No previous studies have explored the effects of mind–body approaches on health-related quality of life (HRQoL) in the frail elderly. Cognition and action are an inseparable whole during functioning. Thus, a new intervention-based approach using familiarity-based movements and a nonjudgmental approach of “cognition-action” was proposed and was tested with Tai Chi on HRQoL in frail institutionalized elderly. Fifty-two participants (58% women) age 65–94 took part in a 24-wk Tai Chi (TC) intervention 4 days/wk or a cognition-action (CA) exercise program of 30 min twice a week. Changes in Mini Mental State score, physical (PCS) and mental component (MCS) summaries (SF12); Falls Efficacy Scale (FES); and exercise self-efficacy were explored. PCS improved from 33.6 ± 6.7 to 51 ± 4.8 in the TC group and from 30.6 ± 9.9 to 45.1 ± 10.2 in the CA group (p < .001). MCS of SF-12 (p < .001), FES (p < .001), and exercise self-efficacy (p < .01) were enhanced significantly in both groups. Adapted CA programs and Tai Chi were both efficient in improving HRQoL of frail elderly.