Hindawi Publishing Corporation
Evidence-Based Complementary and Alternative Medicine
Volume 2013, Article ID 726062, 12 pages
Extension Trial of Qigong for Fibromyalgia: A Quantitative and
Jana Sawynok,1Mary Lynch,2and Dana Marcon3
1Department of Pharmacology, Dalhousie University, 5850 College Street, P.O. Box 15000, Halifax, NS, Canada B3H 4R2
2Departments of Anesthesiology, Psychiatry and Pharmacology, Dalhousie University, QEII Health Sciences Centre, Dickson Centre,
5820 University Avenue, Halifax, NS, Canada
3Personal Training Clinic, Halifax, NS, Canada
Correspondence should be addressed to Jana Sawynok; firstname.lastname@example.org
Received 30 May 2013; Revised 3 July 2013; Accepted 8 July 2013
Academic Editor: Romy Lauche
Copyright © 2013 Jana Sawynok et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This extension trial is an open-label observational trial of 20 subjects with fibromyalgia who undertook level 2 Chaoyi Fanhuan
some daily practice for 6 months. Quantitative measures, assessed at baseline, 8 weeks, 4 and 6 months, were of pain, impact, sleep,
physical and mental functions, and practice time. Qualitative comments also were recorded. Compared to baselines, CFQ practice
led to significant improvements in pain, impact, sleep, and physical function in the 13 subjects (65%) who completed the trial;
other domains as well. Qualitative comments by the remaining 푁 = 8 trial completers and 푁 = 7 withdrawals indicate different
changes were present at 8 weeks and were maintained for the 6-month trial duration. A highly motivated subgroup of 푁 = 5, who
experiences with the practice. This extension trial indicates that diligent CFQ practice over time produces significant health gains
in fibromyalgia in a subset of individuals. Future studies will need to address factors that might predispose to favourable outcomes.
practiced the most, had the best outcomes in terms of end symptomology, and qualitative comments indicated health benefits in
Qigong, which means the cultivation of qi or the energetic
essence of the human being, has a long history extending
thousands of years, is part of contemporary Traditional
Chinese Medicine and constitutes a distinct approach to
healing [1, 2]. Qigong practice (internal qigong) involves
physical movements and postures, breathing practices, and
meditative techniques, and there are many forms [1, 2]. Mul-
tiple forms of qigong are now practiced in many countries,
and there is an emerging literature reporting health benefits
in several chronic health conditions [3, 4]. More recently,
qigong has been characterized as “mindful exercise”  or
“meditative movement”  and this provides domains in
which components of the practice can be considered.
Fibromyalgia is a chronic pain condition associated with
sleep and mood disturbances and diminished quality of life
[7, 8]. In 2008, a Swedish study reported long-term benefits
in pain, sleep, and psychological function in fibromyalgia in
a controlled study involving daily practice of qigong for 7
involving a similar regimen , we conducted a controlled
trial of Chaoyi Fanhuan Qigong (CFQ)  for fibromyalgia
in which subjects were trained in level 1 CFQ movements,
practiced daily for 8 weeks, and were encouraged to continue
practice for 6 months . Wait list subjects served as a con-
trol group and underwent instruction and practice at the end
of the wait time. In both cohorts (immediate, delayed), there
function, and mental function, and benefits were maintained
to6months.Followingthattrial,somesubjects(푁 = 10)
Furthermore, cases of marked benefits in fibromyalgia in
those undertaking community-based training and engaging
in extensive CFQ practice were documented . In view of
this, we undertook an extension trial in which participants
voluntarily undertook level 2 CFQ training (meditation) in
the community, continued their practice, and were known,
2Evidence-Based Complementary and Alternative Medicine
in a further trial in which level 2 CFQ (meditation) was
added to the level 1 CFQ (movement) instruction. The
goals of the extension trial were (a) to determine whether
level 2 CFQ instruction and further practice would produce
additional benefits in fibromyalgia and (b) to document
health effects of extensive practice of CFQ. Fibromyalgia
is a complex and difficult condition to treat  and is a
challenge for both patients and clinicians . While drugs
are approved for treating fibromyalgia, these have limited
limited effectiveness in the long-term , and longitudinal
important to explore all possible modalities for this condi-
tion, including practices considered as complementary and
alternative medicine or CAM [19, 20].
2.1. Participants. The controlled trial of level 1 CFQ was
conducted between September 2009 and July 2011 .
