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Research examining psychological and physiological benefits of Qigong and Tai Chi is growing rapidly. The many practices described as Qigong or Tai Chi have similar theoretical roots, proposed mechanisms of action, and expected benefits. Research trials and reviews, however, treat them as separate targets of examination. This review examines the evidence for achieving outcomes from randomized controlled trials (RCTs) of both. The key words Tai Chi, Taiji, Tai Chi Chuan, and Qigong were entered into electronic search engines for the Cumulative Index for Allied Health and Nursing (CINAHL), psychological literature (PsycINFO), PubMed, Cochrane database, and Google Scholar. STUDY INCLUSION CRITERIA: RCTs reporting on the results of Qigong or Tai Chi interventions and published in peer-reviewed journals from 1993 to 2007. Country, type and duration of activity, number/type of subjects, control conditions, and reported outcomes were recorded for each study. Outcomes related to Qigong and Tai Chi practice were identified and evaluated. Seventy-seven articles met the inclusion criteria. The nine outcome category groupings that emerged were bone density (n = 4), cardiopulmonary effects (n = 19), physical function (n = 16), falls and related risk factors (n = 23), quality of life (n = 17), self-efficacy (n = 8), patient-reported outcomes (n = 13), psychological symptoms (n = 27), and immune function (n = 6). Research has demonstrated consistent, significant results for a number of health benefits in RCTs, evidencing progress toward recognizing the similarity and equivalence of Qigong and Tai Chi.
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Literature Review: Fitness
A Comprehensive Review of Health Benefits of
Qigong and Tai Chi
Roger Jahnke, OMD; Linda Larkey, PhD; Carol Rogers, APRN-BC, CNOR, PhD; Jennifer Etnier, PhD;
Fang Lin, MS
Abstract
Objective. Research examining psychological and physiological benefits of Qigong and Tai
Chi is growing rapidly. The many practices described as Qigong or Tai Chi have similar
theoretical roots, proposed mechanisms of action, and expected benefits. Research trials and
reviews, however, treat them as separate targets of examination. This review examines the
evidence for achieving outcomes from randomized controlled trials (RCTs) of both.
Data Sources. The key words Tai Chi, Taiji, Tai Chi Chuan, and Qigong were entered into
electronic search engines for the Cumulative Index for Allied Health and Nursing (CINAHL),
psychological literature (PsycINFO), PubMed, Cochrane database, and Google Scholar.
Study Inclusion Criteria. RCTs reporting on the results of Qigong or Tai Chi interventions
and published in peer-reviewed journals from 1993 to 2007.
Data Extraction. Country, type and duration of activity, number/type of subjects, control
conditions, and reported outcomes were recorded for each study.
Synthesis. Outcomes related to Qigong and Tai Chi practice were identified and evaluated.
Results. Seventy-seven articles met the inclusion criteria. The nine outcome category
groupings that emerged were bone density (n 54), cardiopulmonary effects (n 519), physical
function (n 516), falls and related risk factors (n 523), quality of life (n 517), self-efficacy
(n 58), patient-reported outcomes (n 513), psychological symptoms (n 527), and immune
function (n 56).
Conclusions. Research has demonstrated consistent, significant results for a number of
health benefits in RCTs, evidencing progress toward recognizing the similarity and equivalence
of Qigong and Tai Chi. (Am J Health Promot 2010;24[6]:e1–e25.)
Key Words: Tai Chi, Taiji, Meditation, Qigong, Mind-Body Practice, Mindfulness,
Meditative Movement, Moderate Exercise, Breathing, Prevention Research.
Manuscript format: literature review; Research purpose: Setting: health care,
community; Health Focus: fitness/physical activity, psychosocial/spiritual health,
stress management; Strategy: education, skill building; Target population: all adults,
seniors; Target population circumstances: all SES, international, race/ethnicity
INTRODUCTION
A substantial body of published
research has examined the health
benefits of Tai Chi (also called Taiji), a
traditional Chinese wellness practice.
In addition, a strong body of research
is also emerging for Qigong, an even
more ancient traditional Chinese well-
ness practice that has similar charac-
teristics to Tai Chi. Qigong and Tai Chi
have been proposed, along with yoga
and pranayama from India, to consti-
tute a unique category or type of
exercise referred to currently as med-
itative movement.
1
These two forms of
meditative movement, Qigong and Tai
Chi, are close relatives, having shared
theoretical roots, common operational
components, and similar links to the
wellness and health-promoting aspects
of Traditional Chinese Medicine
(TCM). They are nearly identical in
practical application in the health-
enhancement context and share much
overlap in what TCM describes as the
‘‘three regulations’’: body focus (pos-
ture and movement), breath focus, and
mind focus (meditative, mindful com-
ponents).
1,2
Because of the similarity of Qigong
and Tai Chi, this review of the state of
the science for these forms of medita-
tive movement will investigate the
benefits of both forms together. In
presenting evidence for a variety of
health benefits, many of which are
attributable to both practices, we will
point to the magnitude of the com-
bined literature and suggest under
what circumstances Qigong and Tai
Chi may be considered as potentially
equivalent interventions, with recom-
mendations for standards and further
research to clarify this potential.
Roger Jahnke, OMD, is with the Institute of Integral Qigong and Tai Chi, Santa Barbara,
California. Linda Larkey, PhD, Carol Rogers, APRN-BC, CNOR, PhD, and Fang Lin, MS, are
with the Arizona State University College of Nursing and Healthcare Innovation, Phoenix, Arizona.
Jennifer Etiner, PhD, is with the University of North Carolina, Greensboro, North Carolina.
Send reprint requests to Linda Larkey, PhD, Arizona State University College of Nursing and Healthcare
Innovation, 500 N 3rd Street, Phoenix, AZ 85004; larkeylite@msn.com.
This manuscript was submitted October 13, 2008; revisions were requested June 2, 2009; the manuscript was accepted for
publication July 21, 2009.
Copyright E2010 by American Journal of Health Promotion, Inc.
0890-1171/10/$5.00
+
0
DOI: 10.4278/ajhp.081013-LIT-248
July/August 2010, Vol. 24, No. 6 e1
OBJECTIVES
Previously published reviews have
reported on specific outcomes of either
Tai Chi or Qigong, mostly addressing
only one of these practices, and rarely
taking into account the similarity of the
two forms and their similar outcomes.
These reviews have covered a wide
variety of outcomes, with many focused
on specific diseases or symptoms, in-
cluding hypertension,
3
cardiovascular
disease,
4,5
cancer,
6–8
arthritic disease,
9
stroke rehabilitation,
10
aerobic capaci-
ty,
11
falls and balance,
12,13
bone mineral
density,
14
and shingles-related immuni-
ty,
15
with varying degrees of support
noted for outcomes in response to
Qigong or Tai Chi.
Other reviews have addressed a broad
spectrum of outcomes to demonstrate
how Qigong
16–19
or Tai Chi
20–26
has
demonstrated improvements for par-
ticipants with a variety of chronic health
problems or with vulnerable older
adults. Although many of these reviews
have utilized selection criteria that
restrict their focus to rigorous empirical
studies, others have used less stringent
criteria. The purpose of this review is to
evaluate the current evidence for a
broad range of health benefits for both
Qigong and Tai Chi using only ran-
domized controlled trials (RCTs), and
to evaluate the potential of treating
these two forms of meditative move-
ment as equivalent forms. A complete
description of Qigong and Tai Chi is
presented and the equivalence of their
theoretical roots and their common
elements of practice are established.
Then, the body of evidence for out-
comes in response to Qigong and Tai
Chi is reviewed to examine the range of
health benefits. Finally, to more criti-
cally evaluate similarities across studies
of the two practices, we discuss the
potential of treating them as equivalent
interventions in research and the in-
terpretation of results across studies.
Research question 1: What health
benefits are evidenced from RCTs of
Qigong and Tai Chi?
Research question 2: In examining
the Qigong and Tai Chi practices
incorporated in research, and the
evidence for health benefits commen-
surate with each, what claims can be
made for equivalence of these two
forms of practice/exercise that have
typically been considered to be sepa-
rate and different?
Overview of Qigong and Tai Chi
Qigong is, definitively, more ancient
in origin than Tai Chi, and it is the
overarching, more original discipline
incorporating widely diverse practices
designed to cultivate functional integ-
rity and the enhancement of the life
essence that the Chinese call Qi. Both
Qigong and Tai Chi sessions incorpo-
rate a wide range of physical move-
ments, including slow, meditative, flow-
ing, dance-like motions. In addition,
they both can include sitting or stand-
ing meditation postures as well as either
gentle or vigorous body shaking. Most
importantly, both incorporate the pur-
poseful regulation of both breath and
mind coordinated with the regulation
of the body. Qigong and Tai Chi are
both based on theoretical principles
that are inherent to TCM.
1
In the
ancient teachings of health-oriented
Qigong and Tai Chi, the instructions
for attaining the state of enhanced Qi
capacity and function point to the
purposeful coordination of body,
breath, and mind (paraphrased here):
‘‘Mind the body and the breath, and
then clear the mind to distill the
Heavenly elixir within.’’ This combina-
tion of self-awareness with self-correc-
tion of the posture and movement of
the body, the flow of breath, and
mindfulness, are thought to comprise a
state that activates the natural self-
regulatory (self-healing) capacity, stim-
ulating the balanced release of endog-
enous neurohormones and a wide array
of natural health recovery mechanisms
that are evoked by the intentful inte-
gration of body and mind.
Despite variations among the myriad
forms, we assert that health-oriented
Tai Chi and Qigong emphasize the
same principles and practice elements.
Given these similar foundations and the
fashion in which Tai Chi has typically
been modified for implementation in
clinical research, we suggest that the
research literature for these two forms
of meditative movement should be
considered as one body of evidence.
Qigong
Qigong translates from Chinese to
mean, roughly, to cultivate or enhance
the inherent functional (energetic)
essence of the human being. It is
considered to be the contemporary
offspring of some of the most ancient
(before recorded history) healing and
medical practices of Asia. The earliest
forms of Qigong make up one of the
historic roots of contemporary TCM
theory and practice.
2
Many branches of
Qigong have a health and medical
focus and have been refined for well
over 5000 years. Qigong purportedly
allows individuals to cultivate the nat-
ural force or energy (Qi) in TCM that
is associated with physiological and
psychological functionality. Qi is the
conceptual foundation of TCM in
acupuncture, herbal medicine, and
Chinese physical therapy. It is consid-
ered to be a ubiquitous resource of
nature that sustains human well-being
and assists in healing disease as well as
(according to TCM theory) having
fundamental influence on all life and
even on the orderly function of celes-
tial mechanics and the laws of physics.
Qigong exercises consist of a series of
orchestrated practices including body
posture/movement, breath practice,
and meditation, all designed to en-
hance Qi function (that is, drawing
upon natural forces to optimize and
balance energy within) through the
attainment of deeply focused and re-
laxed states. From the perspective of
Western thought and science, Qigong
practices activate naturally occurring
physiological and psychological mecha-
nisms of self-repair and health recovery.
Also considered part of the overall
domain of Qigong is ‘‘external Qigong,’’
wherein a trained medical Qigong ther-
apist diagnoses patients according to the
principles of TCM and uses ‘‘emitted
Qi’’ to foster healing. Both internal
Qigong (personal practice) and external
Qigong (clinician-emitted Qi) are seen
as affecting the balance and flow of
energy and enhancing functionality in
the body and the mind. For the purposes
of our review, we are focused only on the
individual, internal Qigong practice of
exercises performed with the intent of
cultivating enhanced function, inner Qi
that is ample and unrestrained. This is
the aspect of Qigong that parallels
what is typically investigated in Tai Chi
research.
There are thousands of forms of
Qigong practice that have developed
in different regions of China during
various historic periods and that have
e2 American Journal of Health Promotion
been created by many specific teachers
and schools. Some of these forms were
designed for general health-enhance-
ment purposes and some for specific
TCM diagnostic categories. Some were
originally developed as rituals for
spiritual practice, and others to em-
power greater skill in the martial arts.
An overview of the research literature
pertaining to internal Qigong yields
more than a dozen forms that have
been studied as they relate to health
outcomes (e.g., Guo-lin, ChunDo-
SunBup, Vitality or Bu Zheng Qigong,
Eight Brocade, Medical Qigong).
2,27–29
The internal Qigong practices gen-
erally tested in health research (and
that are addressed in this review)
incorporate a range of simple move-
ments (repeated and often flowing in
nature) or postures (standing or sit-
ting) and include a focused state of
relaxed awareness and a variety of
breathing techniques that accompany
the movements or postures. A key
underlying philosophy of the practice
is that any form of Qigong has an effect
on the cultivation of balance and
harmony of Qi, positively influencing
the human energy complex (Qi chan-
nels/pathways) that functions as a
holistic, coherent, and mutually inter-
active system.
