EFFECTS OF QIGONG ON BLOOD PRESSURE, BLOOD
PRESSURE DETERMINANTS AND VENTILATORY FUNCTION
IN MIDDLE-AGED PATIENTS WITH ESSENTIAL
American Journal of Chinese Medicine, Summer, 2003 by Myung Suk Lee, Myeong
Soo Lee, Euy-Soon Choi, Hun-Taeg Chung
This study was designed to measure changes in blood pressure (BP), urinary
catecholamines and ventilatory functions of patients with mild essential hypertension after
10 weeks of Qigong (Shuxinpingxuegong). Fifty-eight patients volunteered to participate
in this study and were randomly divided into either a Qigong group (n = 29), or a control
group (n = 29). Systolic blood pressure and diastolic blood pressure decreased
significantly in the Qigong group such that both became significantly lower after 10 weeks
in the Qigong than in the control group. Also, there was a significant reduction of
norepinephrine, metanephrine and epinephrine compared to baseline values in the
Qigong group. The ventilatory functions, forced vital capacity and forced expiratory
volume per sec, were increased in the Qigong group but not the control. These results
suggest that Qigong may stabilize the sympathetic nervous system is effective in
modulating levels of urinary catecholamines and BP positively, and in improving
ventilatory functions in mildly hypertensive middle-aged patients.
Keywords: Qigong; Essential Hypertension; Blood Pressure; Blood Pressure
Determinants; Catecholamines; Ventilatory Function.
Generally, essential hypertension is high blood pressure (BP) where there is no
detectable medical cause or organ pathology but treatable risk factor for cardiovascular
disease (Turner, 1994). Untreated hypertensives are at greater risk for heart failure,
stroke and renal failure (Johnston, 1991). The standard medical treatment for essential
hypertension consists primarily of the use of antihypertensive drugs. However, there are
potential problems with drug therapy due to their side-effects and consequent lowering of
quality of life (Croog et al., 1986; Houston, 1989; Swislocki et al., 1989). With respect to
this concern, there has been increasing interest in non-pharmacological treatments of
hypertension (Frumkin et al., 1978; Joint National Commitee, 1986). For instance, there
are reports regarding the efficacy of behavioral intervention for the control of BP such as
meditation, relaxation, autogenic training, hypnosis, stress management and biofeedback
(Andrews et al., 1982; Davison et al., 1991; Henderson et al., 1998; Raskin et al., 1999;
Schneider et al., 1995).
Medical Qigong as a major branch of traditional Chinese medicine (TCM) has been used
clinically for preventing and curing disease, as well as improving and maintaining health.
And Qigong is a generic term used to denote methods used to cultivate, regulate and
harness Qi (vital energy) for general self-preservation and health, healing, self-defense,
longevity, and, particularly, spiritual development (Lee and Lei, 1999). Medical Qigong is
divided into two parts: internal and external. Internal Qi is developed by individual practice
of qigong and it is more beneficial for self-help health promotion. Lee and Lei (1999)
divided internal Qigong into three types: movement-oriented Qigong, meditation-oriented
Qigong and breathing-oriented Qigong. As far as healing is concerned, beneficial effects
on mindbody health may be the same in spite of style differences.
Data from controlled trials suggest that Qigong is effective in lowering BP (Bornoroni et
al., 1993; Hong, 1996; Lee et al., 2000; Li et al., 1993; Xing et al., 1993; Youshan et al.,
1993). Although these investigations have reported that Qigong may play a positive role
on hypertension patients, these studies have used limited methods, e.g. the reception of
Qi from a Qi master. Then it is needed and potentially beneficial for many people to
extend previous findings related with Qigong and hypertension by using self-training
methods. Accordingly, the primary purpose of this study is to test the hypothesis that 10
weeks of self-help Qigong exercise will reduce the BP of patients with mild essential
The second aim is to examine the underlying mechanism of reducing BP by measuring
BP determinants in Qigong groups. And the third aim is to investigate changes of
ventilatory functions that may be related with BP indirectly. To accomplish these aims, the
BP, urinary catecholamines levels, the ventilatory functions, forced vital capacity (FVC)
and forced expiratory volume per sec (FE[V.sub.1]), were measured before and after 10
weeks of self-help Qigong in patients with essential hypertension.