The current extension trial took place between March and
September 2012 and was conducted at the Pain Management
Unit, Queen Elizabeth II Health Sciences Centre, Halifax,
with Ethics Review Committee approval. Original partici-
pants were invited to a review session of trial results (25
attended) and invited to join the extension trial. 푁 = 20
for longitudinal tracking. During the initial trial, there were
several training cohorts, so the amount of time between level
1 and level 2 CFQ instruction was variable.
were assigned the same study number as in the original trial
2.2. Training and Practice. Extension trial participants
received training in level 2 CFQ by a certified instructor
(DM) at two half-day (4 hours each) training sessions. This
was followed by weekly group practice sessions (60mins)
for 8 weeks. Participants were required to practice daily for
practice was encouraged to the end of the trial.
CFQ was developed in the 1990s  and is available
locally in Nova Scotia. Level 1 instruction consists of a set
of 7 movements which are slow and rhythmical and are
accompanied by a relaxed mental state and connection-to-
body feeling. In a set, there are 10 repetitions of movements
1–5, and 5 repetitions of movements 6-7; each set takes 10–
12mins to complete. Level 2 consists of instruction in medi-
tation techniques, primarily sitting meditation, but standing
and lying meditation also were presented as practice options.
with the chair, feeling the chair, disengaging thought, and
switching into open awareness. With standing meditation,
attention is brought to the lower abdomen and into the feet,
with lying meditation, to the lower abdomen and contact
with the floor, with similar feeling-of-contact and mental
instructions. Meditation is practiced for 30min intervals.
Participants were required to practice for a total of 60mins
per day, with a recommendation of level 1 CFQ (movements)
and level 2 CFQ (meditation) for 30mins each.
2.3. Outcome Measures. Quantitative measures were the
same as in the level 1 CFQ controlled trial  and com-
ply with recommendations for core domain assessments
in chronic pain and fibromyalgia trials [21, 22]. Measures
included (1) pain (NRS-PI, 11-point numerical rating scale
pain intensity, with anchors of “no pain” and “pain as bad as
you can imagine”), (2) Fibromyalgia Impact Questionnaire
(FIQ), (3) Pittsburgh Sleep Quality Index (PSQI), and (4)
SF-36 Health Survey (physical and mental scores analysed
separately). Participants also completed the following: (5)
Patient Satisfaction Scale (How satisfied are you with the
qigong treatment? with −3 = very unsatisfied, 0 = neither
satisfied nor dissatisfied, +3 = completely satisfied) and (6)
Patient Global Impression of Change Scale (How would you
with −3 = very much worse, 0 = no change, +3 = very much
side effects from their practice. A qualitative questionnaire,
which invited open-ended comments on experiences, also
was included. (At Baseline: briefly describe changes to your
health with completion of the first phase of the trial. At 8
weeks: describe changes in your health that you attribute to
CFQ practice over the past 8 weeks. At 4 and 6 months:
describe changes in your health since entering the study that
you attribute to CFQ practice.) Those that had previously
voluntarily undertaken level 2 CFQ training were identified
of training (baseline) and at the last weekly group session (8
weeks); 4–6 months reports were returned by mail.
2.4. Statistical Analysis. Statistical analysis was conducted
on the group that completed the trial to 6 months, the per
6-month values. Pain, sleep, and SF-physical comparisons
were performed using one-way repeated measures analysis
of variance (ANOVA), with the Holm-Sidak method for
multiple comparisons versus baseline. FIQ scores failed the
one-way ANOVA with the Student-Newman-Keuls test for
way repeated measures ANOVA) and normality (one-way
ANOVA) and could not be further analysed.
3.1. Baseline Characteristics. Demographics and baseline
(푁 = 20) were extracted from the earlier trial  (Table 1).
of the original groups (pain 6.45, 6.65; impact 65.53, 59.73;
sleep 13.79, 12.35; SF-physical 29.94, 33.22, SF-mental 38.13,
39.03 for immediate and delayed training groups, resp.).
mental function indicate that participants are representative
푁 = 13 (65%) completed the 6-month period; 푁 = 5
Evidence-Based Complementary and Alternative Medicine3
entry to the earlier controlled trial) .