Tai Chi
Tai Chi translates to mean ‘‘Grand
Ultimate,’’ and in the Chinese culture,
it represents an expansive philosoph-
ical and theoretical notion that
describes the natural world (i.e., the
universe) in the spontaneous state of
dynamic balance between mutually
interactive phenomena including the
balance of light and dark, movement
and stillness, waves and particles. Tai
Chi, the exercise, is named after this
concept and was originally developed
both as a martial art (Tai Chi Chuan or
taijiquan) and as a form of meditative
movement. The practice of Tai Chi as
meditative movement is expected to
elicit functional balance internally for
healing, stress neutralization, longevi-
ty, and personal tranquility. This form
of Tai Chi is the focus of this review.
For numerous complex sociological
and political reasons,
2
Tai Chi has
become one of the best-known forms
of exercise or practice for refining Qi
and is purported to enhance physio-
logical and psychological function.
The one factor that appears to differ-
entiate Tai Chi from Qigong is that
traditional Tai Chi is typically per-
formed as a highly choreographed,
lengthy, and complex series of move-
ments, whereas health-enhancement
Qigong is typically a simpler, easy-to-
learn, more repetitive practice. How-
ever, even the longer forms of Tai Chi
incorporate many movements that are
similar to Qigong exercises. Usually,
the more complex Tai Chi routines
include Qigong exercises as a warm-up,
and emphasize the same basic princi-
ples for practice, that is, the three
regulations of body focus, breath focus,
and mind focus. Therefore Qigong
and Tai Chi, in the health promotion
and wellness context, are operationally
equivalent.
Tai Chi as Defined in the
Research Literature
It is especially important to note that
many of the RCTs investigating what is
described as Tai Chi (for health
enhancement) are actually not investi-
gating the traditional, lengthy, com-
plex practices that match the formal
definition of traditional Tai Chi. The
Tai Chi used in research on both
disease prevention and used as a
complement to medical intervention is
often a ‘‘modified’’ Tai Chi (e.g., Tai
Chi Easy, Tai Chi Chih, or ‘‘short
forms’’ that greatly reduce the number
of movements to be learned). The
modifications generally simplify the
practice, making the movements more
like most health-oriented Qigong ex-
ercises that are simple and repetitive,
rather than a lengthy choreographed
series of Tai Chi movements that take
much longer to learn (and, for many
participants, reportedly delay the ex-
perience of ‘‘settling’’ into the relaxa-
tion response). A partial list of exam-
ples of modified Tai Chi forms from
the RCTs in the review is: balance
exercises inspired by Tai Chi,
30
Tai Chi
for arthritis, five movements from Sun
Tai Chi,
31
Tai Chi Six Form,
32
Yang
Eight Form Easy,
33,34
and Yang Five
Core Movements.
34
In 2003, a panel of Qigong and Tai
Chi experts was convened by the
University of Illinois and the Blueprint
for Physical Activity to explore this very
point.
35
The expert panel agreed that it
is appropriate to modify (simplify) Tai
Chi to more efficiently disseminate the
benefits to populations in need of cost-
effective, safe, and gentle methods of
physical activity and stress reduction.
These simplified forms of Tai Chi are
very similar to the forms of Qigong
used in health research.
For this reason, it is not only
reasonable but also a critical contribu-
tion to the emerging research dialogue
to review the RCTs that explore the
health benefits resulting from both of
these practices together, as one com-
prehensive evidence base for the med-
itative movement practices originating
from China.
METHODS
Data Sources
The following databases were used
to conduct literature searches for
potentially relevant articles: Cumula-
tive Index for Allied Health and
Nursing (CINAHL), psychological lit-
erature (PsycINFO), PubMed, Google
Scholar, and the Cochrane database.
The key words included Tai Chi, Taiji,
Tai Chi Chuan, and Qigong, combined
with RCT or with clinical research
terms. Additional hand searches
(based on word-of-mouth recommen-
dations) completed the search for
articles.
Study Inclusion Criteria
Criteria for inclusion of articles
required that they (1) were published
in a peer-reviewed English-language
journal between 1993 and December
2007; (2) were cited in nursing, med-
ical, or psychological literature; (3)
were designed to test the effects of Tai
Chi or Qigong; and (4) used an RCT
research design. The literature search
resulted in the identification of 576
articles to be considered for inclusion.
The full texts of 158 articles appearing
to meet initial criteria 1 through 4 were
retrieved for further evaluation and to
verify which ones were, in fact, RCTs,
resulting in a final set of 77 articles
meeting all of our inclusion criteria.
Data Abstraction
Articles were read and results were
entered into a table according to
criteria established by the authors for
categorization and evaluation of the
studies and outcomes. Included in
July/August 2010, Vol. 24, No. 6 e3
Table 1 for review and discussion are
type and number of patients random-
ized, duration and type of intervention
and control condition, measured out-
comes, and results. As the information
was entered into the table, it became
apparent that some of the authors
reported results from the same study in
more than one article. Thus, the 77
articles selected actually represented
66 unique studies, with one study
reporting a range of outcomes across
five articles, and five other studies’
results published in two articles each.
An additional two articles were not
entered into the table
36,37
because the
same results were reported in newer
articles. Other than these two dropped
articles, multiple articles are entered
into the table as representing one
study (see Table 1) so that the full
range of outcomes reported across the
articles can be reported without inflat-
ing the number of studies.
Synthesis
Three authors independently re-
viewed the articles selected for inclu-
sion and considered categorizing stud-
ies by type of patient or disease
outcome. Many of the studies drew
participants from a general, healthy
population (n 516), so a category
schema based on patient type or
disease would not have included all of
the studies. The authors revisited the
long list of health benefits and out-
comes assessed across the studies and
generated broad categories that com-
bined related health outcomes into
larger groups. These initial categories
were defined based on identifying the
most frequently measured primary
outcomes, and then refining the
groups to develop an investigation
framework that accommodated all of
the research outcomes into at least one
of the categories. These categories of
outcomes related to Qigong and Tai
Chi practice were discussed and con-
tinually reworked until we had clear,
nonoverlapping boundaries for each
category based on similar symptoms or
health indicators related to a common
function or common target organ
system. These groupings are not in-
tended to be conclusive taxonomies
but rather are used for this review as
convenient and meaningful tools for
evaluating similar groups of outcomes.
In this way, examining health out-
comes across a variety of study designs
and populations (including healthy,
diseased, or at-risk patients) was
possible.
RESULTS
Study Description
A total of 6410 participants were
included across these reported studies.
Although some of the studies com-
pared Qigong or Tai Chi to other
forms of exercise (n 513), many
compared Qigong or Tai Chi to a
nonexercise treatment control group
such as education or usual care (n 5
43) and some used both exercise and
nonexercise comparison groups to
evaluate effects of Qigong or Tai Chi
interventions (n 511). Many studies
included healthy adults (n 516
studies), while other studies included
participants based on specific risk
factors or diagnosis of disease, includ-
ing arthritis (n 55), heart disease (n
56), hypertension (n 55), osteopo-
rosis risk (e.g., perimenopausal status;
n53), fall risk determined by age and
sedentary lifestyle or poor physical
function and balance (n 518), breast
cancer (n 51), depression (n 52),
fibromyalgia (n 52), immune dys-
function, including human immuno-
deficiency virus/acquired immune de-
ficiency syndrome and varicella history
or vaccine response (n 53), muscular
dystrophy (n 51), Parkinson’s disease
(n 51), neck pain (n 51), sleep
complaints (n 51), chronic disease (n
51), and traumatic brain injury (n 5
1). Some of the studies (n 59)
monitored adverse effects during the
interventions and none reported an
adverse event.
The studies originated from 13 coun-
tries (USA, n 534; China [including
Hong Kong], n 59; Korea, n 54;
Australia and New Zealand, n 55;
Sweden, n 54; Great Britain, n 53; Italy
and Taiwan, each n 52; Netherlands,
Israel, Poland, and Spain, each n 51).
Outcomes
From all of the studies, 163 different
physiological and psychological health
outcomes were identified. Many of the
studies assessed outcomes across more
than one category (e.g., physical func-
tion as well as a variety of psychosocial
and fitness outcomes), so some studies
are discussed in more than one section
in the review of categories that follows.
The nine outcome category group-
ings that emerged are bone density (n
54); cardiopulmonary effects (n 5
19); physical function (n 516); falls,
balance, and related risk factors (n 5
23); quality of life (QOL; n 517); self-
efficacy (n 58); patient-reported
outcomes (PROs; n 513); psycholog-
ical symptoms (n 527); and immune-
and inflammation-related responses (n
56). Within each category of out-
comes, there were both Qigong and
Tai Chi interventions represented.
Bone Density
Resistance training and other
weight-bearing exercises are known to
increase bone formation
38
and have
been recommended for postmeno-
pausal women for that purpose.
39
Interestingly, most Qigong and Tai Chi
practices involve no resistance and only
minimal weight bearing (such as gentle
knee bends), yet the four RCTs (total
sample size 5427) included in this
review reported positive effects on
bone health. One study examined the
effect of Qigong
40
and three examined
Tai Chi.
41–43
Bone loss was retarded
and numbers of fractures were less
among postmenopausal women prac-
ticing Tai Chi compared to usual
care.
41
In another study, bone loss was
less pronounced for postmenopausal
females practicing Tai Chi or resis-
tance training compared to no-exercise
controls, but this effect was not found
in the older men participating in the
study.
43
Shen et al.
42
compared Tai Chi
to resistance training and reported
significant changes in biomarkers of
bone health in both groups. Bone
mineral density increased for women
following Qigong exercises as com-
pared to no-exercise controls.
40
In
summary, current research suggests a
favorable effect on bone health for
those practicing Tai Chi or Qigong.
Cardiopulmonary
Nineteen studies (Qigong, n 57;
Tai Chi; n 512) reported favorable
cardiovascular and/or pulmonary out-
comes. Participants in this grouping of
studies were generally older adults
(mean age 561.02) and inclusion
criteria varied from history of disease
to reported sedentary behavior. Mea-
e4 American Journal of Health Promotion
sures of cardiopulmonary function
were representative of cardiopulmo-
nary fitness and cardiovascular disease
risk and included blood pressure,
heart rate, ejection fraction rates,
blood lipids, 6-minute walk distance,
ventilatory function, and body mass
index (BMI).
One of the most consistent findings
was the significant reduction in blood
pressure reported in multiple studies,
especially when Qigong
44,45
or Tai
Chi
46,47
were compared to inactive
control groups such as usual care,
educational classes, or wait-list con-
trols. Even when compared to active
control groups such as aerobic exercise
or balance training, Tai Chi showed a
significant reduction in blood pressure
in two studies.
48,49
Other studies, how-
ever, that utilized active control inter-
ventions expected to reduce blood
pressure (e.g., low to moderate physical
activity interventions) showed positive
changes for both groups, but without
significant differences between Qi-
gong
28
or Tai Chi
50,51
and the compari-
son group, thus providing preliminary
evidence that these meditative move-
ment practices achieve similar results to
conventional exercise.
Other indicators of cardiac health
have been evaluated. Reduced heart
rate is reported
49,51,52
as well as in-
creases in heart rate variability.
53
These
reported changes in blood pressure,
heart rate, and heart rate variability
suggest that one or several of the key
components of Tai Chi and Qigong—
body, breath, and mind—may affect
sympathetic and parasympathetic bal-
ance and activity.
Biomarkers of heart health have
been shown to improve in response to
Qigong or Tai Chi practice. Yeh et al.
34
reported significantly improved serum
B-type natriuretic peptide levels in
response to Tai Chi compared to usual-
care controls, indicating improved left
ventricular function. Lipid profiles
improved in two studies
44,46
comparing
Qigong and Tai Chi to inactive con-
trols, whereas another study of Qi-
gong
54
reported no change in choles-
terol levels compared to inactive (wait-
list) controls. Pippa et al.
54
also re-
ported no change in ejection fraction
rates following a 16-week study of
Qigong among participants with a
history of chronic atrial fibrillation.
Urine catecholamine levels were sig-
nificantly decreased in participants
practicing Tai Chi compared to wait-list
controls,
45
but a similar trend did not
reach significance in another study
with only 15 participants per treatment
condition.
34
A variety of cardiopulmonary fitness
indicators have been examined for
both Qigong and Tai Chi. Participants
with a history of heart failure reported
significant improvements in the incre-
mental shuttle walk following a com-
bined Tai Chi/Qigong intervention
implemented in two studies incorpo-
rating inactive control groups.
34,55
Women treated for breast cancer
achieved significantly increased dis-
tances in the 6-minute walk test in
response to Tai Chi compared to a
psychosocial support control interven-
tion
56
and VO
2max
increased signifi-
cantly more following a Tai Chi inter-
vention compared to resistance
training and usual-care control
groups.
53
In contrast to these consis-
tent findings for cardiopulmonary
benefits, one study found no signifi-
cant improvement in response to
Qigong, whereas aerobic training did
achieve significant changes. In this
small (n 511 in each arm of study)
crossover study of patients with Par-
kinson’s disease, participants practiced
Qigong or aerobic training in random
order for 7 weeks (with 8 weeks’ rest in
between intervention periods); results
on the 6-minute walk test, VO
2peak
, and
VO
2/Kg
ratio were significantly im-
proved for those who completed the
aerobic exercise protocol, but no sig-
nificant effects were found for those
practicing Qigong.
