Effect of Tai Chi exercise and its cessation on internet addiction in college students: a randomized controlled trial

JING ZHAO1, LIANG CHENG2

1College of Physical Education, Southwest University of Science and Tchnology, Mianyang, China; 2Sichuan Academy of Chinese Medicine Sciences, Chengdu, China; Human Movement Science, Sichuan Sports College, Chengdu, China.

Summary. Background: This study aimed to explore the intervention effect of Tai Chi exercise on internet addiction in college students and its maintenance effect after cessation, providing a scientific basis for the application of Tai Chi in internet addiction intervention among college students. Methods. Fifty-one non-sports-major college students with mild or moderate internet addiction were randomly divided into a Tai Chi group (n = 23) and a control group (n = 24). The Tai Chi group underwent 12 weeks of Tai Chi exercise, while the control group maintained their regular study schedule without additional physical exercise. The Chinese Internet Addiction Scale and serum dopamine and β-Endorphin levels were assessed at baseline (T0), week 12 (T1), and week 16 follow-up (T2). Results. At T1, the Tai Chi group showed significantly lower scores in total internet addiction, compulsive symptoms, withdrawal symptoms, tolerance symptoms, interpersonal and health problems, and time management problems than the control group (p < 0.05), with higher dopamine and β-Endorphin levels (p < 0.05). At T2 (4 weeks after cessation), the Tai Chi group still had significantly lower scores in total internet addiction, compulsive symptoms, withdrawal symptoms, tolerance symptoms, interpersonal and health problems, and time management problems than the control group (p < 0.05), with higher β-Endorphin levels (p < 0.05). Conclusion. Twelve weeks of Tai Chi exercise can effectively alleviate internet addiction symptoms in college students and maintain some effect for 4 weeks after cessation, which is related to the regulation of serum dopamine and β-Endorphin levels by Tai Chi exercise.

Key words. Tai Chi, college students, internet addiction, dopamine, β-Endorphin

Effetti della pratica del Tai Chi e della sua interruzione sulla dipendenza da Internet negli studenti universitari: uno studio randomizzato controllato

Riassunto. Background. Scopo dello studio è quello di valutare l’efficacia dell’intervento basato sull’esercizio del Tai Chi sulla dipendenza da Internet negli studenti universitari e il suo effetto di mantenimento dopo la cessazione, fornendo una base scientifica per l’applicazione del Tai Chi nell’intervento sulla dipendenza da Internet tra gli studenti universitari. Metodi. Cinquantuno studenti universitari non iscritti a corsi di laurea in discipline sportive, affetti da dipendenza da Internet di grado lieve o moderato, sono stati suddivisi in modo casuale in un gruppo Tai Chi (n = 23) e in un gruppo di controllo (n = 24). Il gruppo Tai Chi ha seguito un programma di 12 settimane di Tai Chi, mentre il gruppo di controllo ha mantenuto il proprio normale programma di studio senza ulteriore esercizio fisico. La Scala cinese di dipendenza da Internet e i livelli sierici di dopamina e β-endorfina sono stati valutati all’inizio dello studio (T0), alla settimana 12 (T1) e al follow-up della settimana 16 (T2). Risultati. Al T1, il gruppo Tai Chi ha mostrato punteggi significativamente più bassi per quanto riguarda la dipendenza totale da Internet, i sintomi compulsivi, i sintomi di astinenza, i sintomi di tolleranza, i problemi interpersonali e di salute e i problemi di gestione del tempo rispetto al gruppo di controllo (p < 0,05), con livelli più elevati di dopamina e β-endorfina (p < 0,05). Al T2 (4 settimane dopo la cessazione), il gruppo Tai Chi presentava ancora punteggi significativamente più bassi per quanto riguarda la dipendenza da Internet complessiva, i sintomi compulsivi, i sintomi di astinenza, i sintomi di tolleranza, i problemi interpersonali e di salute e i problemi di gestione del tempo rispetto al gruppo di controllo (p < 0,05), con livelli più elevati di β-endorfina (p < 0,05). Conclusione. Dodici settimane di pratica del Tai Chi possono alleviare efficacemente i sintomi della dipendenza da Internet negli studenti universitari e mantenere un certo effetto per 4 settimane dopo la cessazione, il che è correlato alla regolazione dei livelli sierici di dopamina e β-endorfina indotta dalla pratica del Tai Chi.