Extension trial group
(푁 = 20)
Age at enrollment, years (SD)
Duration of fibromyalgia, years (SD)
BMI at enrollment (IQR)
Pain medications, mean number (SD)
Other medications, mean number (SD)
Baseline NRS-PI, mean (SD)
Baseline FIQ, mean (SD)
Baseline PSQI, mean (SD)
Baseline SF-physical, mean (SD)
Baseline SF-mental, mean (SD)
had previously voluntarily undertaken level 2 CFQ training;
body (푁 = 1), headache (푁 = 1), discolored hands and feet
푁 = 7 withdrew from the study (4 by week 8, 3 more by 4
months)(Figure 1).Sideeffectsincludedpain(푁 = 5),cooler
(푁 = 1), intermittent cough (푁 = 1), and increased stress
3.2. Quantitative Assessments. The results for pain, impact,
sleep, and physical and mental functions for the entire group
are presented in Figure 2. Improvements in quantitative
scores were generally manifested by 8 weeks and maintained
effects for pain, impact, sleep, and physical function. Mental
function showed directional trends towards improvement
(see also qualitative comments). Data was also analysed
as subgroups: (1) those who voluntarily undertook level 2
7). These results are presented in Figure 3. Both subgroups
post practice differences. Baseline values appeared different
between subgroups, with the highly motivated subgroup
(푁 = 1); none of those reporting side effects withdrew.
(푁 = 5), (2) other participants who completed the trial
completing the trial showed improvements in pain, impact,
sleep, and physical and mental functions, with similar pre-
(푁 = 8), and (3) those that withdrew from the trial (푁 =
significantly different (푃 = 0.04, Student’s 푡-test).
are indicated in Table 2. On average, the group completing
the trial practiced 35–44min/day throughout. The 푁
and 60mins/day); the remaining subgroup completing the
trial had lower practice times at 8 weeks and these declined
over time (38, 24, and 20mins/day). Those that withdrew
from the trial had the lowest practice times at 8 weeks.
“completely satisfied”): 5.9 ± 1.8 at 8 weeks, 5.8 ± 1.9 at 4
5 highly motivated subgroup complied with 60mins/day
practice over 8 weeks and maintained this over time (66, 57,
ing the trial were uniformly high at all intervals (7 indicates
Completed controlled trial of level
1 CFQ for fibromyalgia
N = 73
Entered extension trial of level
2 CFQ for fibromyalgia N = 20
Withdrawals N = 7
Minimal baseline pain level N = 2
Lack of effect at week 8 N = 2
Not known N = 3
Completed extension trial N = 13
Prior exposure to level 2 CFQ N = 5
No prior exposure to level 2 CFQ N = 8
Figure1:Subject dispositioninopen-label extension trialofqigong
level 1 and level 2 CFQ) for extension trial participants as indicated
in the categorical checklist (0, 15, 30, 45, 60min options).
66 ± 13
57 ± 20
60 ± 15
푁 = 13 trial completers
44 ± 2138 ± 23 35 ± 26
푁 = 5 motivated
months, and 6.3 ± 1.0 at 6 months. Patient global impression
For those who completed the trial (푁 = 13), the number
(46%) reported no longer taking any pain medications at the
end of the trial; all had been taking pain medications at the
beginning of the trial.
comments by the 푁 = 5 who voluntarily undertook level 2
as well as subsequent voluntary practice. Improvements in
many areas were identified after 8 weeks and consolidated at
4 and 6 months. Comments indicate further health benefits
are reports of improvements in asthma (006, 007), food
allergies (006, 007), allergies and sinus headaches (098),
chemical sensitivities (006, 007), carpel tunnel symptoms,
푁 = 8 others
of change scores (mean ± SD) also were uniformly high (7
analysis of these scores was undertaken.
at the end of the trial, this was 1.1 ± 1.3. Six participants
38 ± 1424 ± 13 20 ± 13
푁 = 7 withdrawals
indicates “very much improved”): 5.6 ± 1.6 at 8 weeks, 5.7 ±
20 ± 10
1.4 at 4 months, and 5.6 ± 1.0 at 6 months. No subgroup
of pain medications (mean ± SD) at entry was 3.2 ± 1.3;
3.3. Qualitative Assessments. Table 3 presents qualitative
CFQ training prior to entering the extension trial. Baseline
comments reflect experiences following the previous trial,
4Evidence-Based Complementary and Alternative Medicine
P = 0.028
P = 0.010
P = 0.012
P = 0.019
P = 0.040
P = 0.036
P = 0.045
P = 0.002
P = 0.004
P = 0.012
P = 0.004
P = 0.008
All subjects completing 6 months
Values shown in panels are means; mean (SD) values depicted in the lower panel. 푃 values shown for values significantly different (푃 < 0.05)
trial over 6 months (푁 = 13). (a) Pain (Numerical Rating Scale Pain Intensity), (b) impact (Fibromyalgia Impact Questionnaire), (c) sleep
from baseline (B).