57
Most of the nonsignificant findings
have been found in studies with par-
ticipants with some form of chronic
illness or recovery from cancer at study
entry. For example, respiratory func-
tion improved clinically, but not sig-
nificantly, for patients with chronic
heart failure practicing Tai Chi com-
pared to usual care,
34
and, as described
above, was relatively unchanged for the
Qigong group with a history of Par-
kinson’s disease compared to an aero-
bic training control group.
57
A group
of patients with muscular dystrophy
58
showed a trend for improvement that
did not reach significance compared to
a wait-list control. Further, no change
in cardiovascular function was report-
ed for sedentary participants with a
history of osteoarthritis.
59
Aerobic ca-
pacity was shown to improve with Tai
Chi, though not significantly more so
than with inactive controls, in a small
study of breast cancer survivors.
52,53,56
It
is important to point out that of these
five studies that failed to demonstrate
significant improvements following
Qigong or Tai Chi, four had 31 or
fewer participants. It is difficult to
discern whether nonsignificant find-
ings in cardiopulmonary fitness are
because of some pattern of ineffec-
tiveness with chronic and debilitating
illness or whether they are a result of
the limited statistical power.
One of the key risk factors for
cardiac disease is obesity. Qigong has
demonstrated a greater reduction in
BMI as compared to an exercise
control group in two studies,
28,47
but
this difference was not significant.
Another study demonstrated a
marked but nonsignificant reduction
in waist circumference with Tai Chi
compared to usual care for older
adults.
52
Conversely, one study using
Qigong and two with Tai Chi (re-
spectively)
48,54,59
reported no change
in BMI compared to usual care and
another implementing a Qigong in-
tervention
60
failed to maintain weight
loss, suggesting the data are incon-
clusive at this point as to whether or
not these practices may consistently
affect weight.
A few studies of both Qigong and Tai
Chi have examined level of intensity,
indicating that some forms of these
practices fall within the moderate
intensity level,
11,61
but for the most
part, level of exercise intensity is not
reported. Cardiopulmonary benefits of
Qigong and Tai Chi may partially be
explained as a response to aerobic
exercise, but with the wide range of
speeds with which these exercises are
executed, it would be important to
assess this factor for a better under-
standing of the elements that contrib-
ute to outcomes. Regardless of the
mechanisms, the preponderance of
studies on cardiopulmonary outcomes
show that Qigong and Tai Chi are
effective compared to inactive controls,
or at least approximately equal to the
expected benefits of conventional
exercise.
July/August 2010, Vol. 24, No. 6 e5
Table 1
Randomized Controlled Trials Testing Health Benefits of Qigong and Tai Chi
Source
Subjects:
No. (Male/Female),
Description, Mean Age Exercise Duration Exercise Group Control Group Reported Outcomes
Audette et al.
53
27 (0/27), sedentary,
71.4 y
12 wk (60 min 33 d/wk) TC 10-movement Yang
(n 511)
BW (n 58); UC later
recruited and not
randomized (n 58)
Cardiopulmonary: VO
2max
qin TC more than
BW and UC*; heart rate variability, high
frequency qand low frequencyQin TC
only* no between group difference
Falls and balance: strength, hand grip and
knee extension qTC only* and left knee
extension qin TC more than BW*;
flexibility, only toe touch flexibility qin TC
more than BW*; balance, only
nondominant OLS with eyes closed qin
TC more than BW*
Barrow et al.
55
52 (42/10), older adults
with history of chronic
heart failure, 69.5 y
16 wk (55 min 32 d/wk) TC with Chi Kung
(n 525)
UC (n 527) Cardiopulmonary: incremental shuttle walk q
in TC more than UC ns
Patient-reported outcomes: perceived
symptoms of heart failure Qin TC more
than UC*
Psychological: depression (SCL-90-R) Qin
TC more than UC ns; anxiety Qin both
groups ns
Brismee et al.
103
41 (7/34), history of knee
osteoarthritis, 70 y
12 wk TC and 6 wk no
training (40 min 33
d/wk, 6 wk group training,
6 wk home training, 6 wk
detraining)
TC Yang 24-form simplified
(n 518)
6 wk of HL followed
by no activity same
as exercise group
(n 513)
Physical function: WOMAC qin TC more
than HL* with Qfor detraining period
Patient-reported outcomes: pain Qin TC
more than HL*; adverse outcomes ns
Burini et al.
57
26 (9/17), history of
Parkinson’s disease,
65.2 y
7 wk each of aerobics
(45 min 33 d/wk) and
QG (50 min 33 d/wk) 20
sessions each with 8 wk
between intervention
periods
QG (n 511) AT sessions
(n 511)
Cardiopulmonary: 6-min walk and Borg scale
for breathlessness qand spirometry and
cardiopulmonary exercise test Qfor AT
more than QG*
Patient-reported outcomes: Parkinson’s
Disease Questionnaire ns for both; Unified
Parkinson’s Disease Rating Scale ns;
Brown’s Disability Scale ns
Psychological: Beck Depression Inventory ns
Chan et al.
41
132 (0/132), history of
postmenopausal and
sedentary, 54 y
12 mo (45 min 35 d/wk) TC Chuan Yang style
(n 554)
UC (n 554) Bone density: fractures (1 TC and 3 UC) BMD
measured by dual energy x-ray
absorptiometry in femoral neck, Qin TC
less than UC ns and trochanter Qboth ns;
peripheral quantitative computed
tomography of distal and ultradistal tibia Q
less in TC than UC*
Channer et al.
51
126 (90/36), history of
MI, 56 y
8 wk (2 d/wk 33 wk,
then 1 d/wk 35 wk)
TC Wu Chian-Ch’uan
(n 531)
AE (n 530) or cardiac
SG (n 54) discussed
risk factor modification
and problems in
rehabilitation
Cardiopulmonary: immediate SBP and DBP
QTC and AE ns and HR qin AE more
than TC*; over time, SBP Qboth ns and
DBP and resting HRQin TC more than
AE*; SG too small for comparison
e6 American Journal of Health Promotion
Table 1, Continued
Source
Subjects:
No. (Male/Female),
Description, Mean Age Exercise Duration Exercise Group Control Group Reported Outcomes
Chen et al.
40
87 (0/87), history of BMD
T§22.5, 45 y
12 wk (studied for
2 wk, then 3 d/wk)
QG Baduanjin
(n 544)
NQ (n 543) Bone density: BMD maintained in QG and Q
in NQ*;
Immune/inflammation: interleukin-6 Qin QG
and qin NQ*
Cheung et al.
28
88 (37/51), older adults
in community with
history of hypertension,
54.5 y
16 wk (120 min 32 d/wk 3
4 wk then monthly and
encouraged to practice 60
min in A.M. and 15 min in
P.M.37 d/wk)
QG Guolin (n 547) E (n 541) Cardiopulmonary: BP, HR, waist
circumference, BMI, total cholesterol,
renin, and 24-h urinary protein excretion Q
QG and E ns; ECG QG and E nc/ns
QOL: SF-36 QE ns
Psychological: Beck Anxiety Inventory Qand
Beck Depression Inventory q; QG and
E ns
Choi et al.
73
59 (15/44), living in care
facility, ambulatory with
history of at least 1 fall
risk factor,
77.8 y
12 wk (35 min 33 d/wk) TC Sun style (n 529) UC (n 530) Falls and balance: FALLS ns, but falls
efficacy for TC qand QUC*; knee and
ankle strength, OLS eyes open, and toe
reach qand 6-m walk Qmore than UC*;
OLS eyes open nc
Self-efficacy: falls efficacy for TC qand Q
UC*
Chou et al.
108
14 (7/7), community-
dwelling Chinese,
history of depression
from a psychogeriatric
clinic, 72.6 y
3 mo (45 min 33 d/wk) TC Yang style 18
form (n 57)
WL (n 57) Psychological: Center for Epidemiological
Studies Depression Scale QTC more
than WL*
Elder et al.
60
92 (13/79), history of
completing 12-wk weight
loss intervention and loss
of at least 3.5 kg, 47.1 y
24 wk (10 h overall with
28-min QG sessions)
QG Emie Zhen Gong
(n 522)
TAT (n 527) and
SDS (n 524)
Cardiopulmonary: weight loss maintenance
for TAT and qQG and SDS*
Faber et al.
30
238 (50/188) frail (51%)
or prefrail (48.9%)
older adults living in
care facility, 85 y
20 wk (60 min exercise
and 30 min social time
31 d/wk 34 wk for
socialization, then 32
d/wk for 16 wk)
TC (BE inspired by TC)
(n 580)
FW (n 566) or
UC (92)
Falls and balance: falls lower for TC more
than FW and UC ns; when FW and TC
combined, fall risk Qand physical function
(6-m walk, timed chair stand, TUG, and
FICSIT-4) qcompared to UC in prefrail,*
frail ns, also TC compared to FW ns
Patient-reported outcomes: Performance-
Oriented Mobility Assessment qfor TC
and FW and exercise groups combined
more than UC* and prefrail,* frail ns;
Groningen Activity Restriction Scale Qfor
FW more than control* TC vs. UC ns
Fransen et al.
31
152 (40/112) older adults,
history of chronic
symptomatic hip or
knee osteoarthritis,
70.8 y
12 wk (60 min 32 d/wk) TC for Arthritis by Dr. Lam
from Sun Style 24 forms
(n 556)
H (n 555) and WL
control (n 541)
Physical function: WOMAC: pain and function
QTC and H ns with treatment effect for
physical function moderate*; pain score Q
for H compared to WL,* TC ns; physical
performance: TUG, 50-foot walk, and stair
climb Qmore for H than WL*; timed stair
climb for QTC and H ns
July/August 2010, Vol. 24, No. 6 e7
Table 1, Continued
Source
Subjects:
No. (Male/Female),
Description, Mean Age Exercise Duration Exercise Group Control Group Reported Outcomes
QOL: SF-12 Physical qH more than WL*
and TC more than WL borderline*; SF-12
Mental ns
Patient-reported outcomes: pain and function
QTC and H ns
Psychological: Depression Anxiety & Stress
21 Qin H* and TC ns
Galantino et al.
66
38 (38/0), history of long
term care of HIV/AIDS,
between 20 and 60 y
8 wk (60 min 32 d/wk) TC (n 513) AE (n 513) and UC
(n 512)
Physical function: FR, SR, sit-up, and
physical performance test all improved
more than UC* and TC compared to AE nc
QOL: Medical Outcomes Short Form-HIV
improved TC and AE more than control*;
spiritual well-being improved TC AE and
UC ns
Psychological: Profile of Mood States
improved TC and AE more than control*
Gatts and
Woollacott
65
19 (2/17), balance-
impaired seniors,
77.5 y
3 wk (90 min 35 d/wk) TC Twelve Classical TC
Postures (n 511)
TC-based and axial
mobility program;
same group practiced
TC after control time
(n 58)
Falls and balance: TUG Qmore for TC than
control*; FRqfor TC and control; OLS and
tandem stance both legs qmore TC than
control*; tibialis anterior more qfor TC
than control*; gastrocnemius qonly TC
after control time*
Gemmell and
Leathem
96
18 (9/9), history of
traumatic brain injury
symptoms, 45.7 y
6 wk (45 min 32 d/wk) TC Chen style (n 59) WL UC (n 59) QOL: SF-36 and Rosenberg Self-Esteem
Scale no different ns except role emotional
qTC more than UC*
Psychological: Visual Analogue Mood Scales
improved TC more than UC*; Rosenberg
Self-Esteem Scale nc, ns
Greenspan
et al.
32
269 (0/269), congregate
independent living,
transitionally frail with at
least 1 fall in past year,
.70 y and 50% over 80 y
48 wk (60 increasing to
90 min 32 d/wk)
TC 6 simplified forms
(n 5103)
WE (n 5102) Physical function: Sickness Impact Profile for
physical function and ambulation Qmore
TC than WE*
Patient-reported outcomes: Sickness Impact
Profile and physical and ambulation
perceived health status QTC more than
WE*; self-reported health nc TC and WE ns
Hammond and
Freeman
100
133 (13/120), history of
fibromyalgia from a
rheumatology outpatient
department, 48.53 y
10 wk (45 min 3
1 d/wk)
TC for arthritis (part of
patient ED group including
fibromyalgia information,
postural training, stretching,
and weights) (n 552)
RG (n 549) Self-efficacy: Arthritis Self-Efficacy Scale q
TC more than RG at 4 mo*; at 8 mo ns
Patient-reported outcomes: Fibromyalgia
Impact Questionnaire QTC more than
RG* at 4 mo*; at 8 mo ns
Psychological: Anxiety and depression TC
and RG ns
Hart et al.