Parole chiave. Tai Chi, studenti universitari, dipendenza da Internet, dopamina, β-endorfina.

Introduction

Internet Addiction Disorder (IAD) is defined by the World Health Organization as a chronic or periodic addictive state caused by excessive internet use, characterized by psychological or physiological dependence on the pleasure of going online, difficulty resisting the urge to use the internet again, and often accompanied by neglect of real-life, study, and work1,2. Addicts often exhibit symptoms such as cybersex addiction, cyberrelationship addiction, online gaming addiction, information collection addiction, and cybercompulsive behaviors3,4. IAD can lead addicts to neglect real-life, study, and work, and may have more severe consequences5,6.

Among Chinese college students, IAD is relatively common, with an addiction rate of about 12.7%7, mainly due to lack of self-management ability, low mood, high stress, etc.8. IAD not only affects the mental health of college students but can also lead to serious consequences such as declining academic performance and social skill regression9. Currently, intervention methods for IAD in college students mainly include psychotherapy10, behavioral therapy11, and pharmacotherapy12, but these methods have certain limitations, such as long treatment cycles, high costs, and easy relapse. In recent years, physical exercise has received attention as an adjunct intervention. Studies show that physical exercise can positively affect IAD by regulating neurotransmitter levels, relieving stress, and improving mood13-15. However, existing research has obvious shortcomings in experimental intervention: on one hand, there are limitations in sample size and population selection, with most studies limited to specific populations and difficult to generalize; on the other hand, there is little research on the maintenance effect after stopping physical exercise, and most focus on behavioral and psychological aspects, lacking in-depth analysis from a biochemical perspective.

Tai Chi, a traditional Chinese fitness method, emphasizes the unity of body and mind, combining movement and stillness. Through slow, gentle movements and breathing regulation, it helps practitioners relieve stress, regulate emotions, and positively impact mental health16-18. Therefore, Tai Chi has certain implications for addressing IAD in college students. However, few existing studies report the effect of Tai Chi on IAD in college students. An 8-week Tai Chi intervention for IAD college students found it could relieve fatigue but had no significant effect on Internet addiction test scores19. Another study held a different view, suggesting 16 weeks of Tai Chi had a positive impact on IAD treatment in college students20. Although some studies found regular Tai Chi exercise could reduce IAD symptoms in college students, the maintenance effect after stopping Tai Chi exercise remains underreported.

Given the current research status and shortcomings, this study recruited college students with mild or moderate IAD through questionnaires, conducted a Tai Chi exercise intervention experiment, and explored the therapeutic effect of Tai Chi exercise on IAD and its maintenance effect after cessation. This study will provide quantitative evidence for Tai Chi treatment of IAD in college students, enrich the theoretical system of Tai Chi promoting mental and physical health from a biochemical perspective, and offer new solutions for addressing IAD in college students. The study hypothesis is that regular Tai Chi exercise can effectively alleviate IAD symptoms in college students and maintain some effect after cessation.

Materials and methods

Participants

This study is registered with ClinicalTrials. gov (NCT06921096). This study was a randomized controlled trial (two-arm parallel design, assessor-blinded). The data statisticians were blinded to the group allocation. This study was approved by the Sichuan Sports College Committee (20240901). Using the Chinese Internet Addiction Scale (CIAS)21 designed for Chinese college students (CIAS scores of 26-53 indicate mild addiction; 54-80, moderate addiction; 81-104, severe addiction; detailed criteria are in the methods section), we screened out non-sports-major students with mild or moderate IAD from our university.

Inclusion criteria. Participants aged 18-25; CIAS scores of 26-53 (low internet dependence), 54-80 (moderate dependence)21. Only mild and moderate cases were included; non-sports majors; the study followed the Declaration of Helsinki, and all participants understood the purpose and signed consent forms.