(Pittsburgh Sleep Quality Index), (d) physical function (SF-Health Survey, Physical), and (e) mental function (SF-Health Survey, Mental).
Evidence-Based Complementary and Alternative Medicine5
Figure 3: Effects of qigong practice on pain, impact, sleep, and physical and mental functions in subgroups who had previously voluntarily
undertaken level 2 CFQ training (푁 = 5, highly motivated) (black circles) and others who completed the 6-month extension trial (푁 = 8)
(white circles). (a) Pain (Numerical Rating Scale Pain Intensity), (b) impact (Fibromyalgia Impact Questionnaire), (c) sleep (PittsburghSleep
Quality Index), (d) physical function (SF-Health Survey, Physical), and (e) mental function (SF-Health Survey, Mental). Values shown are
at baseline, 푁 = 3 at 8 weeks).
means;mean(SD)valuesdepictedinthelowerpanel.Meanvaluesforthosewhowithdrewfromthetrialaredepictedbygreysquares(푁 = 7
Table3:Qualitativecommentsby푁 = 5subjectswhovoluntarilyundertooklevel2CFQtrainingafterthelevel1trialandthencompletedthe
and duration of fibromyalgia (FM) are indicated for each subject (mo = month).
Evidence-Based Complementary and Alternative Medicine
extension trial. Baseline comments relate to experiences following the trial and then community-based instruction and continued practice.
Comments retain original wording and content but are edited to remove identifying and extraneous information. Original trial number, age,
SubjectBaseline comments Comments following qigong practice
Week 8: food allergies have greatly improved. No longer have asthma
and am off puffers; have been able to increase exercise without
shortness of breath. Wood smoke no longer bothers me. Sleep less and
have more energy, better quality of sleep. Am calmer. Carpal tunnel
[symptoms] and tendonitis are gone. Mind is less “brain fogged.”
Much less pain and stiffness; rare migraines versus frequent migraines.
Month 4–6: have discontinued inhalers, no indication of asthma. Am
exercising more (biking 20kms/day). Sleep well and feel well. Food
allergies are nonexistent and chemical sensitivities much reduced
(4mo). Have discontinued all prescription medications (Ventolin,
Elavil, Tryptophan, Advil, Imitrex). Am able to do things I haven’t
done in years, have more energy (6mo).
Note: reports practicing 10–14, then 14–18hrs per week
Week 8: function very well on less sleep. Food allergies are improved.
Asthma has improved and am no longer on puffers. Have started
running and hiking. Pollen season had no effect on me this year;
usually have severe pollen allergies. Was allergic to grass [asthma
attack and /or headache]; this year can smell cut grass [with no
symptoms] and it smells good. Better quality of sleep, rarely wake at
night. Mind is clearer, am more alert. Am in less pain and have gone a
very long time without needing Tylenol.
Month 4–6: off all sleep medications (Tryptophan, Elavil), and quality
of sleep has improved. Bike 1hr (20kms) every weekday morning,
something I couldn’t do before. Food allergies have improved, [now]
regularly eat cheese or yogurt [strong allergies before]. Other
“allergies” (scents) no longer bother me (4mo). Asthma no longer an
Note: reports practicing 10, then 14–15hrs per week
Week 8: Qigong has changed my life in so many positive ways. Have
learned to accept pain. Am much more accepting and much calmer.
When I started Qigong, I was using a walker, then canes, and now I
am able to walk without canes. Have also lost a lot of weight which I
hadn’t been able to lose before. Feel at home in my body. The benefits
of Qigong are many.
Month 4–6: [No comments at 4mo] Qigong has given me my life
back. When I started, was using a walker, couldn’t sleep and was in
terrible pain. Now feel peaceful; am walking, sleeping well; pain levels
have come down considerably. Eyesight has come down from 6.25 &
6.75 to 4.25 and 4.50. Was housebound, now I can walk the dog and go
out to do errands. Still have problems with fatigue but overall, am
much better (6mo).