87
18 (16/2), history of stroke,
community-dwelling,
54.77 y
12 wk (60 min 3
2 d/wk)
TCC (n 59) BE (n 59) Falls and balance: BBS, OLS, Emory
Fractional Ambulation Profile, Romberg,
TUG improved in BE,* not TCC ns
e8 American Journal of Health Promotion
Table 1, Continued
Source
Subjects:
No. (Male/Female),
Description, Mean Age Exercise Duration Exercise Group Control Group Reported Outcomes
QOL: Duke Health Profile improved TC,* not
BE ns
Hartman et al.
67
33 (5/28), community-
dwelling with lower
extremity osteoarthritis,
68 y
12 wk (60 min 3
2 d/wk)
TC 9-form Yang (n 518) UC with phone calls
every 2 wk to discuss
issues related to
osteoarthritis
(n 515)
Physical function: OLS, 50-ft walk, and chair
rise TC and UC ns with small to moderate
effect size for TC only
QOL: Arthritis Impact Measurement Scale II
(satisfaction with life) qand tension Q
more for TC than UC*; pain and mood
both ns
Self-efficacy: arthritis self-efficacy qTC
more than UC*
Hass et al.
88
28 (not reported), older
adults transitioning to
frailty, 79.6 y
48 wk (60 min 3
2 d/wk)
TC 8 of 24 simplified
forms (n 514)
WE (n 514) Falls and balance: center of pressure during
S1 and S2 improved for TC more than
WE*; S3 for both ns
Irwin et al.
110
112 (41/71), healthy older
adults, 70 y
16 wk (40 min 3
3 d/wk)
TC Chih (n 559) HE (n 553) QOL: SF-36 improved for physical
functioning, bodily pain, vitality, and mental
health for TC more than HE*; role
emotional Qfor HE more than TC*; role
physical, general health, and social
functioning both groups ns
Psychological: Beck Depression Score qTC
and HE ns
Immune/inflammation: varicella zoster virus
responder-cell frequency qTC more than
HE*
Irwin et al.
90
36 (5/13), healthy older
adults, 70.5 y
15 wk (45 min 3
3 d/wk)
TC Chih (n 514) WL (n 517) QOL: SF-36 only role physical and physical
functioning improved more for TC than
WL*
Immune/inflammation: varicella zoster virus
cell–mediated immunity qmore for TC
than WL*
Jin
109
96 (48/48), TC
practitioners, 36.2 y
History of TC 46.4 mo
males/34 mo females 2
sessions of exposure to
stress followed by
respective treatment
TC long form or Yang style
(n 524)
BW (n 524),TC M
(n 524), and NR
(n 524)
Psychological: Profile of Mood States
improved all treatments* with state anxiety
Qin TC more than reading*; BP and HR
qunder stress for TC and BW more than
M and NR*; adrenaline Qmore for TC
than M*; noradrenaline qmore for TC
than NR*; salivary cortisol qall groups*
Judge et al.
74
21 (0/21), sedentary,
68 y
6 mo (20 min walking plus
other exercise 33 d/wk
for TC and no exercise for
12 wk, then 30 min 31
d/wk for FT)
TC simple with strength
training and walking
(n 512)
FT (n 59) Falls and balance: OLS qmore for TC than
FT ns; knee extension qmore for TC
than FT*; sitting leg press improved TC
and FT ns
July/August 2010, Vol. 24, No. 6 e9
Table 1, Continued
Source
Subjects:
No. (Male/Female),
Description, Mean Age Exercise Duration Exercise Group Control Group Reported Outcomes
Kutner et al.
97
130 (?/?), TC BT and
control, mostly women,
healthy older adults,
76.2 y
15 wk (45 min total 32
d/wk TC and 1 d/wk BT
and ED)
TC 10 modified forms from
108 (n 551)
BT (n 539) and ED
control (n 540)
QOL: SF-36 all groups nc
Self-efficacy: self-confidence qmore for TC
and BT than EC*
Psychological: Rosenberg self-esteem q
more TC than BT or EC ns
Lansinger et al.
64
122 (36/86) history of
long term nonspecific
neck pain, 43.8 y
3 mo (1 h 31–2 d/wk
310–12 sessions)
QG Biyun (n 560) ET (n 562) Physical function: grip strength and cervical
ROM qboth groups ns
Patient-reported outcomes: neck pain and
Neck Disability Index Qboth groups ns
Lee et al.
44,101
36 (14/22), history
of hypertension, 53.4 y
8 wk (30 min 32 d/wk) QG Shuxinpingxuegong
(n 517)
WL (n 519) Cardiopulmonary
44
: (2004a) BP Qmore in
QG than WL*; HDL and APO-A1 qmore
in QG than WL*; high-density lipoprotein
and apolipoprotein A1 qand total
cholesterol Qin QG pre-post*;
triglycerides Qin QG and qin WL ns
Self-efficacy
101
: Self-efficacy and perceived
benefitsqin QG and Qin WL*
Psychological
101
: emotional state qin QG
and Qin WL*
Lee et al.
45,107
58 (not reported), history
of hypertension,
56.2 y
10 wk (30 min
33 d/wk)
QG Shuxinpingxuegong
(n 529)
UC WL (n 529) Cardiopulmonary
107
: HR Qmore in QG than
WL*; epinephrine and norepinephrine Q
for QG and qfor WL*; cortisol Qfor QG
and qfor WL ns
Psychological
107
: Self-report stressQQG
more than WL*; epinephrine and
norepinephrine Qfor QG and qfor WL*;
cortisol Qfor QG and qfor WL ns
Cardiopulmonary
45
: BP and catecholamines
Qfor QG and qfor UC*; ventilatory
function qmore for QG than UC*
Lee et al.
91
139 (45/96), resident of
care facility, ambulatory,
Chinese, 82.7 y
26 wk (60 min 3
3 d/wk)
TC (n 566) UC (n 573) QOL: health-related QOL qTC more than
UC*
Psychological symptoms: self-esteem qTC
more than UC*
Li et al.
33
48 (not reported), older
adults, 68.88 y
3 mo (3 d/wk) TC Yang 8-form easy
TC (n 526)
SC (n 522) Falls and balance: OLS improved TC more
than SC*
Physical function: SF-12 physical,
instrumental activities of daily living, 50-ft
walk, and chair rise all improved TC more
than SC*
Psychological: SF-12 mental qmore TC
than SC*
e10 American Journal of Health Promotion
Table 1, Continued
Source
Subjects:
No. (Male/Female),
Description, Mean Age Exercise Duration Exercise Group Control Group Reported Outcomes
Li et al.
105
118 (22/96), history
of moderate sleep
complaints and
community-dwelling
adults, 75.4 y
24 wk (60 min 3
3 d/wk)
TC Yang (n 562) EC (n 556) Physical function: OLS and SF-12 physical q
and chair rise and 50-ft walk QTC more
than EC*
Patient-reported outcomes: sleep duration and
efficiency qand sleep quality, latency,
duration, and disturbances, Epworth
Sleepiness Scale, and Pittsburg Sleep
Quality Index Qmore for TC than EC*;
sleep dysfunction both and medication Q
TC only ns
Psychological: SF-12 mental qboth ns
Li et al.
75,99
256 (77/179), sedentary
77.48 y
6 mo (60 min 3
2 d/wk)
TC Yang style 24 forms
(n 5125)
SC (n 5131) Falls and balance
75
: fewer falls and fewer
injurious falls for TC than SC*; and BBS,
Dynamic Gait Index, FR, and OLS qand
50-ft walk and TUG Qmore for TC than
SC* all sustained at 6 mo follow-up
Falls and balance
99
: activities-specific
balance qmore for TC than SC*
Self-efficacy
99
: falls self-efficacyq(mediator)
and fear of falling (SAFFE) Qmore for TC
than SC*
Psychological: fear of falling (SAFFE) Q
more for TC than SC*
Li et al.
68,70,92,112,123
6401 (9/85), sedentary,
72.8 y
6 mo (60 min 3
2 d/wk)
TC Yang style 24 forms
(n 549)
WL (n 545) Physical function
68
: SF-20 physical function
qamong TC more than WL over time* r
scores
Self-efficacy
68
: self-efficacy qamong TC
more than WL over time* rscores
QOL
92
: SF-20 (general health survey) q
more for TC than WL*; TC with lower
levels of health perception, physical
function, and high depression at baseline
and movement confidence q5q
physical function*
Psychological
112
: Physical function self-
esteem and Rosenberg self-esteem q
more for TC than WL*
Self-efficacy
123
: barrier and performance self-
efficacy qTC more than WL*; exercise
adherence qTC than WL*; and SE
conditions related to adherence for TC
Maciaszek et al.
76
49 (49/0), sedentary, history
of osteopenia or
osteoporosis, 70.2 y
18 wk (45 min 3
2 d/wk)
TC 24 form (n 525) UC (n 524) Falls and balance: Posturographic Platform
(time Q; % task performance and total
length of path qfor TC*; and % task
performance and total length of path q
more for TC than UC*
July/August 2010, Vol. 24, No. 6 e11
Table 1, Continued
Source
Subjects:
No. (Male/Female),
Description, Mean Age Exercise Duration Exercise Group Control Group Reported Outcomes
Mannerkorpi and
Arndorw
69
36 (0/36), history of
fibromyalgia, 45 y
3 mo (20 min 3
1 d/wk)
QG with Body
Awareness (n 519)
UC (n 517) Physical function: chair stand and hand grip
TC and UC ns
Patient-reported outcomes: body awareness
qTC more than UC*; fibromyalgia
symptoms TC and UC ns
Manzaneque
et al.
113
29 (14/15), healthy young
adults, 18–21 y
1 mo (30 min 3
5 d/wk)
QG Eight Pieces of Brocade
(low intensity) (n 516)
UC (n 513) Immune/inflammation: leukocytes,
eosoinophils, monocytes, and C3 levels Q
TC than UC*; trend for neutrophils; total
lymphocytes, T lymphocytes, t helper
lymphocytes, concentrations of complement
C4 or immunoglobulins ns
McGibbon et al.
85
36 (16/20), history of
vestibulopathy, 59.5 y
10 wk (70 min 3
1 d/wk)
TC Yang (n 519) VR (n 517) Falls and balance: gait speed qTC more than
VR*; step length qfor TC and VR*; stance
duration QVR* more than TC; step width q
VR and TC ns: mechanical energy
expenditure (hip QTC more than VR*; ankle
qmore for TC than VR*; knee and leg both
ns); peak trunk forward velocity qTC more
than VR*; forward velocity range and peak
or range of lateral trunk velocity TC and VR
ns; peak trunk angular velocity qmore for
VR than TC*; trunk angular velocity in frontal
plane and change in peak and range TC and
VR ns; trunk velocity peak and range
positively correlated with change in leg
mechanical energy expenditure for TC* and
VR negative relationship
McGibbon
et al.
86
26 (11/15), history
of vestibulopathy, 56.2 y
10 wk (70 min 3
1 d/wk)
TC Yang (n 513) VR (n 513) Falls and balance: gaze stability qmore for
VR than TC*; whole-body stability and foot
fall stability qmore for TC than VR*;
correlation between change in gaze
stability and whole-body stability , and foot-
fall stability and gaze stability for VR not
TC*; correlation between foot-fall stability
and whole-body stability for VR and TC*
Motivala et al.
50
32 (14/18), out of
63 who completed RCT
for herpes zoster risk in
aging study, 68.5 y
37 wk TC (? min 3
1 d/wk)
TC Chih (n 519) PR and slow
moving physical
movement
(n 513)
Cardiopulmonary: pre-ejection period q
posttask more for TC than PR*; BP and HR
TC and PR ns
Mustian
et al.
56,93
21 (0/21), history of breast
cancer 52 y
12 wk (60 min 3
3 d/wk)
TC Yang and Chi
Kung (n 511)
PS (n 510) Cardiopulmonary
56
: 6-min walk qfor TC and
Qfor PS*; aerobic capacity qfor TC and Q
for PS ns
Physical function
56
: (2006) muscle strength
(hand grip qfor TC and Qfor PS*); and
flexibility (abduction qTC and PS, flexion,
extension, horizontal adduction and
abduction qmore for TC than PS*; and
body fat mass Qfor TC and qfor PS ns
e12 American Journal of Health Promotion
Table 1, Continued
Source
Subjects:
No. (Male/Female),
Description, Mean Age Exercise Duration Exercise Group Control Group Reported Outcomes
QOL
93
: health-related QOL qfor TC* and Q
PS ns
Psychological
93
: Self-esteem qfor TC and
Qfor PS*
Nowalk et al.
84
110 (15/95), long term care
residents, 84 y
13–28 mo (3 d/wk) TC with behavioral
component (n 538)
Physical therapy weight
training (n 537) and
ED Control (n 535)
Falls and balance: falls no difference between
groups
Pippa et al.
54
43 (30/13), history of stable
chronic atrial fibrillation,
68 y
16 wk (90 min 3
2 d/wk)
QG (n 522) WL control
(n 521)
Cardiopulmonary: 6-min walk qfor QG and
Qfor WL*; Ejection fraction, BMI,
cholesterol ns
Sattin et al.
