Tai chi is a well-known therapeutic slow-motion rhythmic exercise based on traditional Chinese medicine (TCM), has been widely practiced for health promotion in older adults. According to our knowledge, there is a scarcity of evidence, and Tai Chi practice is controversial to support that all styles of Tai Chi movements are safe or effective for those having physiological and musculoskeletal functional declines. Therefore, we systematically reviewed the randomized control trial studies to examine the effect of different types of Tai Chi (TC) exercises on physical and functional fitness in elders with physical and functional declines living in the community. We followed the PRISMA guide throughout the study. Of the 18 papers reviewed, we analyzed the risk of bias, quality, and methodology following PICO guidelines. We retrieved 18 scientific papers from the different webs of science and databases by selecting Bullion words and MESH items according to our objective. We scrutinized 866 research papers through our inclusion and exclusion criteria; only 18 papers that fulfilled the inclusion criteria went through an extensive review. Tai Chi with its 24 styles is safe, improves joint mobility function, posture control, hemodynamic balance, and stabilizes body balance in the elderly with musculoskeletal conditions. It can be practiced by elders with chronic conditions living in the community, but style adjustment is required. Future studies are required to conduct more randomized control studies to evaluate the effect of Tai Chi exercises on biochemical level for those elders with other chronic health conditions.