Note 1: reports practicing 12, then 7–12hrs per week
Note 2: 036 also offered written information on experiences with CFQ
prior to entering the extension trial. Before the earlier trial, she was
practically housebound and had little hope for improvement. She had
been diagnosed with fibromyalgia, psoriatic arthritis, bursitis, asthma,
high blood pressure, irritable bowel syndrome, temperomandibular joint
disorder, depression, and severe sleep apnea. She was taking 4 pain
medications (codeine contin, pregabalin, tramadol/acetaminophen, and
hydromorphone) as well as 7 other medications. By the time she entered
the extension trial, her experiences had allowed her to discontinue
hydromorphone, tramadol/acetaminophen, methotrexate, flovent,
salbutamol, and her codeine contin intake had dropped dramatically.
She also no longer needed her cane or CPAP (continuous positive airway
pressure) machine. She had lost a substantial amount of weight. Her case
is interesting, as she started classes with “little hope that it would help.
How could these simple movement patterns help?”
FM: 7 years
Less pain, more relaxed, slept better,
increased energy. [With level 2] when
practice diligently, experience calmness,
less pain, better sleep; when skip practice,
am angry, tired, and [have] major
FM: 11 years
Allergies are much better, pain is reduced,
much happier and more at peace. Can
deal with stress better. [With level 2]
quality of sleep has improved, pain
FM: 10 years
At the beginning was using a walker and
then a cane; now walk without a cane.
Was depressed and felt hopeless about my
health, now feel grounded and peaceful.
Have reduced amount of medication by
half. Have lost 135 pounds on my journey
with the practice as well. [With level 2]
greater personal peace.
Evidence-Based Complementary and Alternative Medicine7
Table 3: Continued.
SubjectBaseline commentsComments following qigong practice
Week 8: mood elevated. Sugars much better controlled. Blood pressure
is excellent. Less flares of fibromyalgia. Better flexibility/mobility,
especially with arms and shoulders. Lots of pain after doing Qigong,
but it is just memories working through. Have had black hands and
feet, dizziness and bruises that appear for no reason. Realistic
expectations with health, especially with my diabetes. Have pain and
tired all the time, but live as best I can. Qigong keeps my mood and
Month 4–6: mood is the huge change from attempting suicide to
going [on a trip] and planning more travel. Enjoy my work and am
more tolerant of others. Body is a lot more flexible and mobile, get out
walking a few kms most days. Am doing things that I never thought I
would be able to do again (4mo). Always mood much better after any
amount of Qigong. Mobility greatly increased (6mo).
Note: reports practicing 4, then 5hrs per week
Week 8: fewer sinus headaches due to allergies. Restorative sleep more
frequent. More positive about life and its challenges; more peaceful,
tolerant and understanding. Cut back in the number of hours spent at
work. Not wasting energy on guilt and worry over things I cannot
Month 4–6: decrease in allergies and sinus problems. Decrease in
tolerance to stress due to uncovering underlying anxiety; expect this
to change again as soon as I continue my practice. Overall condition
has improved (4mo). Ability to cope with stress has increased.
Improvement in severity of pain and frequency (6mo).
Note: reports practicing 6, then 4-5hrs per week
FM: 25 years
Biggest thing is mood; from attempting
suicide to having hope. Mobility much
better, less pain. Able to tolerate things.
Like a weight has been lifted off my
shoulders. [With level 2] deeper
understanding of energy flows, blockages
which cause pain. Ability (sometimes) to
let the pain come and focus on something
FM: 18 years
Improved sleep, decreased pain, more
calm and peaceful. [With level 2] allergies
improved, fewer sinus headaches and
infections. Happier and deal with stressful
situations with increased calmness.
tendonitis (006), migraine headaches (006), weight loss
(036), vision (036), blood pressure (087), and mood (087). In
several instances, there was discontinuation of medications
for asthma (006, 007), sleep (006), mood (007), and pain
(006, 007). In some cases, multiple drugs were discontinued
(006, 036). There are many comments relating to marked
participants indicate substantial amounts of practice in this
open-ended format (10–15hrs/week) (006, 007, 036).
Table 4 summarizes qualitative comments offered by
remaining participants who completed the extension trial
(푁 = 8). Several comments are positive and, in addition to
cular dystrophy symptoms (048). There are also comments
indicating pain as a result of practice (019, 029, 044, 075)
(see also side effects) and difficulties with meditation (019,
029, 042). Self-reported practice times in the open format
for this group are lower than those in the highly motivated
Table 5 summarizes qualitative comments by those who
withdrew from the trial. There are several positive comments
as a result of earlier qigong experiences (004, 005), including
reduced blood pressure (004, 087), stopping medications
(025, 082), and quality of life improvements (089). There are
also challenges with the meditation instruction (060). Two
and would not have been included in the trial if a minimum
symptom severity (≥4) was required.