77
311 (20/291), transitionally
frail with history of 1 or
more falls in past year (55
African Americans), 80.1 y
48 wk (60–90 min
32 d/wk)
TC 6 of 24 Simplified
(n 5158)
WE (n 5153) Falls and balance: activities-specific balance
qmore among TC than WE*
Psychological: Falls Efficacy Scale Qmore
among TC than WE*
Shen et al.
42
28 (7/21), sedentary from
a senior living facility,
79.1 y
24 wk (40 min 3
3 d/wk)
TC Yang Style
Simplified 24 forms
(n 514)
RT (n 514) Bone density: sedentary older adults on bone
metabolism (serum bone-specific alkaline
phosphatase/urinary pyridinoline) qmore
for TC than RT at 6 wk* and TC returned to
baseline and RT less than baseline*;
parathyroid hormone qmore for TC than
RT at 12 wk*; serum 1,25-vitamin D3 TC
and RT ns; serum calcium qmore for TC
than RT at 12 wk compared to 6 wk*;
urinary calcium Qfor TC* not RT; serum
and urinary Pi TC and RT ns
Song et al.
59,104
43 (0/72), history of
osteoarthritis and no
exercise for
1 y prior, 63 y
12 wk (60 min 3
3 d/wk for 2 wk then
31 d/wk for 10 wk)
TC Sun Style modified
for arthritics (n 522)
UC (n 521) Cardiopulmonary
59
: BMI, 13-min ergometer
TC and UC ns
Falls and balance
59
: OLS, trunk flexion and
sit-ups qmore for TC than UC*; flexibility
and knee strength TC and UC ns
Patient-reported outcomes
104
: pain and
stiffness Qand perceived benefits q
more for TC than UC*; TC performed more
health behaviors than UC*
Stenlund et al.
82
95 (66/29), history
of coronary artery
disease, 77.5 y
12 wk (60 min QG and
120 min discussion on
various themes)
QG (TC & Medicinsk
QG) (n 548)
UC (n 547) Falls and balance: Falls Efficacy Scale,
tandem standing, OLS left, climb boxes left
TC and UC ns; OLS right and climb boxes
right qmore for TC than UC*; and
coordination Qmore for UC than TC*; and
self-reported activity level qfor TC more
than UC*
Pyschological: fear of falling between TC and
UC ns
July/August 2010, Vol. 24, No. 6 e13
Table 1, Continued
Source
Subjects:
No. (Male/Female),
Description, Mean Age Exercise Duration Exercise Group Control Group Reported Outcomes
Thomas et al.
52
207 (113/94), healthy,
community-dwelling,
68.8 y
12 mo (60 min 33 d/wk) TC Yang style 24
forms (n 564)
PS (n 565) or
UC (n 578)
Cardiopulmonary: energy expenditure qfor
TC and RT more than UC ns; waist
circumference and HR Qmore TC and RT
than UC ns; insulin sensitivity Qmore for
RT than UC* and more for TC than UC ns;
BMI, body fat, BP, cholesterol, and
glucose TC, RT, and UC ns
Tsai et al.
46
76 (38/38), sedentary
with prehypertension
or stage I, 52 y
12 wk (50 min 33 d/wk) TC Yang (n 537) UC (n 539) Cardiopulmonary: BP and total cholesterol Q
for TC* and qfor UC ns; BMI and HR TC
and UC ns; triglyceride QTC* and qUC*;
LDL QTC* and qUC ns; high-density
lipoprotein qTC* and QUC ns
Psychological: trait and state anxiety Q
TC*more than UC ns
Tsang et al.
95
82 (16/66), history
of depression and
chronic illness,
82.4 y
16 wk (30–45 min 33 d/wk) QG Baduanjin
(n 548)
NR group with same
intensity (n 534)
QOL: personal well-being qfor QG and Q
NR*; general health questionnaire QQG
and qNR*; and self-concept Qmore TC
than NR*
Self-efficacy: Chinese General Self-Efficacy
and Perceived Benefits Questionnaire q
more for QG than NR*
Psychological: Geriatric Depression Scale Q
more for QG than NR*
Tsang et al.
94
50 (26/24), history of
chronic disease, 74.6 y
12 wk (60 min 32 d/wk) QG Eight-Section Brocades
(n 524)
BR activities (n 526) QOL: physical health, activities of daily living
psychological health and social
relationships improved for QG*; self-
concept and WHOQOL-BREF QG and
BR ns
Psychological: Geriatric Depression Scale Q
TC and BR ns
Tsang et al.
72
38 (8/30), sedentary,
community-dwelling, type
2 diabetics, 65.4 y
16 wk (45 min 32 d/wk) TC for diabetes (12-
movement hybrid
from Yang and Sun)
(n 517)
Sham exercise (seated
calisthenics
and stretching)
(n 520)
Physical function: 6-min walk, habitual and
maximal gait speed, muscle strength, and
peak power qTC more than SE ns;
endurance Qmore for SE than TC ns; and
habitual physical activity qTC and QSE*
Falls and balance: balance index QTC and
SE ns; OLS open qTC and nc SE ns;
OLS closed and tandem walk QTC and
SE ns; Falls 0–2 TC and SE ns
QOL: SF-36 (except Social Function qfor
TC and QSE*) and Diabetes Integration
Scale TC and SE ns
e14 American Journal of Health Promotion
Table 1, Continued
Source
Subjects:
No. (Male/Female),
Description, Mean Age Exercise Duration Exercise Group Control Group Reported Outcomes
Voukelatos
et al.
78
702 (112/590) community
dwelling, 69 y
16 wk (60 min 31 d/wk) TC 38 programs mostly
Sun-style (83%) Yang
(3%) (n 5271)
WL (n 5256) Falls and balance: sway on floor and foam
mat, lateral stability, coordinated stability,
and choice stepping reaction time
improved TC more than WL*; maximal
leaning balance range qTC more than
WL ns; fall rates less for TC (n 5347) than
WL (n 5337)*
Wang et al.
71
20 (5/15), community-
dwelling with rheumatoid
arthritis class I or II,
49.5 y
12 wk (60 min 32 d/wk) TC Yang style (n 510) Stretching and WE
(n 510)
Physical function: chair stand and 50-ft walk
qTC and WE ns; American College of
Rheumatology 20 QTC more than WE*;
hand grip not reported; Health Assessment
Questionnaire qmore TC than WE*; ESR
and C-reactive protein ns
QOL: SF-36 qmore TC than WE with only
vitality*
Patient-reported outcomes: pain QTC and
qWE ns
Psychological: Center for Epidemiological
Studies Depression Scale qmore TC
than WE*
Immune/inflammation: ESR and C-reactive
protein ns (note TC higher level at
baseline)
Wenneberg
et al.
58
36 (19/17), history of
muscular dystrophy,
55.3 y
12 wk (weekend immersion,
then 45–50 min 31 d/wk
for 4 wk, then every other
week for 8 wk)
QG (n 516) WL control (n 515) Cardiopulmonary: Forced vital capacity and
expiratory volume QQG and WL ns
Falls and balance: BBS unchanged for QG
and QWL ns for intervention period;
subgroup A
QOL: SF-36 general health unchanged for QG
and QWL* and other dimensions ns; Ways
of Coping positive reappraisal coping Qfor
QG and unchanged for WL,* confrontative
coping qQG and QWL ns, and other
dimensions ns
Psychological: Montgomery Asberg
Depression Rating Scale QG and WL ns
Winsmann
106
47 (47/0), veterans.
49.55 y
4 wk (75 min 32 d/wk) TC Chuan Yang Style
(n 523)
UC included group
therapy (n 524)
Patient-reported outcomes: Dissociative
Experiences and Symptom Checklist 90 Q
TC more than UC ns
Wolf et al.
47
311 (20/291), transitionally
frail with average of 5.6
comorbidities, 80.9 y
48 wk (60–90 min 3
2 d/wk)
TC 6 of 24 simplified
forms (n 5158)
WE (n 5153) Cardiopulmonary: BMI QTC and qWE*;
SBP and HR QTC and qWE*; DBP Q
TC more than WE*
Physical function: gait speed and FR qTC
and WE ns; chair stands Q12.3% TC and
q13.7% WE*; 360uturn and pick up object
similar change TC and WE ns; OLS nc
July/August 2010, Vol. 24, No. 6 e15
Table 1, Continued
Source
Subjects:
No. (Male/Female),
Description, Mean Age Exercise Duration Exercise Group Control Group Reported Outcomes
Wolf et al.
79
286 (17/269), transitionally
frail with average of 5.6
comorbidities, 80.9 y
48 wk (60–90 min
32 d/wk)
TC 6 of 24 simplified
forms (n 5145)
WE (n 5141) Falls and balance: TC lower risk for falls from
mo 4 to 12; RR falls TC and WE 0.75 (CI 5
0.52–1.08) ns
Wolf et al.
80
72 (12/60),
sedentary, 77.7 y
15 wk (60 min 3
2 d/wk TC group)
TC 108 forms simplified
to 10 forms (n 519)
BT (n 516) and ED
control (n 519)
Falls and balance: balance: dispersion for
OLS (eyes open), toes up (eyes open and
closed), center of balance X with toes up
(eyes open) and center of balance Y (OLS
eyes open and closed) Qmore BT than
ED and TC*; dispersion for toes up (eyes
open), center of balance X OLS (eyes open
and closed) and toes up (eyes closed), and
center of balance Y for toes up (eyes open
and closed) TC, BT, and ED ns
Psychological: fear of falling Qmore for TC
than BT and ED*
Wolf et al.
49
200 (39/161), community-
dwelling, 76.2 y
15 wk (45 min 31
d/wk in class plus
15 min 2 3daily)
TC (n 572) BT (n 564) and
ED control
(n 564)
Cardiopulmonary: BPQmore for TC than BT
and ED*; 12-min walk q0.01 mile for BT
and ED and Q0.02 for TC*; body
composition changes for TC, BT and ED ns
Physical function: left hand grip strength Q
more in BT and ED than TC*; strength of
hip, knee and ankle via Nicholas MMT
0116 muscle tester, lower extremity ROM
changes TC, BT, and ED ns
Falls and balance: intrusivenessQmore for
TC than ED ns; RR for falls in TC 0.632 (CI
0.45–0.89)* using FICSIT fall definition; for
BT and other fall definitions ns
Psychological: fear of falling Qmore for TC
than BT and ED*
Woo et al.
43
180 (90/90), community-
dwelling, 68.91 y
12 mo (? min 3
3 d/wk)
TC Yang style 24
forms (n 558)
RT (n 559) and UC
(n 559)
Falls and balance: muscle strength (grip
strength and quadriceps) ns; balance
(SMART Balance Master, stance time, gait
velocity, and bend reach) and falls for TC,
RT and UC ns
Bone density: women: BMD loss at hip less
for TC and RT than UC*; BMD loss at
spine less for TC and RT than UC ns; men:
no difference in % change in BMD
Yang et al.
83
49 (10/39), healthy adults,
80.4 y
6 mo (60 min 3
3 d/wk)
QG (sitting and standing)
and Taiji Chen style
Essential 48 form
(n 533)
WL (n 516) Falls and balance: Sensory Organization Test
vestibular ratios and base of support
measures qmore for TC than WL*q;
Sensory Organization Test visual ratios
and feet opening angle for TC and WL nc
e16 American Journal of Health Promotion
Table 1, Continued
Source
Subjects:
No. (Male/Female),
Description, Mean Age Exercise Duration Exercise Group Control Group Reported Outcomes
Yang et al.
114
50 (13/37), history of
received flu immunization
and sedentary, 77.2 y
20 wk (60 min 3
3 d/wk)
QG (sitting and standing)
and Taiji Chen style
Essential 48 form
(n 527)
WL (n 523) Immune/inflammation: hemagglutination
inhibition assay q109% for QG compared
to ,10% for WL*
Yeh et al.
34
30 (19/11), history of chronic
stable heart failure, 64 y
12 wk (60 min 3
2 d/wk)
TC Yang-style 5 core
movements (n 515)
UC including
pharmacologic therapy
and dietary and
exercise counseling
(n 515)
Cardiopulmonary: peak O2 uptakeqTC and
QUC ns; 6-min walk qTC and QUC*;
serum B-type natriuretic peptide QTC and
qUC*; plasma norepinephrine qTC
more than UC ns; no differences in
incidence of arrhythmia between groups
QOL: Minnesota Living with Heart Failure Q
TC and qUC*
Young et al.
48
62 (13/49), history of BP
between 130 and 159
and not taking
medications for
hypertension or insulin
(45.2% black), 66.7 y
12 wk (60 min 32
d/wk class with goal
of 30–45 min 34–5
d/wk)
TC Yang style 13
movements (n 531)
AE class at 40%–60%
HR reserve (n 531)
Cardiopulmonary: BPQTC and AE*; BMI q
slightly TC and AE ns; time in moderate
activity, weekly energy expenditure, and
leisurely walking qfor AE more than
TC ns
Zhang et al.