Exclusion criteria. Severe IAD (CIAS score >80); Tai Chi practice within 6 months; regular exercise habits; history of depression/anxiety or undergoing psychological treatment; use of medications affecting mental state or neurotransmitter levels.

Referring to previous trials reported by Zhang19 and Yang20, who explored Tai Chi interventions among mildly addicted Chinese college students. Considering a 2 (groups) ×3 (measurement times) design and ~10% attrition. G-power software calculated a minimum sample size of 48 (Effect Size=0.3, Power=0.8, α=0.05). Initially, 51 participants were enrolled (from 422 surveyed, with 12.1% mild/moderate addiction rate). Randomization was done using computer-generated random numbers. Participants were numbered 1-51 and assigned to Tai Chi or control groups based on random numbers. The first 25 with smaller numbers went to the Tai Chi group, and the remaining 26 to the control group. During the experiment, 4 participants dropped out (7.8% attrition), leaving 47 completers. The Tai Chi group had 23 participants (19M/4F), and the control group had 24 (19M/5F). Baseline data are in Table 1, with no significant differences between groups.




Tai Chi intervention and exercise adherence

From September to November 2024, the experimental group practiced 24-form simplified Tai Chi for 12 weeks, 3 times/week, 60 minutes/session (including 5-minute warm-up and 5-minute cool-down) at our university’s track, under professional coaching, from 8:00-9:10 AM. Simplified Tai Chi refers to standardized 24-form Tai Chi compiled officially in China and widely adopted in university sports courses.

The first four weeks were dedicated to technique learning, and the subsequent eight weeks to consolidated training. All participants retained their regular academic timetable without undertaking additional physical activity. Note: Exercise would stop if participants had severe psychological issues (depression, anxiety), started medications affecting mental state or neurotransmitters, had worsened IAD (CIAS score >80), or frequently missed sessions. To ensure adherence: Pre-experiment education on Tai Chi’s benefits via PPTs and videos; professional coaches guided and corrected movements. The Tai Chi group’s average participation rate was 92% (25 enrolled, 2 dropped out). Control group participants maintained their original curriculum schedule and daily lifestyle throughout the whole research period; no regular organized physical exercise or structured extracurricular activities were arranged, and their spare-time entertainment and internet usage kept consistent with usual college life. Reference to Cheng16 and Chang17, all participants were followed up biweekly via in-person talks or WeChat to monitor daily behaviors and restrict unauthorized extra exercise or medication. Beyond regular self-report checks, we further verified their course timetables and campus sports club registrations to rule out unplanned regular physical training. All Tai Chi attendees completed session sign-in records, and anyone taking neuroactive medications or participating in consistent external sports was excluded promptly. Small rewards were offered for full attendance, professional coaches delivered regular feedback, and group training strengthened participant compliance. However, objective monitoring via wearable fitness trackers was not available due to resource constraints, so adherence confirmation depended on self-report and manual file checking, which might bring potential self-report bias.

Internet addiction scale survey

The CIAS21, tailored to Chinese college students’ psychological traits, was used. It has 26 items across five dimensions: compulsive symptoms, withdrawal symptoms, tolerance symptoms, interpersonal and health problems, and time management problems. It adopts a 4-point Likert self-rating scale ranging from 1 (strongly disagree) to 4 (strongly agree). The scale has good reliability and validity, with factor consistency coefficients of 0.70-0.82 and internal consistency of 0.944621. The total CIAS score is the sum of all items, with higher scores indicating greater dependence and addiction risk. The CIAS was administered at baseline (T0), week 12 (T1), and week 16 follow-up (T2) for both groups.

Serum dopamine and β-endorphin assays

At baseline (T0), week 12 (T1), and week 16 follow-up (T2), 2 ml of fasting venous blood was collected from participants between 7:00-8:00 AM. Serum dopamine and β-ndorphin levels were measured using radioimmunoassay on a Beckman DXC800 autoanalyzer, with reagents from IBL (Germany). All steps followed the kit instructions, and absorbance was measured at 450 nm to calculate concentrations.

