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Aging & Mental Health
ISSN: 1360-7863 (Print) 1364-6915 (Online) Journal homepage: http://www.tandfonline.com/loi/camh20
Psycho-physical and neurophysiological effects of
qigong on depressed elders with chronic illness
Hector W.H. Tsang , William W.N. Tsang , Alice Y.M. Jones , Kelvin M.T. Fung ,
Alan H.L. Chan , Edward P. Chan & Doreen W.H. Au
To cite this article: Hector W.H. Tsang , William W.N. Tsang , Alice Y.M. Jones , Kelvin M.T.
Fung , Alan H.L. Chan , Edward P. Chan & Doreen W.H. Au (2013) Psycho-physical and
neurophysiological effects of qigong on depressed elders with chronic illness, Aging & Mental
Health, 17:3, 336-348, DOI: 10.1080/13607863.2012.732035
To link to this article: http://dx.doi.org/10.1080/13607863.2012.732035
Published online: 16 Oct 2012.
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© 2013 Taylor & Francis
Aging & Mental Health, 2013
Vol. 17, No. 3, 336–348, http://dx.doi.org/10.1080/13607863.2012.732035
Psycho-physical and neurophysiological effects of qigong on depressed elders
with chronic illness
Hector W.H. Tsanga*, William W.N. Tsangb, Alice Y.M. Jonesb, Kelvin M.T. Funga, Alan H.L. Chana,
Edward P. Chanaand Doreen W.H. Aua
aNeuropsychiatric Rehabilitation Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic
University, Hung Hom, Kowloon, Hong Kong;bCenter for East-meets-West in Rehabilitation Sciences, Department
of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
(Received 1 June 2012; final version received 10 September 2012)
This randomized controlled trial examined the psychological, physical, and neurophysiological effects of a qigong
exercise program on depressed elders with chronic medical illness. The experimental group (n¼21, 80�7 years)
was given a 12-week qigong exercise program, while the comparison group (n¼17, 81�8 years) participated in a
newspaper reading program with the same duration and frequency. Measurement of depression symptoms,
psychosocial functioning, muscle strengths, salivary cortisol, and serum serotonin was conducted. At 12 weeks,
the qigong group had significant reduction in depressive symptoms (F¼11.68; p50.025). Improvement in self-
efficacy (F¼4.30; p50.050), self-concept of physical well-being (F¼6.82; p50.025), and right-hand grip
strength (F¼5.25; p¼0.034) was also found when compared with the comparison group. A change in salivary
cortisol level was found marginally insignificant between groups (F¼3.16; p¼0.087). However, a decreasing
trend of cortisol level was observed. The results provided preliminary evidence for the hypotheses that the
antidepressive effect of qigong exercise could be explained by improvement in psychosocial functioning and
possibly down-regulation of hyperactivity of the hypothalamic–pituitary–adrenal axis.
Keywords: depression; qigong; psychosocial health; physical functioning; serotonin; cortisol
Depression is a devastating mood disorder frequently
accompanied by bodily dysfunctions such as pain,
fatigue, loss of appetite, weight loss/gain, sleeping
difficulties, and inattentiveness (American Psychiatric
Association, 2000). Its comorbidity with other chronic
conditions (i.e., cardiac and respiratory diseases) in late
life is common (Schillerstrom, Royall, & Palmer, 2008;
Taylor, McQuoid, & Krishnan, 2004). The relationship
between depression and chronic conditions has been
previously addressed in the psychological model
proposed by Tsang, Cheung, and Lak (2002). The
model stipulates that chronic illnesses may lead to
disabilities in various aspects of life and reduce the
psychosocial functioning of older adults. Their impair-
ment in physical functioning, daily living, and self-
concept ultimately lead to the onset of geriatric
depression (Mikosch et al., 2010; Paradiso, Duff,
Vaidya, Hoth, & Mold, 2010; Turvey, Schultz,
Beglinger, & Klein, 2009). In severe cases, suicide
might be the ultimate end (Tsoh et al., 2005; Turvey
et al., 2009).
The pathology of depression disorders are under-
pinned by deficiencies of cerebral serotonin (5-hydro-
xytryptamine; 5-HT) and elevation of cortisol (Moreno
et al., 2006; Sanacora et al., 1999). Though there are
inconsistent findings regarding the level of cortisol in
relation to depression (Bremmer et al., 2007; Stewart,
Quitkin, McGrath, & Klein, 2005), there is a central
belief that depression is associated with hyperactivity
resulting in higher cortisol levels (Belmaker & Agam,
2008; Vreeburg et al., 2009). Thus, the principle of
pharmacological treatment is to increase the level of
serotonin synthesis and reduce cortisol secretion in the
brain so as to stabilize moods and reduce over-
reactivity to negative signals among patients with
depression. However, the efficacy of antidepressants
has not been conclusive. More importantly, there are a
number of unwanted side effects reported with the
intake of antidepressants such as headache, sedation,
sleep disturbance, alteration of cardiovascular func-
tion, and bone loss (Diem et al., 2007; Mark et al.,
2011; Schatzberg, 2007). As to non-pharmacological
treatments, reviews have shown that outcomes of
cognitive behavioral therapy are inconsistent in alle-
viating depression (Lynch, Laws, & McKenna, 2010;
Parker & Fletcher, 2007). The limitations of main-
stream treatments have, therefore, stimulated the
growing body of research to investigate the clinical
effects of various forms of alternative therapies for
Health qigong is a holistic mindful exercise that has
increasingly, in recent years, been applied in amelior-
ating symptoms of chronic physical conditions and
emotional disturbances (Ng & Tsang, 2009; Tsang,
Fung, Chan, Lee, & Chan, 2006; Tsang, Mok, Yeung,
& Chan, 2003). The distinctive feature of health qigong
is its integration of focused attention, coordinated
breathing, and interlacing body movements that
promotes the circulation of vital energy which is
*Corresponding author. Email: email@example.com
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Aging & Mental Health 347
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