81
47 (25/22), history
of poor balance, 70.4 y
8 wk (60 min 37 d/wk) TC simplified 24
forms Zhou
(n 524)
UC (n 523) Falls and balance: OLS, trunk and flexion
more TC than UC*; 10-min walk QTC and
UC ns
Psychological symptoms: Falls Efficacy Scale
qmore TC than UC*
!TC indicates Tai Chi; BW, brisk walking; UC, usual care; q, increase in score; Q, decrease in score; OLS, 1-leg stance; ns, scores not significantly different between groups; HL, health
lecture; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index; QG, Qigong; AT, aerobic training; BMD, bone marrow density; AE, aerobic exercise; SG, support group; MI,
myocardial infarction; SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate; NQ, no Qigong; E, exercise; BP, blood pressure; BMI, body mass index; ECG,
electrocardiogram up; nc, no change in scores; QOL, quality of life; WL, wait list; TAT, Tapas acupressure technique; SDS, self-directed support; BE, balance exercises; FW, functional
walking; TUG, timed up and go; FICSIT, Frailty and Injuries: Cooperative Studies on Intervention Techniques; H, hydrotherapy; HIV/AIDS, human immunodeficiency virus/acquired
immunodeficiency syndrome; FR, functional reach; SR, sit and reach; WE, wellness education; ED, education; RG, relaxation group; BBS, Berg Balance Scale; TCC, Tai Chi chuan; HE, health
education; M, meditation; NR, neutral reading; FT, flexibility training; BT, balance training; ET, exercise therapy; ROM, range of motion; HDL, high-density lipoprotein; APO-A1, apolipoprotein
A1; SC, stretching control; EC, exercise Control; SAFFE, Survey of Activities and Fear of Falling in the Elderly; VR, vestibular rehabilitation; RCT, randomized controlled trial; PR, passive rest;
PS, psychosocial support; RT, resistance training; NR, newspaper reading; BR, basic rehabilitation; WHOQOL-BREF, World Health Organization Quality of Life: Abbreviated Version; ESR,
erythrocyte sedimentation rate.
*p#0.05 between groups.
July/August 2010, Vol. 24, No. 6 e17
Physical Function
Decreased physical activity is related
to declining physical function in all
populations, and that decline is com-
pounded by the natural process of
aging.
62,63
Changes in physical function
were assessed in 16 studies (Qigong, n
52; Tai Chi, n 514). Most of the
studies were conducted with older
adults (i.e., studies in which mean age
555 years or older, n 513) and
several recruited specifically for partic-
ipants with chronic pain (e.g., osteo-
arthritis, neck pain, or fibromyalgia, n
55). A number of behavioral mea-
sures of physical function performance
were included in this category of
outcomes, which also includes self-
reported responses on scales repre-
senting physical function. Although
fitness outcomes, such as the 6-minute
walk test, might also be seen as
assessing overall physical function, we
did not include tests already discussed
in the cardiopulmonary fitness catego-
ry, but rather focused on functional
tests that are usually used to assess
capacity for daily living. Studies that
assessed changes in overall physical
activity levels are also included as an
outcome pertaining to physical func-
tion.
Physical function measured with a
wide variety of performance indica-
tors, including chair rise, 50-ft walk,
gait speed, muscle contraction
strength, hand grip, flexibility, and
function as measured on the Western
Ontario and McMaster Universities
Osteoarthritis Index (an osteoarthritis-
specific assessment for function, stiff-
ness, and pain), were variously found
to be significantly improved in five
studies comparing Tai Chi to minimal
activity (usual or stretching activity,
psychosocial support, or education)
comparison groups
56,64–66
and one
study of Tai Chi compared to an
exercise therapy control interven-
tion.
64
One of these studies combined
functional walking with Tai Chi to
achieve significant improvements with
prefrail elders compared to usual
care.
30
In contrast, in seven studies includ-
ing participants with osteoarthritis or
multiple comorbidities, some of the
physical function measures were not
significantly different for Tai Chi or
Qigong in comparison to inactive
controls. This was the case for gait
speed,
47
timed up and go, 50-ft walk
and stair climb
31
and 50-ft walk and
chair stand.
67,68
In one study of 30
patients with osteoarthritis practicing
Tai Chi twice per week
67
and another
with 36 participants with fibromyalgia
that utilized hand grip and chair stand
to test a 20-minutes-per-week Qigong
intervention,
69
neither achieved signif-
icant improvements compared to usual
care. In one exception to this trend,
one measure of functional perfor-
mance, time to complete chair rise, was
significantly improved in transitionally
frail elders in the Tai Chi group
compared to a wellness education
control group.
47
Studies using self-report measures
consistently show positive results for
Tai Chi. Self-reported improvement in
physical function for sedentary older
adults was demonstrated for Tai Chi
compared to wait-list controls
68,70
and a
stretching exercise control.
33
Results in this category of outcomes
are inconsistent, with a preponderance
of studies recruiting sedentary or
chronically ill or frail elder partici-
pants. Even so, a handful of these
studies successfully demonstrated po-
tential for Qigong and Tai Chi to build
performance, even with health-com-
promised individuals. Further studies
are needed to examine the factors that
are important to more critically evalu-
ate these interventions (such as power
considerations or dose and frequency
of the interventions), or learn if there
are particular states of ill health that
are less likely to respond to this form of
exercise.
Falls and Balance
Another large grouping of studies
focused primarily on falls prevention,
balance, and physical function tests
related to falls and balance (such as
one-leg stance). Although there may
be some crossover of implied benefits
to the more general physical function
measures reported above, this separate
category was established to report on
the studies of interventions primarily
targeting falls and related measures.
Fear of falling is reported with the
psychological outcomes and falls self-
efficacy is reported in the self-efficacy
outcomes rather than in this category
of falls and balance.
Outcomes related to falls such as
balance, fall rates, and improved
strength and flexibility were reported
in 24 articles (Qigong, n 52; Tai Chi,
n520; and two studies that included
both practices). Scores directly assess-
ing balance (such as one-leg stance) or
other closely related measures were
consistently, significantly improved in
16 Tai Chi studies that included only
participants who were sedentary or
deemed at risk for falls at base-
line.
33,43,49,53,59,65,71–81
Qigong has been less studied in
relationship to balance-related out-
comes; however, results suggest that
there was a trend to maintain balance
using Qigong in a population of
patients with muscular dystrophy.
58
In
two studies that used both Qigong and
Tai Chi, several measures of balance
were significantly improved with sed-
entary women
82
and with elderly
healthy adults (mean age 80.4 years)
compared to wait list controls.
83
Another set of studies shows the
effect of Tai Chi on balance to be
similar to that of conventional exercise
or physical therapy control interven-
tions aimed at improving physical
function related to balance
53,72,84
or
vestibular rehabilitation.
85,86
On the
other hand, in a study of stroke
survivors comparing Tai Chi to balance
exercises, significant improvements in
balance were achieved in the exercise
control group, but not for Tai Chi.
87
Although knee extension was signifi-
cantly improved, balance was not im-
proved significantly in a Tai Chi
intervention with sedentary women
compared to a flexibility training con-
trol group.
74
Mechanisms of gait performance,
which are important to understanding
how Tai Chi affects balance, were also
studied. Reported improvements were
found in four studies.
80,85,86,88
Strength
and flexibility are also important to fall
prevention. Four studies found signif-
icant improvements in these factors
when Tai Chi was compared to an
active control (brisk walking)
33,53,59,73,81
or inactive controls.
59,73,81
Eight studies directly monitored fall
rates. Studies that incorporate educa-
tional or less active control interven-
tions (e.g., stretching) variously dem-
onstrated significant falls reduction for
Tai Chi
30,75,78,79
or nonsignificant re-
e18 American Journal of Health Promotion
ductions compared to control.
43,49
In a
study comparing Tai Chi to an active
physical therapy intervention designed
to improve balance, results were simi-
lar (nonsignificant differences) be-
tween the two groups.
84
The results are
difficult to interpret because some
participants may fall more because
their level of activity has increased and
some interventions are not monitored
long enough to detect changes in fall
rates.
73
This category of outcomes has a
large body of research supporting the
efficacy of Tai Chi on improving
factors related to falls, and growing
evidence that falls may be reduced.
Longer-term studies to examine fall
rates, and parallel studies that utilize
Qigong as the intervention, may fur-
ther clarify the potential of these
forms of exercise to affect falls and
balance.
Quality of Life
QOL outcomes were reported in 17
articles (Qigong, n 54; Tai Chi, n 5
13). QOL is a broad-ranging concept
derived in a complex process from
measures of a person’s perceived
physical health, psychological state,
personal beliefs, social relationships,
and relationship to relevant features of
the person’s environment.
89
In 13
studies of a wide range of participants
(including healthy adults, patients with
cancer, poststroke patients, patients
with arthritis, etc.) at least one of the
components of QOL was reported to
be significantly improved by Tai Chi
compared to inactive
34,66,67,71,90–93
or
active controls,
87
and by Qigong com-
pared to inactive
94,95
or active control
groups.
72
Qigong also showed im-
provements in QOL compared to an
exercise intervention, but not signifi-
cantly so.
72
Conversely, two studies reported no
change in QOL, both with severely
health-compromised individuals. One
was of short duration (6 weeks),
conducted with patients with traumatic
brain injury.
96
Some improvement in
coping was shown with muscular dys-
trophy patients in response to a Qi-
gong intervention
58
; however, this
finding was not significant, and direct
QOL measures remained unchanged.
One study reported no change in QOL
when Tai Chi was compared to balance
training and an education control
among healthy older adults.
97
With a few exceptions, the prepon-
derance of studies indicate that Qi-
gong and Tai Chi hold great potential
for improving QOL in both healthy
and chronically ill patients.
Self-Efficacy
Self-efficacy is the confidence a
person feels in performing one or
several behaviors and the perceived
ability to overcome the barriers associ-
ated with the performance of those
behaviors.
98
Although this is not a
health outcome itself, it is often asso-
ciated directly with health behaviors
and benefits (e.g., falls self-efficacy
associated with reduced falls) or with
psychological health. Significant im-
provements in this outcome were
reported in eight studies (Qigong, n 5
2; Tai Chi, n 56). Self-efficacy was
generally assessed in the RCTs as a
secondary outcome and reflected the
‘‘problem’’ area under investigation,
such as falls self-efficacy (i.e., feeling
confident that one will not fall) or
efficacy to manage a disease (arthritis,
fibromyalgia) or symptom (pain). Self-
efficacy for falls was significantly in-
creased as a result of participation in
Tai Chi in three studies with adults at
risk for falls compared to wait-list or
usual-care, sedentary control
groups.
68,73,99,123
In studies with clinical
populations, persons with arthritis ex-
perienced improvements in arthritis
self-efficacy
67
and fibromyalgia patients
experienced improvements in the
ability to manage pain
100
after partici-
pating in Tai Chi as compared to
inactive control groups that provided
social interaction (telephone calls and
relaxation therapy, respectively). Last-
ly, the perceived ability to handle stress
or novel experiences
95,101
and exercise
self-efficacy
97,101
were enhanced rela-
tive to inactive control groups as a
function of participation in Qigong or
Tai Chi.
Patient-Reported Outcomes
PROs include reports of symptoms
related to disease as perceived by the
patient. The definition of PROs as ‘‘a
measurement of any aspect of a pa-
tient’s health status that comes directly
from the patient, without the inter-
pretation of the patient’s responses by
a physician or anyone else,’’
102
has
developed over the past decade as an
important indicator of treatment out-
comes that matter to the patient,
including an array of symptoms such as
pain, fatigue, and nausea. Although
PRO lists often include factors such as
anxiety and depression, these are not
included here, but rather in a separate
section to address a range of psycho-
logical effects.
Thirteen studies are included in this
category (Qigong, n 53; Tai Chi, n 5
10). Arthritic pain
31,71,103,104
decreased
significantly in response to Tai Chi
compared to inactive (health educa-
tion or usual-care) controls. Self-re-
ported neck pain and disability
64
im-
proved to a similar degree for Qigong
and an exercise comparison interven-
tion, but the difference between
groups was not significant. Fibromyal-
gia symptoms improved significantly in
one study comparing Tai Chi to a
relaxation intervention,
100
whereas an-
other study reported slight improve-
ments in symptoms for both Qigong
and a usual-care control group with no
significant difference between the
groups.
69
Perceived symptoms of heart
failure,
55
disability,
30
and sickness im-
pact scores
32
decreased in response to
Tai Chi interventions as compared to
inactive controls (either usual care or
educational interventions) and sleep
quality improved for Tai Chi even as
compared to an exercise interven-
tion.
105
With Tai Chi, dissociative ex-
periences and symptoms improved
clinically, but were not statistically
different from gains achieved by a
support group among male veterans.
106
Parkinson’s disease symptoms and dis-
ability were not significantly changed
following a 7-week session of Qigong
compared to aerobic training
sessions.
57
With the wide range of symptoms
and irregular outcomes of these PROs
studies, it is difficult to draw meaning-
ful conclusions about this category.