Statistical Analysis

Data were analyzed using SPSS 20.0. Normality was assessed with the Shapiro-Wilk test. A two-way ANOVA examined group (2) and time (3) interactions. If significant, simple effects were tested; otherwise, main effects were analyzed22. LSD was used for time comparisons, with α=0.05.

Results

The test results are shown in figure 1.




The Shapiro-Wilk test indicated that the measurement data were normally distributed. The interaction results showed that compulsive symptoms (F = 3.18, p = 0.045, η² = 0.045), withdrawal symptoms (F = 3.73, p = 0.027, η² = 0.052), interpersonal and health problems (F = 11.45, p < 0.001, η² = 0.145), total scores of CIAS (F = 28.79, p < 0.001, η² = 0.299), and dopamine (F = 5.84, p = 0.004, η² = 0.080) had significant interactions between group and time. However, tolerance symptoms, time management problems, and β-Endorphin did not show significant interactions between group and time. Further analysis was conducted to determine the simple effects of time or group. The results are as follows:

Between-group comparisons: At T1, the Tai Chi group had significantly lower total scores of CIAS (p < 0.001, η² = 0.318), compulsive symptoms (p = 0.038, η² = 0.092), withdrawal symptoms (p = 0.030, η² = 0.101), tolerance symptoms (p = 0.021, η² = 0.112), interpersonal and health problems (p < 0.001, η² = 0.510), and time management problems (p = 0.010, η² = 0.140) than the control group, with statistically significant differences (p < 0.05). The serum dopamine (p < 0.001, η² = 0.318) and β-Endorphin (p = 0.016, η² = 0.123) levels were significantly higher in the Tai Chi group than in the control group, with statistically significant differences (p < 0.05). Four weeks after cessation (T2), the Tai Chi group still had significantly lower total scores of CIAS (p < 0.001, η² = 0.670), compulsive symptoms (p = 0.023, η² = 0.109), withdrawal symptoms (p = 0.006, η² = 0.158), tolerance symptoms (p = 0.001, η² = 0.215), interpersonal and health problems (p < 0.001, η² = 0.517), and time management problems (p = 0.027, η² = 0.104) than the control group, with statistically significant differences (p < 0.05). The serum β-Endorphin level (p = 0.006, η² = 0.153) was significantly higher in the Tai Chi group than in the control group, with a statistically significant difference (p < 0.05).

Within-group comparisons at different time points in the Tai Chi group: Compared with T0, at T1, the total scores of CIAS decreased by 15.0% (p < 0.001, 95% CI: -12.35 to -6.86), compulsive symptoms decreased by 15.1% (p = 0.016, 95% CI: -3.45 to -0.38), withdrawal symptoms decreased by 12.4% (p = 0.012, 95% CI: -2.85 to -0.36), and interpersonal and health problems decreased by 22.1% (p < 0.001, 95% CI: -5.37 to -2.37). Serum dopamine increased by 21.1% (p < 0.001, 95% CI: 4.57 to 12.24), and β-Endorphin increased by 22.1% (p < 0.001, 95% CI: 9.19 to 36.21). Compared with T0, at T2, the total scores of CIAS decreased by 13.5% (p < 0.001, 95% CI: -11.35 to -5.86), withdrawal symptoms decreased by 15.5% (p = 0.002, 95% CI: -3.25 to -0.75), and interpersonal and health problems decreased by 21.4% (p < 0.001, 95% CI: -4.80 to -1.81). Serum dopamine increased by 15.4% (p = 0.002, 95% CI: 2.36 to 10.04), and β-Endorphin increased by 17.3% (p = 0.011, 95% CI: 4.20 to 31.21).

In the control group, compared with T0, the total scores of CIAS increased by 4.9% at T2 (p = 0.009, 95% CI: 0.80 to 5.37).

Discussion

This study was designed to investigate the therapeutic effects of Tai Chi on internet addiction among college students and the sustained benefits following training discontinuation. The results supported our hypothesis that 12 weeks of Tai Chi exercise can significantly alleviate IAD symptoms in college students and still maintain a certain effect after cessation for 4 weeks. This study provides empirical support for Tai Chi as an effective preventive intervention for IAD in college students.

