Abstract: Coronary heart disease (CHD) predominantly affects the elderly. The decrease of physical function in these individuals makes it difficult for them to tolerate high intensity exercise. This limitation restricts the selection and implementation of exercise-based cardiac rehabilitation programs. Therefore, it is necessary to diversify the types of exercise rehabilitation programs by integrating the patients' physical functional capacity, cultural backgrounds, and exercise preferences, thereby improving their participation rates and long-term adherence. As a traditional Chinese exercise characterized by low intensity, gentle rhythm, and emphasis on the harmony of body and mind, Tai Chi exhibits high safety and proven health-promoting effects, making it particularly suitable for the elderly. Based on this premise, this review systematically summarizes the impacts of Tai Chi intervention on CHD risk factors, the physical and mental health outcomes of CHD patients, the design of Tai Chi intervention protocols, and the evaluation of its safety and adherence. The aim is to provide practical guidance for the standardized application of Tai Chi in CHD exercise rehabilitation, promote the in-depth integration of traditional Chinese exercise with chronic disease management systems, and advance the development of CHD rehabilitation toward precision, individualization, and sustainability.