Pain consistently responded to Tai Chi
in four studies, but other symptoms
were not uniformly assessed.
Psychological
Twenty-seven articles (Qigong, n 5
7; Tai Chi, n 519; and one study using
both Qigong and Tai Chi) reported on
psychological factors such as anxiety,
depression, stress, mood, fear of fall-
July/August 2010, Vol. 24, No. 6 e19
ing, and self-esteem. Most of these
studies examined psychological factors
as secondary goals of the study, and
consequently, they often did not in-
tentionally recruit participants with
appreciable psychological distress.
Nevertheless, a number of substantial
findings dominate this category.
Anxiety decreased significantly for
participants practicing Qigong com-
pared to an active exercise
group.
28,46,107
Depression was shown to
improve significantly in studies com-
paring Qigong to an inactive control,
newspaper reading,
95
and for Tai Chi
compared to usual-care, psychosocial
support, or stretching/education con-
trols.
56,71,108
General measures of mood
(e.g., Profile of Mood States) were
improved significantly for participants
practicing Tai Chi compared to usual-
care controls.
66,96,101,109
Depression improved, but not sig-
nificantly, for both Qigong and exer-
cise comparison groups
28,94
and for Tai
Chi compared to an educational in-
tervention.
110
One study reported im-
proved depression, anxiety, and stress
among patients with osteoarthritis for
both Tai Chi and hydrotherapy groups
compared to a wait-list control, but
only significantly so for hydrotherapy.
31
Nonsignificant changes in anxiety
were reported in a study of Tai Chi
compared to a relaxation interven-
tion
100
and two other studies did not
detect significant differences in de-
pression in response to Tai Chi
55,100
or
Qigong
58
compared to usual-care or
inactive controls. Fear of falling de-
creased significantly in most stud-
ies
49,80,81,99,111
except for one that
showed no change.
82
Reports of self-
esteem significantly improved in tests
of Tai Chi compared to usual care
91,112
and psychosocial support,
93
but the
increase in self-esteem compared to
exercise and education controls was
not significant.
97
Jin
109
specifically created a stressful
situation and measured the response
in mood, self-reported stress levels, and
blood pressure across four interven-
tions, including Tai Chi, meditation,
brisk walking, and neutral reading.
Significant improvements were shown
in adrenaline, heart rate, and nor-
adrenaline in Tai Chi compared to a
neutral reading intervention, and all
groups showed improvements in corti-
sol. In another study examining blood
markers related to stress response,
norepinephrine, epinephrine, and
cortisol blood levels were significantly
decreased in response to Qigong com-
pared to a wait-list control group.
117
This category of symptoms, particu-
larly anxiety and depression, shows
fairly consistent responses to both Tai
Chi and Qigong, especially when the
control intervention does not include
active interventions such as exercise. In
particular, with a few studies indicating
that there may be changes in bio-
markers associated with anxiety and/or
depression in response to the inter-
ventions, this category shows promise
for examining potential mechanisms
of action for the change in psycholog-
ical state.
Immune Function and Inflammation
Immune-related responses have also
been reported in response to Qigong
(n 53) and Tai Chi (n 53) studies.
Manzaneque et al.
113
reported im-
provements in a number of immune-
related blood markers, including total
number of leukocytes, number of
eosinophils, and number and percent-
age of monocytes, as well as comple-
ment C3 levels, following a 1-month
Qigong intervention compared to
usual care. Antibody levels in response
to flu vaccinations were significantly
increased among a Qigong group
compared to usual care.
114
Varicella
zoster virus titers and T cells increased
in response to vaccine among Tai Chi
practitioners.
110
An earlier study con-
ducted by Irwin et al.
90
reported an
increase in varicella zoster virus–spe-
cific cell-mediated immunity among
those practicing Tai Chi compared to
wait-list controls.
Immune function and inflammation
are closely related, and are often
assessed using a variety of blood mark-
ers, particularly certain cytokines and C-
reactive protein. Interleukin-6, an im-
portant marker of inflammation, was
found to be significantly modulated in
response to practicing Qigong, com-
pared to a no-exercise control group.
40
On the other hand, C-reactive protein
and erythrocyte sedimentation rates
remained unchanged among a group of
rheumatoid arthritis patients who par-
ticipated in a Tai Chi class compared to
stretching and wellness education.
71
A number of studies not utilizing an
RCT design have examined blood
markers prior to and after Tai Chi or
Qigong interventions, providing some
indication of factors that might be
important to explore in future RCTs
(and not reported in the table). For
example, improvements in thyroid-
stimulating hormone, follicle-stimulat-
ing hormone, triiodothyronine,
115
and
lymphocyte production
116
have been
noted in response to Tai Chi compared
to matched controls. Pre-post Tai Chi
intervention designs have also shown
an improvement in immunoglobulin
G
117
and natural killer cells,
118
and
similar non-RCTs have suggested that
Qigong improves immune function
and reduces inflammation profiles as
indicated by cytokine and T-lympho-
cyte subset proportions.
119–121
As with the category of psychological
outcomes, these immune- and inflam-
mation-related parameters fairly con-
sistently respond to Tai Chi and
Qigong, while also providing potential
for examining mechanisms of action.
DISCUSSION
In answering research question 1, we
have identified nine categories of
health benefits related to Tai Chi and
Qigong interventions, with varying
levels of support. Six domains of
health-related benefits have dominated
the research with 16 or more RCTs
published for each of these outcomes:
psychological effects (27), falls/bal-
ance (23), cardiopulmonary fitness
(19), QOL (17), PROs (18), and
physical function (16). These areas
represent most of the RCTs reviewed,
with many of the studies including
multiple measured outcomes spanning
across several categories (n 542).
Substantially fewer RCTs have been
completed in the other three catego-
ries, including bone density (4), self-
efficacy (8), and studies examining
markers of immune function or in-
flammation (6).
The preponderance of studies
showed significant, positive results on
the tested health outcomes, especially
when comparisons were made with
minimally active or inactive controls (n
552). For some of the outcomes
addressed in this review, there were
studies that did not demonstrate sig-
e20 American Journal of Health Promotion
nificant improvements for the Tai Chi
or Qigong intervention as compared to
the control condition. For the most
part, however, these nonsignificant
findings occurred in studies in which
the control design was actually a
treatment type of control expected to
produce similar benefits, such as an
educational control group interven-
tion producing similar outcomes to Tai
Chi for self-esteem,
97
aerobic exercise
showing similar results to Qigong in
reducing depression,
28,57
an acupres-
sure group successfully maintaining
weight loss compared to no interven-
tion effect for Qigong,
60
or resistance
training producing similar (nonsignif-
icant) effects as Tai Chi for muscle
strength, balance, and falls.
43,66
It is
important to note that although the
Tai Chi and Qigong interventions did
not produce larger benefits than these
active treatment controls, in most cases
substantial improvements in the out-
come were observed for both treat-
ment groups.
Other studies in which the improve-
ments did not significantly differ be-
tween the treatment group and the
control group suffered from (1) study
designs of shorter duration (4–8 weeks,
rather than the usual 12 or more
weeks),
51,96
although there were some
exceptional studies with significant
results after only 8 weeks
44,81,101
; (2)
selection of very health-compromised
participants or individuals with condi-
tions that do not generally respond to
other conventional treatments or
medicines, such as muscular dystro-
phy,
58
multiple morbidities,
47
fibromy-
algia,
69
or arthritis;
71
or (3) the out-
come measured was not noted as
particularly problematic nor set as an
eligibility criteria for poor starting
levels at baseline (n 55).
28,94
On the other hand, in the areas of
research that address outcomes typi-
cally associated with physical exercise,
such as cardiopulmonary health or
physical function, results are fairly
consistent in showing that positive,
significantly larger effects are observed
for both Tai Chi and Qigong when
compared to no-exercise control
groups and similar health outcomes
are found when compared to exercise
controls. Even with the very wide range
of study design types and strength of
control interventions, and the entry
level of the health status of study
participants, there remains a number
of remarkable and persistent findings
of health benefits in response to both
Qigong and Tai Chi.
In response to research question 2,
we have noted in earlier sections the
ways in which Qigong and Tai Chi are
considered equivalent, and now ad-
dress how studies identifying similar
outcomes in response to these practic-
es may provide additional evidence for
equivalence. On the surface, research
that examines the effects of Qigong on
health outcomes appears to be of lesser
magnitude than the research on what
is typically called Tai Chi. For each
category of outcomes described above,
we noted how many RCTs had been
conducted for each, Tai Chi and
Qigong, and for the most part, there
were many fewer reports on Qigong
than for what is named Tai Chi for any
given outcome examined. Neverthe-
less, across the outcomes examined in
RCTs, the findings are often similar,
with no particular trends indicating
that one has different effects than the
other.
As noted earlier, however, it is not
unusual for the intervention used in a
study or trial to be named Tai Chi, but
to actually apply a set of activities that is
more a form of Qigong, that is, easy-to-
learn movements that are simple and
repeatable rather than the long com-
plex sequences of traditional Tai Chi
movements that can take a long time to
learn. For example, a large number of
studies examining Tai Chi effects on
balance use a modified, repetitive form
of Tai Chi that is more like Qigong.
Thus, although it appears that fewer
studies have been conducted to test
what is called Qigong, it is also clear
that when a practice called Tai Chi is
modified to focus especially on balance
enhancement, for example, it actually
may be Tai Chi in name only.
Given the apparent similarity of
practice forms utilized in research, the
discussion of equivalence of Tai Chi
and Qigong extends beyond the earlier
observation that they are similar in
practice and philosophy. Because re-
search designs often incorporate
blended aspects of both Qigong and
Tai Chi, it is unreasonable to claim that
the evidence is lacking for one or the
other and it becomes inappropriate
not to claim their equivalence. We
suggest that the combined current
research provides a wider base of
growing evidence indicating that these
two forms produce a wide range of
health-related benefits.
The problem with claiming equiva-
lence, then, does not lie within the
smaller number of studies using a form
called Qigong, but rather in the lack of
detail reported across the studies re-
garding whether or not the interven-
tions contain the key elements philo-
sophically and operationally thought
to define meditative movement prac-
tices such as Tai Chi and Qigong. In
previous publications, and in this
review, we note that the roots of both
of these TCM-based wellness practices
require that the key elements of
meditative movement be implement-
ed: focus on regulating the body
(movement/posture); focus on regu-
lating the breath; and focus on regu-
lating the mind (consciousness) to
achieve a meditative state. Given the
equivalence noted in foundational
principles and practice, the differences
among interventions and resultant
effects on outcomes would perhaps
more purposefully be assessed for
intervention fidelity (i.e., adherence to
the criteria of meditative movement).
Beyond the meditative movement
factors that tie the practices and
expected outcomes together, other,
more conventional factors would be
important to assess, each potentially
contributing to variations in outcomes
achieved. For example, dosing (i.e.,
frequency, duration, and level of in-
tensity, including estimate of aerobic
level or metabolic equivalents) may be
important in whether or not benefits
accrue. Or a focus on particular muscle
groups may be critical to understand-
ing changes relative to certain goals
(e.g., how many of the exercises
chosen for a study protocol develop
quadriceps strength likely to produce
results for specific physical function
tests?). Beyond the important similari-
ties of movement and a focus on
breath and mind to achieve meditative
states, there are other aspects that vary
greatly within the wide variety of both
Tai Chi and Qigong exercises, includ-
ing speed of execution, muscle groups
used, and range of motion, all of which
may provide differences in the physio-
July/August 2010, Vol. 24, No. 6 e21
logically oriented outcomes (similar to
the differences that could be noted in
the wide variety of exercises considered
under the aerobic umbrella).
While equivalence of Qigong and
Tai Chi is established for philosophy
and practice, there is still work to be
done to test for similarity of effects.
With consistent reporting on adher-
ence to the above mentioned aspects
of practice, not only could a level of
standardization be implemented, but
also measures that control for variation
of interventions could be used to
better understand differences and
similarities in effects.
1
LIMITATIONS
For purposes of this review, a study
was selected if it was designed as an
RCT and compared the effects of
either Tai Chi or Qigong to those of a
control condition on a physical or
psychological health outcome. Howev-
er, there was no further grading of the
quality of the research design. As a
result of this relatively broad inclusion
criterion, the studies represent a wide
variety in methods of controlling for
balanced randomization and intent to
treat analyses, in the specific methods
of implementing Tai Chi and Qigong,
in the outcomes assessed, in the
measurement tools used to ascertain
the outcomes, and in the populations
being studied.
One difficulty in examining such a
broad scope of studies is that the large
number of studies required that we
logically, but artificially, construct cat-
egories within which to discuss each
group of outcomes. However, by
choosing to categorize by health out-
comes, rather than participant, patient,
or disease types, we have provided one
particular view of the data, and may
have obscured other aspects. For ex-
ample, in a recently published review,
the authors analyzed studies that were
conducted with community-dwelling
adults over the age of 55.
122
Results
showed that interventions utilizing Tai
Chi and Qigong may help older adults
improve physical function and reduce
blood pressure, fall risk, depression,
and anxiety. Another view of these data
may emerge if only studies of chroni-
cally ill participants are evaluated.
