo,
yielded zero. kyudo, or qi gong

On EMBASE, ‘Martial Arts’ yielded 20 papers, but com-

bining the term with ‘health’ and ‘random’ yielded zero.
On EBM Cochrane Database of Systematic Review (SR),
‘martial arts’ yielded nine papers, ‘kung fu’ yielded zero, and
combining either term with ‘health’ and ‘random’ yielded
zero. However, ‘tai chi’ yielded 11 results.
On Web of Science, ‘Martial Arts’ yielded six papers,
combining the term with ‘health’ yielded 13, and adding
‘random’ yielded zero. In each of the databases, searching
for ‘Martial Arts’ in combination with ‘random’ and either
‘heart disease,’ ‘hypertension,’ ‘balance,’ ‘strength,’ or ‘car-
diovascular’’ yielded zero to two results.
We ultimately included 28 RCT articles, which matched
the RCT articles recognized by EMB Reviews-Cochrane
Central Register of Controlled Trials.
Tai chi 16 (32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,
47)
Judo 6 (48,49,50,51,52,53)
Martial arts 1 (54)
Karate 3 (55,56,57)
Kung Fu 1 (58)
Taekwondo 1 (59)
2. Quality assessment
Disagreement between assessors mainly occurred because of
reading errors and differences in interpretation of the method-
ological criteria list. After a consensus meeting, no disagree-
ment persisted. The third reviewer was not called upon to
make any final decisions. The results of the methodological
assessment are presented in Tables 1 and 2.
3. Study characteristics
Most of the RCTs and CCTs that met our criteria were
on tai chi (16). The highest-standard research was con-
ducted by FICSIT(Frailty and Injuries: Cooperative Stud-
ies of Intervention Techniques). Tai chi was followed by
judo (6), karate (3), and taekwondo (1). We found no RCTs
or CCTs on other disciplines such as muay thai (Thailand),
bando (Burma), pentjak-siat (Indonesia), bersilat (Malaysia),
copoiera (Brazil), kahli (Philippines), aikido, kendo, sumo,
or wing fung.

JEBM 3 (2010) 205–219 

c 2010 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University 213
Effects of martial arts on health status
4. Methodological characteristics
Tai chi enjoy the highest study of RCTs. A multicentered trial
consisting of different interventions was conducted by Wolf
et al. and reported under the title ‘Frailty and Injuries: Coop-
erative Studies of Intervention in Techniques’. The longest
study is 3 years follow up Others have shown improved range
of motion in meta-analysis from randomized controlled tri-
als and controlled clinical trials examining the benefits and
harms of exercise programs. Wu et al. looked at isokinetic
strength of leg muscles and postural stability between those
who had practiced tai chi for at least 3 years and those who
had never practiced it. The study showed that subjects with
long-term exposure to tai chi had a higher knee extensor
strength and smaller foot centre of pressure excursions dur-
ing quiet stance. This implies that tai chi helped maintain
postural stability.
5. Characteristics of high quality trials
Most of studies met the criteria of the Delphi list
(Table 1), but did not fully satisfy our additional criteria
(Table 2). However, from our evaluation and critical reading
the meditation, philosophy, side-life discipline, co-aid prac-
tice, intensity in energy consume by Metabolic equivalents
(Mets) or Heart rate (HR) had been seldom mentioned in the
studies.
Discussion
1. Diversity and the heterogeneity
of martial arts in studies
The term martial arts is often used as general phrase to de-
scribe many of the combat arts that have developed in eastern
cultures over the past millennium.
The martial arts that are most recognized and practiced
in the United States are those that originated or evolved
in China, Korea, and Japan. The martial arts, or wushu,
from China include kung fu, tai chi chuan, pa-kua, hsing-
i, huang gar chuan, choy fung, and wing fung. Japanese
martial arts (‘budo’) include aikido, karate, kendo, sumo,
judo, and kyudo. The concept of budo encapsulates the
spirit of the samurai or warrior, the techniques he employs,
plus the ascetic lifestyle, physical prowess, and philoso-
phy of life he represents. The popular martial art credited
to Korea is taekwondo, perhaps the most prevalent of the
martial arts in the United States, and now a full Olympic
sport. The various schools of taekwondo include hapkido,
tang soo do, and hwarang do. Many other forms of martial
arts have evolved throughout the world, such as muay thai
(Thailand), bando (Burma), pentjak-siat (Indonesia), bersi-
lat (Malaysia), copoiera (Brazil), kahli (Philippines), and
214 JEBM 3 (2010) 205–219 
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B Bu et al.
countless others that have yet to be widely practiced or
studied in the West. Discussions of martial arts have even
been discovered in the writings of the ancient Greeks and
Egyptians.
Styles in martial arts, in particular those which include
punches and kicks, may be characterized as either “exter-
nal/hard styles” or “internal/soft styles.” In the internal/soft
styles, such as tai chi chuan (also known as tai chi) and
aikido, there is more emphasis on aesthetics, harmony, and
a sense of calmness; these arts are often dubbed ‘Zen in
motion.’
