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Background and Purpose: Risk factors for stroke include hypertension, diabetes, low blood high-density lipoprotein (HDL), physical inactivity and obesity. Among these, hypertension is the most important controllable risk factor for stroke. A total of at least 30 minutes exercise every day is recommended for prevention of stroke. This study aims to evaluate the effectiveness of Tai Chi exercise versus brisk walking exercise in reducing stroke risk factors.Methods: This was a randomized controlled trial. A total of 246 subjects with stroke risk factors were recruited from two outpatient clinics. They were randomly assigned into one of the three groups, namely, Tai Chi group (n=82), walking group (n=82), and control group (n=82). The Tai Chi group received Tai Chi training, which consisted of two 60-minute sessions each week for three months, and self-practice for 30 minutes every day. The walking group performed brisk walking for 30 minutes every day. The control group was advised to maintain their routine activities. The primary outcome was blood pressure. Secondary outcomes included fasting blood for lipid profile and sugar; body mass index, waist circumference and body fat percentage. Data were collected at baseline and 3-month post-intervention. Generalized estimating equations (GEE) model was used to compare the changes in outcomes across time between groups.Results: The mean age of the 246 subjects was 64.4 (SD=9.8), with 45.5% (n=112) were male. The GEE analysis showed that, as compared to the control group, the Tai Chi group demonstrated statistically significant greater reduction in systolic blood pressure (B=-10.25, P=0.001) and diastolic blood pressure (B=-6.50, P=0.002), and significant increase in HDL (B=0.16, P=0.012), while no significant differences were noted in the walking group. No significant changes were noted in the other outcome variables at 3-month.Conclusion: Regular Tai Chi exercise was effective in reducing the stroke risk factors by reducing high blood pressure and increasing HDL. Longer follow-up period was suggested for monitoring the sustainability of both Tai Chi and brisk walking to reveal the empirical effects of both exercises on stroke prevention.