This was an extension to a previous randomized controlled
trial in which level 2 CFQ (meditation) was added to level
1 CFQ (movement) for subjects with fibromyalgia. Qigong
was recently characterized as meditative movement , and
we were interested in determining whether components
of the practice could be examined sequentially. We also
wished to document health effects in those who engaged in
extensive qigong practice. The trial is best characterized as
an open-label observational trial; it is also a long-term trial
(2-3 years) and provides valuable longitudinal information
on the effects of diligent practice. Quantitative results in
those who completed the extension trial indicate significant
improvements in core domains of fibromyalgia as a result of
qigong practice. Subgroup analysis indicates that the highly
motivated group and others who completed the trial attained
improvements in function. Of note in the highly motivated
subgroup is the observation that postpractice absolute values
for pain (scores of 2-3) and impact (scores of 15–25) suggest
mild symptomology. Qualitative comments by the highly
motivated subgroup recapitulate benefits in core domains, as
well as indicating diverse further health benefits (improve-
ments in allergies/sensitivities, migraines, asthma, blood
contain positive health comments but are more moderate in
tone. Subgroups were distinguished in terms of self-reported
8 Evidence-Based Complementary and Alternative Medicine
Table 4: Qualitative comments of the remaining 푁 = 8 subjects who completed the extension trial. Baseline comments relate to experiences
following level 1 CFQ. Comments retain original wording and content but are edited to remove identifying and extraneous information.
Original trial number, age, and duration of fibromyalgia (FM) are indicated for each subject (mo = month).
Qigong helped me
enormously at first,
physically and emotionally.
Have not practiced
faithfully; do about
15mins/day. Most negative
health changes are due to
degenerative discs, pinched
nerve in neck, bad
shoulder, foot, and hand.
Weight loss, tightening of
core and leg muscles, walk
further. Blood pressure
Comments following qigong practice
Week 8: for the first 2 weeks felt worse, or not improved; had a lot of
movements during meditation which I found exhausting, woke stiff and
sore. By week 3/4 was feeling a bit more energetic and woke feeling better,
but tired. By week 6, was feeling good upon waking. By week 7/8, am
feeling good most of the day. Back gets sore by late afternoon. Burning and
stiffness due to fibromyalgia are mostly gone. Have more energy, less pain.
Month 4–6: had to stop sitting meditation as it caused lower back pain, so
do lying meditation; very relaxing, fall asleep within minutes. Sleep more
soundly and have more energy. Less fibromyalgia pain (still have arthritis
aches—spine and hand) (4mo). Am more relaxed, fall asleep more easily.
Note: reports practicing 5, then 2-3hrs per week
FM: 14 years
FM: 9 years
decreased [154 to 110], off
system has improved.
meds for over a year.
Overall healthier. Immune
Week 8: there haven’t been many changes. Stopped doing meditation as
found it hurtful (physically) and depressing (mentally).
Month 4–6: bad fall and having trouble healing. Stopped Qigong due to
Note: reports practicing 4, then 0–2hrs per week
FM: 12 years
Because of disability, live in
poverty with limited
resources. Stressful housing
situations have created
health issues. CFQ has
gotten me through crises.
When not in crisis, very
noticeable positive effects.
Week 8: anxiety up and down. Level 2 caused temporary overwhelming
emotional responses; however, they passed. Less muscle tension and
Month 4–6: negative changes in health since learning CFQ—central
nervous retinopathy, psoriasis, and high cholesterol. Positive changes—less
pain, headaches, stiffness, aches, increased mobility, and sleep.
Note: reports practicing 5, then 3-4hrs per week
FM: 1 year
Understand my condition
more and therefore am
more in control.
Week 8: have learned to control anxiety, am more in control and relaxed.
Pain seems to improve after practicing Qigong; it helps me cope with pain.
Month 4–6: no changes (4mo). Have not practiced Qigong (6mo).
Note: reports practicing 3, then 0-1hr per week
Week 8: feel relaxed; meditation makes me calm and peaceful.
Month 4–6: osteoarthritis in left knee and spinal stenosis have worsened
[with] certain parts of Qigong practice (4mo). Meditation gives me peace
of mind (6mo).
Note: reports practicing 3.5, then 1–4hrs per week
FM: 2 years
[Have] osteoarthritis of
back and knees and
generalized over body, in
both thumbs, ankle, elbows;
have high blood pressure.