Materials and Methods:
Subjects: Participants were recruited from members of a Catholic Church and Credit
association from two regions of Mokpo-Shi in Korea on a voluntary basis. Ninety-seven
exhibited resting BP in a sitting position in the range of essential hypertension (140
mmHg < systolic blood pressure (SBP) < 180 mmHg and 90 mmHg < diastolic blood
pressure (DBP) < 100 mmHg) and 65 volunteered to participate in the study. They were
assigned to either a Qigong group (n = 33) or control group (n = 32) by their living
regions. Four subjects dropped out of the Qigong group and three subjects out of the
control group. Finally, there were 29 in the Qigong group (age: 55.8 [+ or -] 6.3 years;
height: 161.6 [+ or -] 6.6 cm; weight: 62.9 [+ or -] 9.5 kg; illness duration: 3.89 [+ or -] 2.57
years; male: n = 10, female: n = 19) and 29 in the control group (age: 57.1 [+ or -] 7.6
years; height: 162.6 [+ or -] 6.6 cm; weight: 65.2 [+ or -] 9.5 kg; illness duration: 4.4 [+ or -
] 3.6 years; male: n = 13, female: n = 16). Exclusion criteria included: current involvement
in a health promotion program; unwillingness to accept randomization into either study
group; self-reported pregnancy or parental report of subjects' history of congenital heart
defect, diabetes, asthma or any chronic illness that requires regular pharmacological
None were affected and all consented to participate in the study. Patients with secondary
forms of hypertension were excluded on the basis of a complete history and physical
examination, radiologic and ultrasound examinations, and urinalysis.
Measurement of Blood Pressure: After 10 minutes of rest prior to intervention, BP was
measured twice in succession by the auscultatory method (Deluxe Aneroid
Spygmomanometer, Mac-check, Japan) with a contact microphone secured on the left
brachial artery. Two assistants measured BP and pulse rate (PR) consecutively and the
values were averaged.
Urinary Catecholamines: All urine samples were taken for 12 hours between 8 am and 8
pm because of sampling problems for 24 hours. Urine samples were refrigerated during
the 12-hour collection period without preservatives. At the end of collection and after the
evaluation of volume, aliquots were frozen at-80[degrees]C without preservatives until
assayed. They were analyzed by the Center of Pathology in the Green Cross Reference
Laboratory. Urinary catecholamines were assayed using high performance liquid
chromatography (HPLC) with Electrochemical Detection at 0.65 v and metanephrine (ME)
was analyzed by UV spectrophotometer-4020.
Ventilatory Function: The maximum FVC measure used a microspirometer (Micro-
spirometer Kent ME 1 2A, England) and evaluated how strongly and rapidly a person
exhales after inhaling until reaching total lung capacity. The amount of expiration in one
second is measured as FE[V.sub.1]. These measures allow an experimenter to evaluate
a lung capacity and circulation ability.
Intervention: The Qigong treatment was Shuxinpingxuegong, which was developed by a
Chinese named Zhang GuangDe (Jang, 1998). Shuxinpingxuegong, which is composed
of eight types of movement (Table 1), and was known empirically to benefit in preventing
and treating circulatory system disease but this was not scientifically proven. Before the
Qigong, to validate that this instrument was appropriate for the high BP patients, a group
of three athletic physiology professors and two Qigong experts helped to reconstruct this
instrument as warming-up exercise, Qigong and cool-down exercise. To test the effect of
the Qigong, the magnitude and strength of the Qigong was measured by the change in
the indirect heartbeat. The calculated target heart rate was used to determine the
exercise strength. This experiment was carefully designed so that the exercise strength
did not exceed 50% through 60% maximum exercise capacity.
The warming-up exercise, which was designed for relaxing the body, was a sequence of
breathing exercise, neck exercise, arm exercise, waist exercise and leg exercise. The
Qigong exercise was performed with inhalation when the muscles were contracted and
inhalation when the muscles were relaxed. This exercise started with stage 1 two-arm
motion and ended at the 8th stage with massage (Table 1). The cool-down exercise was
performed with the magnetic-massage method in which a subject touched the head and
lightly massaged the hands and legs for about 5 minutes.
The entire exercise time was about 30 minutes, and this included the warming-up (5
minutes), the Qigong (20 minutes) and the cool-down exercise (5 minutes). The exercise
was performed around 3 to 5 pm with a Qigong expert and experimenter while watching a
recorded videotape at a quiet place of temperature 18[degrees]C-22[degrees]C.
Experimental Procedures: This study is a quasi experiment; non-synchronized control
group Pre-Post test. All testing was conducted at the Department of Nursing in Mokpo
Catholic University. A week prior to the beginning of the experiment, all subjects visited
the laboratory room in order to become familiar with the experimental conditions and to
become accustomed to the basic experimental procedures. Also, they were given their
experimental date. Subjects were asked to refrain from food, coffee, tea and smoking for
at least 4 hours before the assessment and to refrain from alcohol for at least 24 hours
prior to the experiment. The measurements were done before the experiment to measure
baseline values and after 10 weeks to see the effects of intervention.