2. The martial arts lifestyle
Martial arts are often viewed as part of the trio of practices
that consist of the healing arts, the self-exploration arts, and
the vital physical fitness arts. The healing arts that we are
now familiar include traditional Chinese medicine meridian
theory, chi and blood theory, channels and points, acupres-
sure, acupressure massage, and some of the herbal remedies
that now pervade the West. Of the self-exploration arts, med-
itation and yoga have become the most mainstream. Other
derivatives of meditation arts, such as qi gong and collective
or individual meditation, have been practiced in the United
States for decades. Various practices of directed breathing
and attempts to direct the energies of the psyche have begun
to evolve. Many forms of mental exercise aimed at develop-
ing mental focus as well as concentration have evolved from
the self-exploration arts. For general self-improvement, prac-
titioners of martial arts traditionally practiced meditation as
part of the trio of practices. The development of the physi-
cal, the mental, and the spiritual being were all regarded as
part of the same process. However, martial arts students in
the West usually focus exclusively on physical exercise. As
a consequence, we have lost some of the context of these
living arts (60).
3. Characteristics of included studies
and excluded studies
According to MeSH tree and Sport Discus scope, research on
the effects of martial arts on health has mainly focussed on
tai chi, judo, karate, and taekwondo. Tai chi is the most stud-
ied discipline of martial arts for its effects on health status.
Studies on tai chi have investigated its effects on cardio-
vascular health, hypertension, strength, balance, osteoarthri-
tis, and quality of life. However, because RCT design is
difficult for martial arts, the heterogeneity of studies was
high. The most difficult point for researchers is that martial
arts is not simply a physical exercise, but a comprehensive
body-mind-spirit exercise. Its effects on health are therefore
multidimensional.
B Bu et al.
4. Health benefits of martial arts
In their development, many of the martial arts were in-
fluenced by Eastern philosophical and religious thought,
particularly Buddhism and Daoism (Taoism). Buddhism em-
phasizes the role of individual effort to attain self-mastery,
self-realization, and enlightenment. Daoism advocates the
use of certain physical exercises and breathing exercises di-
rected to the same end. The martial arts therefore require
practitioners to develop both their bodies and their minds.
Because the martial arts give specific attention to both ele-
ments, they differ from most other sports and physical activ-
ities, which usually focus on purely physical training.
Martial arts can also be divided by function and philosophy
into traditional and non-traditional, according to the way they
are taught. Traditional teachers emphasize self-improvement,
whereas non-traditionalists emphasize self-defense. When
instructing their students, traditionalists focus on three pri-
orities, in the following order: spiritual development, dis-
cipline, and physical fitness (including aesthetic form and
coordination). Non-traditional instruction emphasizes com-
bat, discipline, and spiritual development. Both schools of
thought offer advantages to practitioners, encouraging the
cultivation of such traits as self-confidence, which can then
be applied to everyday life (61).
The most-studied martial art, tai chi, is a traditional Chi-
nese martial art that was developed in the 13th century and
is based on the inspiration of a fight between a crane and
a snake. The philosophy behind tai chi practice is intercon-
nected with Chinese medical theory, which holds that good
health is a result of the body’s vital energy, the chi, circulat-
ing freely throughout the body. Illness occurs as a result of
blockage of chi. Tai chi is believed to promote and unblock
the free flow of chi if practiced with the correct posture and
sufficient mindfulness and relaxation. Although it has been
widely practiced in China for centuries as an art form, reli-
gious ritual, relaxation technique, exercise, and self-defense
method, it was only during the early 1980s that Chinese sci-
entists began to investigate the potential health benefits of
tai chi. Tai chi is the most popular style discipline of martial
arts. In fact, it is probably the world’s most popular martial
art, because tens of millions of people in China and all over
the world practice it as daily exercise. It is characterized by
slow, controlled, rhythmic movements that are circular and
continuous.
A variety of health-related benefits of tai chi for older
adults have been documented, including stress reduction
(62), improved agility and balance, posture control (63), and
lower extremity strength. Tai chi can impede the decline of
the muscular-skeletal system that occurs with aging, and the
associated deterioration in functional capacity and increased
risk of falls and hip fractures (64). A further benefit of tai chi
JEBM 3 (2010) 205–219 
c 2010 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University
Effects of martial arts on health status
is that, compared to most drugs, it is relatively inexpensive
and requires little technological input (65).
Tai chi has a number of therapeutic elements, including (a)
small to large degrees of motion, (b) knee flexion, (c) straight
and extended head and trunk, (d) combined rotation of head,
trunk, and extremities, and (e) asymmetrical diagonal arm
and leg movements (66). In terms of metabolic demands,
tai chi is approximately equivalent to walking 6 km/h, and
produces an average increase in heart rate of 50% using one
type of simplified form of Tai chi. Because tai chi have been
well reviewed for its benefits to the cardiovascular system,
strength, and balance, we only provide this conclusion for
reference.