Qigong has been of great
benefit. Because of
(MD), am limited in moves
and practice. Even though
am getting weaker due to
MD, Qigong has definitely
helped with stiffness and
FM: 17 years
Week 8: am definitely more flexible and can raise my arms up further and
for a longer period of time. The meditation aspect has presented challenges.
Month 4–6: even though have not been physically able to practice more
than approximately 60mins/day, it has been of some benefit to me. Hands
and feet are warmer, feel calmer. Have recently experienced further
progression of MD which has limited me (4mo). Joints are definitely not as
stiff when practicing Qigong (6mo).
Note: reports practicing 5, then 1.5–3hrs per week
FM: 5 years
Sleep improved, pain
decreased, calmer, clearer
Week 8: pain level has increased since starting meditation. Am mostly
relaxed during the lying down meditation; pain dissipates during this time.
Overall pain has increased, interfering with sleep. Stiffness increased also.
Month 4–6: pain levels went up while practicing Level 2. Reduced the
amount of time in the last 3 weeks to get a break. Have started the daily
routine again to see if there is any improvement (4mo) Stopped doing
meditation and pain levels went down. Still practicing [movements] but not
as much as previously. Removed wheat from diet, and stiffness, pain levels
and swelling reduced.
Note: reports practicing 6, then 4-5hrs per week
Evidence-Based Complementary and Alternative Medicine9
Table 4: Continued.
SubjectBaseline comments Comments following qigong practice
Week 8: more relaxed, and joints feel better. Pain seems to be better most of
the time. Qigong has helped me cope better.
Month 4–6: helped me become more active, given me strength to do more
[short walks, biking for first time in years]. Could do more, but my arthritic
foot stops me. Qigong has not seemed to help this area.
Note: reports practicing 3, then 2–7hrs per week
FM: 22 years
Felt better, less pain, more
Table 5: Qualitative comments of the 푁 = 7 subjects who withdrew from the extension trial. Baseline comments relate to experiences
following level 1 CFQ. Comments retain original wording and content and are edited to remove identifying and extraneous information.
Original trial number, age, and duration of fibromyalgia (FM) are indicated for each subject.
SubjectBaseline comments Comments following qigong practice
Week 8: more energetic, less pain, happier; blood pressure
has gone down.
Month 4: WITHDRAWAL
Note 1: reports practicing 2hrs per wk at week 8
Note 2: reports pain level 2 at baseline, and 3 at week 8
Am feeling and doing much better, more happy,
more relaxed, more carefree.
Lowered pain and tiredness, improved mobility and
Week 8: WITHDRAWAL
Note: pain level 3 at baseline
Same as when started except for taking medications
Week 8: WITHDRAWAL
Improved sleep, but has deteriorated since trial
ended. Improved sense of well-being. Increased
sense of control of my pain even though pain the
same as before.
Week 8: although had a marked improvement in the first
level trial, have had no positive response from this second
level. Had great difficulty with the training presentation—the
material was presented in ways that challenge my worldview.
Month 4: WITHDRAWAL
Note: reports practicing 2hrs per wk at week 8
Pain reduced, better sleep. Diagnosis of diabetes, so
was a confusing time.
Week 8: WITHDRAWAL
Qigong helped me relax. Stopped taking too many
pain pills because Qigong is helping.
Week 8: WITHDRAWAL
Now know the connection between relaxation and
how we perceive pain. Qigong makes me feel rested
Week 8: qigong relaxes me and improves my peace of mind.
Am less anxious and less depressed. Can work pain free for
longer periods of time. Found the movements beneficial for
lower back problems. Find it hard to put time aside [for
Qigong], would benefit from longer practice sessions. It has
to become a way of life to get full benefits.
Month 4: WITHDRAWAL
Note: reports practicing 5hrs per week at week 8
indicate that dedicated CFQ practice over time produces
marked and sustained benefits in core domains relevant to
fibromyalgia, as well as additional health benefits. These
gia and related conditions, where sustained qigong practice
(daily for 6–12 weeks) is involved [9, 23, 24]. Other trials
of qigong for fibromyalgia used qigong as part of a weekly
[25–27]. Improvements in some conditions in the present
trial noted in qualitative comments (e.g., blood pressure) are
Collectively, these quantitative and qualitative results
supported by an emerging literature . Of particular note
is the magnitude of change in several conditions (asthma
gies/sensitivities). Beneficial effects were most prominent in
the group that engaged in the most qigong practice. Similar
marked improvements in diverse conditions were observed
after extended CFQ practice in case reports . Based on
these results, and recognizing that these benefits occur in
those who have been compromised for an extended period
of time (fibromyalgia mean duration 11.8 years, 푁 = 13),
further studies on the health benefits of qigong practice,
and especially extended practice, in fibromyalgia as well as
10Evidence-Based Complementary and Alternative Medicine
other chronic health conditions, are encouraged. In some
frameworks, fibromyalgia is considered a central sensiti-
zation syndrome along with other disorders (e.g., chronic
fatigue syndrome, regional pain disorders, irritable bowel
syndrome, and headache disorders) [29, 30], and it would be
interesting to ascertain effects of qigong in these conditions.