The potential role of Tai Chi in intervening IAD among college students has gained attention. Ye23 assessed the intervention effects of various sports on IAD through meta-analysis and found that exercising at least 3 times per week for no less than 45 minutes each time had a positive effect on quitting IAD. Among the 7 sports assessed, Tai Chi was considered the optimal choice. However, previous studies have not been entirely consistent. An 8-week Tai Chi intervention study showed that although participants’ fatigue symptoms were alleviated, the improvement in IAD symptoms was not statistically significant19. In contrast, a 16-week study found that Tai Chi had a significant positive impact on IAD in college students20. This study, through a 12-week Tai Chi intervention, further confirmed the significant improvement effect of Tai Chi on IAD symptoms and found that the intervention effect had a certain degree of persistence after a 4-week cessation follow-up. This finding not only aligns with Ye’s23 research conclusions but also provides new evidence for the maintenance effect of Tai Chi on IAD college students after cessation.

This study found that Tai Chi-induced changes in serum dopamine and β-Endorphin may serve as one potential pathway for alleviating IAD symptoms. Dopamine and β-Endorphin are vital neurotransmitters closely associated with addictive behaviors24,25. It is hypothesized that dopamine fluctuation could modulate the cerebral reward system and relieve craving and withdrawal of internet addiction, yet current findings cannot confirm direct causality between dopamine variation and addiction remission. Previous literature suggests abnormal dopamine metabolism contributes to excessive internet dependence26. In our research, elevated dopamine among Tai Chi exercisers was statistically observed, which is speculated to help participants transfer behavioral preference away from online activities, though this deduction remains unproven in the present trial. Moreover, increased β-Endorphin may improve mood by producing analgesic and pleasurable effects and further ease addictive symptoms. The above deduction accords with Zhao et al.’s research, which reported Tai Chi could raise these two neurotransmitters in older females and benefit mood status27. Similarly, our data verified Tai Chi can regulate the two indicators among college students, providing correlational evidence for the hypothesized neurophysiological pathway rather than definite causal proof. Our study only observes statistical correlation between neurotransmitter change and IAD improvement; specific causal mechanisms need further verification via follow-up experiments.

The limitations of this study include the relatively small sample size and the restriction to non-sports-major college students, making it difficult to generalize the findings to other populations. Future trials will cooperate with multiple universities to enroll participants covering various majors and age groups and expand sample size to improve external validity. Additionally, although this study explored the intervention mechanism of Tai Chi from a biochemical perspective, it did not delve into its neurophysiological mechanisms. Future research could combine brain imaging techniques to further uncover the intervention mechanisms of Tai Chi on IAD, such as observing the effects of Tai Chi practice on the brain’s reward system and emotional regulation network through functional magnetic resonance imaging. Lastly, the absence of an active control group involving alternative sports prevents us from distinguishing the specific therapeutic effects unique to Tai Chi from general exercise benefits. Future randomized trials will incorporate active control interventions including jogging and yoga to distinguish exercise-specific effects via cross-group comparison.

Conclusion

A 12-week structured Tai Chi program significantly mitigates IAD symptoms in college students, with beneficial effects persisting for four weeks upon exercise termination. This is related to the regulation of serum dopamine and β-Endorphin levels by Tai Chi. It is recommended to incorporate Tai Chi into intervention programs for IAD in college students as a non-pharmacological adjunct to psychological therapy and behavioral therapy.

Conflicts of interest. The authors declare that there is no conflict of interest.

Authors’ contributions. All authors jointly tested, the first author completed, and the correspondence author was responsible for the paper. All authors read and approved the final version of the manuscripta.

Funding. This study was supported by the General Program of the 77th Batch of China Postdoctoral Science Foundation (2025M773176), the Central Guidance for Local Science and Technology Development Fund Projects (2024ZYD0001), and the Key Project of School-level Teaching Reform of Sichuan Sports College (TZYJG 2025001).

Acknowledgments. We would like to thank all participants for taking part in this study.

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