Judo is a Japanese martial art in which opponents use
balance and body weight, with minimal physical effort, to
throw or pin each other or hold each other in a lock (67).
We found six judo RCTs and CCTs articles, making judo
the second most well-studied discipline of martial arts. How-
ever, most of these studies focussed on improving athletes’
competitive ability, not on health effects. This may impute to
judo is a Olympic competition games.
Karate is a traditional Japanese form of unarmed combat,
now widely popular as a sport, in which fast blows or kicks
are used (68). We included three karate-related articles in
our evaluation. As with judo, research on karate focussed on
improving athletes’ competitive ability.
The terms ‘martial arts’ and ‘kung fu’ were seldom
used alone in RCT research articles. There only one arti-
cle on general martial arts, and one on kung fu. There were
no RCTs or CCTs found for other disciplines of martial
arts.
5. Martial arts as an exercise prescription
for different cohorts
The choice of martial art for an individual should be based
on such factors as contact or no-contact, impact or non-
impact, external/hard style or internal/soft style, and fre-
quency of injuries and accidents. Intensity could be clas-
sified by Metabolic equivalents (Mets) or Heart rate (HR).
Therefore, when choosing a martial art as an exercise pre-
scription, the individual must choose the focus of the en-
deavor. If the focus is purely on sport, with competition as
the goal, external hard styles such as judo might be preferred.
Other potential students might be drawn to martial arts that
emphasize all-round health–mental, moral and physical–and
self-actualization of the practitioner. These types of mar-
tial arts view competitions as distractions. In these schools,
attention is placed on the development and perfection of
techniques. Aikido and tae chi are examples of this type of
discipline.
215
Effects of martial arts on health status
6. Difficulties of health research
of martial arts
1) The main argument in health research on martial arts is
about whether martial arts is a physical exercise just like
other exercises, a body-mind or body-mind-spirit practice,
or a mindfulness of movement activity. So the studies’ inves-
tigation design and evaluation criteria do not always match
standards set for medical studies, such as the Delphi list cri-
teria for evaluating RCTs. Therefore, we decided to use the
Delphi technique to develop a complementary criteria list for
martial arts research. Our aim is not to replace any current
criteria list, but to improve the research standing of martial
arts.
2) Direct translation presented its own difficulties. For exam-
ple, the word “chi,” upon which the meridian theory rests, can
be translated as life, air, breath, energy, disease, or abnormal
sensation. Related difficulties included the diversity of mar-
tial arts, and their attendant different culture backgrounds,
religions, overlapping terms, traditional secrecy, and effects
on health.
3) The lack of basic research and RCTs on martial arts in-
hibits the use of martial arts as an exercise prescription for
different purposes, such as keeping fit, shaping, self-defense,
and physical therapy. There is a need for basic investigations
on the physiological, anatomical, psychological, neurolog-
ical, and immunological effects of martial arts, as well as
assessments of intensity, heart rate, VO2Max, and effects on
common medical conditions (76–79).
Conclusion and Recommendations
1. In order to evaluate the impact of martial arts on health,
we searched for research articles in eight databases. How-
ever, our search for relevant RCTs and CCTs returned very
limited results. In the 28 studies found, tai chi was the most
studied of the martial arts, followed by judo, karate, and
taekwondo. Because of the diversity of martial arts, the het-
erogeneity of the studies is high. The research fields were
widely distributed, and included health, injuries, and moral
and psychological studies.
2. Most studies on the health effects of martial arts found
positive results.
Recommendations
1. Since martial arts have a high impact on a large segment
of the world population, as a exercise prescription, martial
arts should be further studied for information that will assist
people in selecting a suitable exercise prescription. Martial
arts can thus move from an experience-based to an evidence-
based health science.
216 JEBM 3 (2010) 205–219 
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B Bu et al.
2. In order to avoid heterogeneity of investigations, we
strongly recommend that martial arts disciplines and styles
should be categorized according to their characteristic effects
on different body systems, as well as characteristics such as
contact or non-contact and high- or low-impact. PubMed and
Sport Discus could also help researchers by categorizing the
MeSH tree and Scope Note to reduce the heterogeneity of
martial arts.
3. We hope that our proposed complementary evaluation
criteria for martial arts research can help researchers avoid
heterogeneity of research in the future, and to assess the over-
all effects of martial arts on the body, spirit, and mind. This
traditional exercise can thus become a modernized exercise
prescription for different cohorts.
Acknowledgement
This study was supported by the National Sports General
Bureau Key Laboratory (Planned project no. 2010009) &
Doctoral Construct Unite Fund (Chengdu Sport University),
the Chinese Scholarship Council (Project no. 20085106),
and the Faculty of Health Science, University of Sydney,
Australia
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