The results obtained were statistically treated with SAS. Unpaired t-test and [chi square]
was used to evaluate statistical differences of demographic data and comparison of group
differences between control and Qigong groups. If there was a statistical difference in
baseline value, we also used the repeated measured ANCOVA for those variables. And a
paired t-test was used to analyze the differences between baseline and after 10 week
Changes in BP and PR are presented in Table 2. Mean basal values of SBP and DBP
were not different between the two groups. The levels of SBP and DBP at Post decreased
significantly compared to the levels at Pre (SBP: p < 0.001; DBP: p < 0.001) in Qigong
group, but increased slightly in the control. There were significant group differences in the
levels of SBP and DBP at Post between Qigong and control group (SBP: p < 0.001; DBP:
p < 0.001). There was a significant increase after 10 weeks compared to the levels of Pre
in the control group PR but not in the Qigong group.
Table 3 displays the baseline levels and changes after 10 weeks of intervention on
urinary catecholamine levels. The levels of catecholamines had a tendency to decrease
after 10 weeks of intervention compared to baseline in the Qigong group but slightly
increased in the control group. There were significant group differences of
norephinephrine (NE) (p < 0.05) and ME at the baseline (p < 0.005), but not in
ephinephrine (E) level. The levels ore at Post decreased significantly compared to Pre (p
< 0.05) in Qigong group, but increased slightly in control. Also, there was a significant
reduction of NE and ME compared to baseline values in the Qigong group. Because there
were differences in baseline values of NE and ME, ANCOVA were done with baseline
values as covariants. ANCOVA for NE reveals a significant difference between Qigong
and control group (F = 6.24, p = 0.0001). However, there was no significant effect in ME
levels (p > 0.1) by ANCOVA.
Ventilatory functions of the Qigong group increased significantly after 10 weeks of Qigong
compared to baseline (FVC, p < 0.001; FE[V.sub.1], p < 0.001) and there were significant
group differences in values at 10 weeks between Qigong and control groups (FVC, p <
0.001; FE[V.sub.1], p < 0.001) (Table 4). But, there was a slight decrease in the control
group with no significance.
The aim of this study was to examine the clinical utility of self-training Qigong on essential
hypertensive patients. We found that SBP and DBP were reduced by 10 weeks of Qigong
as well as levels of catecholamines, but not in the control group. Furthermore, there was
significant improvement in ventilation functions.
BP (SBP and DBP) decreased after 10 weeks of Qigong but remained the same in the
control. These phenomena are similar to other reports of Qigong studies. Many groups
have assessed the effect of Qigong on hypertensive patients and they reported that
receiving Qi positively affects BP, levels of catecholamines and cholesterol, heart rate,
and other aspects of health (Agishi, 1998; Bornoroni et al., 1993; Hong, 1996; Lee et al.,
2000; Li et al., 1993; Xing et al., 1993; Youshan et al., 1993). BP has been shown to be
directly linked to sympathetic nervous system (SNS) activity, and the urinary
catecholamine assay has been used as an integrated measure for sympathoadrenal
system activity (SSA), a unique neuroendocrine unit comprising the sympathetic nervous
system and the adrenal glands (Macdonald, 1995). Hence, lower BP levels after Qigong
is compatible with stabilization of SNS activity since BP has been shown to be directly
linked to SNS activity.
There is agreement among investigators that urine catecholamin levels, though
representing only a small portion of the total catecholamines released into the
bloodstream, are a good reflection of sympathetic activity. Because NE is located mainly
in the sympathetic post-ganglionic neurons and its concentration increases when the
sympathetic tone is increased due to physiological or psychological stress (James et al.,
1989), the finding of lower concentrations of NE and E after 10 weeks of Qigong could
reflect a stabilization of sympathetic tone. A decrease in cathecholamine production might
be the mechanism underlying the observed reduction of BP. This is consistent with results
of other studies, which showed that Qigong reduced NE, and sympathetic nervous
system activity and increased parasympathetic nervous system activity (Hong, 1996; Lee,
1993; Lee et al., 2002; Lee et al., 2000; Li et al., 1990; Yang, 1993).
From the results obtained for ventilatory function, it may be considered that 10 weeks of
Qigong had beneficial effects on expiratory capacity. Similarly, 10 days of Qigong
breathing increased ventilatory efficiency about 20% for oxygen uptake and carbon
dioxide production (Lim et al., 1993; Zhang et al., 1992). In the study of Wannamethee et
al. (1995) on middle-aged British men, lower FE[V.sub.1] was associated with an
increased risk of stroke that in multivariate analysis was independent of age, smoking,
physical activity, pre-existing ischemic heart disease, diabetes, antihypertensive
treatment and SBP. Increased levels of FVC and FE[V.sub.1] may indicate that Qigong
has potential beneficial effects for reducing the symptoms of essential hypertension.
However, further study is necessary.
In summary, these results revealed that 10 weeks of Qigong reduced levels of SBP, DBP,
NE, E and improved ventilatory functions in mild hypertensive middle-aged patients.
These results indicate that Qigong has relaxation effects and stabilizes the sympathetic
nervous systems in patients with essential hypertension. Hence, Qigong may be
applicable to the improvement and prevention of symptoms of hypertension.