Thus, it was recently reported that qigong is of benefit in
chronic fatigue syndrome .
There are several methodological issues to consider in
Qigong, along with tai chi, is characterized as meditative
movement  and is a complex intervention with many
componentspotentiallycontributingto efficacy [3, 5, 31]. It is
impossible to blind qigong practice, and trial designs such as
randomized controlled trials of fixed protocols, community-
based observational trials, cross-sectional studies of long-
term practitioners, and studies that integrate qualitative
methods to capture the richness of participant experiences
porates several of these recommended trial design elements.
(2) Plurality of Forms, Components. There are many forms of
qigong [1, 2], and the contribution of a particular component
of activity to the outcome is not clear. Considering qigong
as meditative movement  is useful as it provides domains
for comparison, and future trials can compare qigong with
exercise regimens or with meditation groups. However, there
are various forms (aerobic, strength, and flexibility) and
intensities (mild, moderate) of exercise, and this area has
its own research challenges [33, 34]. Additionally, there
is a multiplicity of mind-body interventions (mindfulness,
meditation)and this field also contends with methodological
challenges . The current trial did not have a comparison
group and assessed pre- versus post-intervention outcomes
in a quantitative and qualitative manner; it is pragmatic
and akin to clinical practice. (3) Extent of Practice, Effective-
ness of Practice. How much qigong practice is needed for
clinically meaningful effects (“minimal dose”), and whether
further practice leads to better outcomes (“dose-response
relationship”), are important issues. Furthermore, there is
the issue of effectiveness (“bioavailability”), of whether all
time spent seemingly engaged in an activity is equivalent
. Post hoc analysis of outcomes in relation to extent of
practice indicated differences between those who practiced
per protocol or minimally in the earlier controlled trial .
In the present trial, we also observed a practice-response
relationship, as those who practiced the most had the best
outcomes. Systematic assessment of practice time is feasible
using standard protocols in controlled trials, as well as with
observational trials, and is encouraged for all qigong trials.
Furthermore, meta-analysis of qigong trials for fibromyal-
gia will need to consider this factor in clustering studies
for analysis [19, 36]. Finally, motivation for or barriers to
continued/extensive practice (e.g., use of booster sessions,
group versus individual sessions, nature of instruction, and
effectiveness of different instructors) will need to be con-
sidered in future studies. (4) Identifying Those Who Benefit
from Qigong. In this trial, 13/20 (65%) undertook additional
pre- versus postpractice benefits. This subgroup represents
18% of original trial completers (13/73). Extensive qigong
practice requires a considerable commitment and will not
be suitable for everyone for many reasons. However, because
multiple health benefits can result from diligent practice,
as documented here and in case studies of CFQ , there
will be some willing to engage in such practice if it means
relief from a long-standing condition which has not been
amenable to other approaches. Future studies on qigong
could include additional assessments of participant factors
(e.g., psychosocial profile, locus of control, and attitudes
towards CAM), to determine those that might predispose to
favourable outcomes. Thus, those with fibromyalgia exhibit
differences in health related locus of control, cognitive
attributes, and perceived social support compared to other
chronic pain populations and/or controls, for example, [37,
38]. This approach fits within the conceptual frameworks of
attribute-treatment interactions , preference trials ,
and personalized medicine.
efits in fibromyalgia as indicated by quantitative assessments
in core domains for fibromyalgia. Qualitative comments
to extent of practice.
Conflict of Interests
Jana Sawynok and Mary Lynch have no conflict of interests
relating to this study. Dana Marcon is a community-based
The authors thank Paulette Nauss and Joan Falkenham
for their valued contributions as trial coordinators. They
also thank Allison Reid for statistical processing, generating
figures, and independently checking qualitative comments
in tables against original comments to ensure accuracy of
information reported. This study was funded in part by the
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