Thus, there may be other ways to
examine the RCTs reported in the
current review such that specific dis-
eases or selected study populations
may reveal more consistent findings
(positive or negative) for certain out-
comes that are clearly tied to entry
level values.
CONCLUSION
Our intent has been to recognize the
common critical elements of Qigong
and Tai Chi, based on their similarities
in philosophy and principles as well as
common practice components. With
this established, we thoroughly explore
the range of findings for similar health
outcomes and treat the two as equiva-
lent aspects of one form of mind-body
practice.
The preponderance of findings are
positive for a wide range of health
benefits in response to Tai Chi, and a
growing evidence base for similar
benefits for Qigong. As described,
there are foundational similarities be-
tween Qigong and Tai Chi interven-
tion protocols, as traditional Tai Chi is
typically modified and adapted for ease
of dissemination to more closely re-
semble forms of Qigong. This supports
the rationale that outcomes can be
tabulated across both types of studies,
further supporting claims of the
equivalence of Qigong and Tai Chi.
A compelling body of research
emerges when Tai Chi studies and the
growing body of Qigong studies are
combined. The strongest, most consis-
tent evidence is demonstrated for
effects on bone health, cardiopulmo-
nary fitness, some aspects of physical
function, QOL, self-efficacy, and fac-
tors related to falls prevention, while
findings are mixed for effects of Tai
Chi or Qigong on psychological factors
and PROs. Study design factors that
appear to yield mixed findings are (a)
the frequent choice of physical activity
as a control group intervention, re-
sulting in limited power to detect
significant differences, (b) selection of
participants who do not demonstrate
deficiencies in baseline levels of the
outcomes to be assessed, and (c) the
use of study participants with severe,
chronic, progressive illnesses who may
be slower to respond or may not
respond at all to the practices. Other
studies, however, suggest that Tai Chi
or Qigong may improve or slow the
progression of such illnesses. This may
be especially likely when the practices
are implemented early as an aspect of
wellness, prevention, or disease man-
agement in a proactive, risk reduction
context. In a recent review addressing
Tai Chi and Qigong research among
older adults, it was pointed out that no
adverse events were reported across
studies.
122
The substantial potential for
achieving health benefits, the minimal
cost incurred by this form of self-care,
the potential cost efficiencies of group
delivered care, and the apparent safety
of implementation across populations,
points to the importance of wider
implementation and dissemination.
SO WHAT? Implications for Health
Promotion Practitioners and
Researchers
What is already known on this topic?
The current state of research
splinters these TCM-based wellness
practices by identifying them with
different names, and treating them
as distinct fields of inquiry, reducing
the potential for evaluating health
outcomes across Qigong and Tai
Chi research.
What does this article add?
This review has identified nu-
merous outcomes with varying levels
of evidence for the efficacy for
Qigong and Tai Chi. The stronger
evidence base for bone health,
cardiorespiratory fitness, physical
function/balance and QOL, and
the potential demonstrated for psy-
chological benefits and falls pre-
vention, is sufficient to suggest that
Tai Chi and Qigong be promoted as
a viable, accessible alternative, es-
pecially for individuals who might
prefer these activities over more
conventional or vigorous forms of
exercise. In addition to the health
promotion and dissemination im-
plications, the current state of the
science outlines the challenges for
researchers.
What are the implications for health
promotion practice or research?
The wide variations in popula-
tions and outcomes studied, the
frequently lacking descriptions of
interventions or dose, and the con-
e22 American Journal of Health Promotion
Acknowledgments
This research is supported in part by NIH/NCCAM grant
U01 AT002706-03 (PI:Larkey) and NIH/NINR grant
1F31NR010852-01 and a John A. Hartford BAGNC
Scholarship, 2008–2010 (PI:Rogers).
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July/August 2010, Vol. 24, No. 6 e25
... These applied psychophysiological feedback techniques are patient-guided and allow the practitioner to control the functions and processes of the body through specific movements or stances, breathing techniques, and meditative exercises [18]. They are equivalent in effect and therapeutic application [19] with therapeutic Taijiquan considered a specific Qigong technique. In fact, Qi means "energy" and Gong means "work" and as a contemporary umbrella term, Qigong encompasses several techniques of energetic cultivation in which therapeutic Taijiquan perfectly fits. ...
... Recent studies suggest that Taijiquan and Qigong have several mental health benefits [18][19][20][21][22][23][24]. These techniques are suggested to assist in managing anxiety and depression in children and adolescents [18,24] as well as in patients with several health conditions such as breast cancer in women [20] or heart failure in elders [21], for example. ...
... Furthermore, considering that these therapies are low-cost, safe [19], require little space and are feasible in many circumstances [25], this study has the objective to understand if Taijiquan and Qigong can be applied as an online distance therapeutic option to reduce the psychological impact of home confinement and social distancing. As well, it is of utmost importance to add practical tools to the pool of available interventions to assist the population in managing emergent mental health issues. ...
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Mandatory lockdown resulting from a pandemic may be effective against the physical impact of the virus; however, the resulting mental strains can lead to the development of several mental disturbances. Taijiquan and Qigong are considered traditional vegetative biofeedback therapies that allow the practitioner to control the functions and processes of the body through specific movements or stances, breathing techniques, and meditative exercises. This study aims to understand if these techniques can be applied as an online distance therapeutic option to reduce the psychological impact of home confinement and social distancing. Sixty-four participants were recruited and allocated to three groups. The experienced and novice Taijiquan and Qigong participants’ groups received the intervention for 8 weeks while the control group did not receive any intervention. The outcomes were psychological well-being and psychological distress levels and were assessed by the Mental Health Inventory and a written interview. The experienced Taijiquan and Qigong participants achieved significant improvements in psychological well-being and psychological distress. Novice Taijiquan and Qigong participants achieved a significant improvement in anxiety levels. Additionally, the control group showed a significant decrease in psychological well-being. This study suggests that this distance online program of Taijiquan and Qigong is feasible and may benefit the mental health of participants during a lockdown.
... The most important component is to relax and be in a natural state: the individual relaxes their whole body and calms their mind, letting their posture, breathing, and mind go with the flow [18]. Qigong is suitable for individuals at almost all fitness levels and can be practised at any time, any place, without any need for special equipment [19,20]. Systematic reviews have concluded that various forms of qigong, such as Chan-Chuang qigong, tai chi, and Baduanjin, may alleviate symptoms from various diseases, including cancer and fibromyalgia, and help patients after a stroke [21,22]. ...
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PurposeTo evaluate the effect of Chan-Chuang qigong with breathing meditation on quality of life (QoL) and interoceptive awareness in patients with breast cancer during chemotherapy.Methods This was a randomised controlled trial. Participants were randomly assigned to a qigong group (n = 30), which practised Chan-Chuang qigong with breathing meditation for 15 weeks, and a control group (n = 30), which received routine care. Outcomes were measured by using the European Organization for Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ-C30) and Multidimensional Assessment of Interoceptive Awareness (MAIA-C).ResultsThe qigong group, when compared with the control group and baseline, exhibited significantly improved emotional function (p = 0.01) and decreased role function (p = 0.04) at week 15. The MAIA-C indicated a significant difference between groups in self-regulation at week 15 (p = 0.04). Within the qigong group, changes were found in attention regulation (p = 0.03), emotional awareness (p = 0.04), self-regulation (p = 0.01), and body listening (p = 0.002).ConclusionsA 15-week programme of Chan-Chuang qigong with breathing meditation is a simple and safe intervention for patients with breast cancer to improve their emotional function and adjust to their role identity. Participants who practised qigong achieved increased awareness of their own bodies and were able to better regulate their emotion and attention.Trial registerClinicalTrials.gov Identifier: NCT05385146
... The World Health Organization defines exercise for well-being as "a Traditional Chinese Medicine technique that combines movement, meditation and breathing to improve circulation, immune system and the flow of the body's energy or Qi" [9]. Different systematic reviews and clinical trials have demonstrated that exercise for well-being improves cardiovascular system function, physical function, pain and psychological disorders associated to chronic diseases or palliative care [10,11]. Many medical academic institutions in the United States and other Western countries are seriously considering the use of exercise for well-being in medicine and psychiatry based on the positive results that different clinical trials have achieved [12,13]. ...
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Full-text available
The objective of this study was to assess the efficacy of an active exercise physiotherapy programme versus an exercise for well-being programme improving muscle strength, range of movement, respiratory capacity and quality of life of women with fibromyalgia. A randomized, assessor-blind, controlled trial was conducted. A total of 141 women diagnosed with fibromyalgia were randomized to a physiotherapy exercise group (n = 47), an exercise for well-being group (n = 47) and a control group (n = 47). The study lasted 4 weeks and the experimental groups received 45 min sessions performed twice a week on alternate days. The primary outcome measures were range of movement and muscle strength. The secondary outcome measures were respiratory capacity and quality of life. The results showed statistically significant improvements in the exercise for well-being and physiotherapy groups vs. the control group at week 5 in relation to joint range of movement (p = 0.004), muscle strength (p = 0.003) and quality of life (p = 0.002). The changes found in all the spirometry parameters seem to be associated to some of the changes in joint range of movement and muscle strength as well as quality of life. Physiotherapy and exercise for well-being improved upper limb and lower limb range of movement and the muscle strength of women with fibromyalgia.
... general aerobic exercise, Health Qigong has been proven more effective at enhancing sleep quality (25). Qi is the universal air, while Gong refers to practice and exercise (26). Qigong, a traditional Chinese health practice with a long and storied history, may be generally divided into internal Qigong and external Qigong (27). ...
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Full-text available
Objective The high rate of relapse has become the primary obstacle of drug rehabilitation. In this study, we explored the relationship between sleep disorders and relapse inclination in substance users, as well as the potential mediating mechanisms and corresponding interventions. Methods A total of 392 male substance users were recruited to complete the questionnaires on sleep disorders, quality of life and relapse inclination. On account of this, 60 participants with sleep disorders were randomly screened and allocated to the intervention and control groups. The former received 12 weeks of Health Qigong aimed at treating sleep disorders, whereas the latter performed their regular production work. Results Sleep disorders had a positive effect on relapse inclination, quality of life was a potential mediator of this relationship, and 12-week Health Qigong designed to treat sleep disorders improved not only their sleep quality but also their overall quality of life, which in turn reduce the tendency to relapse. Conclusion Current research not only explores the high-risk factors influencing relapse, but also develops customized intervention strategies, which have theoretical and practical implications for decreasing relapse and increasing abstinence.
... WEL was developed to combine evidence-based practices to move the field of energy healing above baseline . WEL includes elements drawn from qigong, Gestalt therapy, yoga, and other evidence-based techniques (McCraty, 2005;Chiesa and Serretti, 2009;Jahnke et al., 2010;Feinstein, 2012;Church et al., 2014), which can be practiced supplementally to EcoMeditation (Church, 2011). In particular, EcoMeditation includes elements of four evidence-based techniques: The Quick Coherence Technique for regulating heart rate variability (HRV), Emotional Freedom Techniques (EFT), mindfulness, and neurofeedback (Davidson et al., 2003;Zotev et al., 2011;Church, 2013;McCraty and Zayas, 2014). ...
Article
Full-text available
Background A plethora of literature has delineated the therapeutic benefits of meditation practice on psychological functioning. A novel meditative practice, EcoMeditation, includes elements of four evidence-based techniques: The Quick Coherence Technique for regulating heart rate variability (HRV), Emotional Freedom Techniques (EFT), mindfulness, and neurofeedback. Objectives Changes in psychological symptoms, including anxiety, depression, posttraumatic stress, pain, and happiness were measured following a one-day virtual EcoMeditation training workshop. The current study extended on previous literature by adding measures of transcendent experiences and flow states. Methods Participants were drawn from a convenience sample of 151 participants (130 female, 21 male) aged between 26 to 71 years ( M = 45.1, SD = 9.19) attending a one-day virtual EcoMeditation workshop. They were assessed pre-workshop, post-workshop, and at 3-months follow-up. Results Post-workshop results ( N = 111) indicated a significant reduction in anxiety (−42.3%, p < 0.001), depression (−37.5%, p < 0.001), posttraumatic stress (−13.0%, p < 0.001), and pain (−63.2%, p < 0.001) Likert mean scores when compared to pre-workshop. There was also a significant increase in happiness (+111.1%, p < 0.001), flow states (+17.4%, p < 0.001), and transcendent experiences (+18.5%, p < 0.001). At 3-months follow-up, a one-way repeated measures ANOVA ( N = 72) found significant decreases in anxiety, depression, and pain symptoms between pre-test and post-test, as well between pre-test and follow-up. Flow, happiness, and transcendent experiences increased significantly between pre-test and post-test, as well as between pre-test and follow-up, with over 71% of participants experiencing clinically significant improvements. Significant reductions in posttraumatic stress and depression symptoms between pre-test and follow-up were also noted. Conclusion EcoMeditation is associated with significant improvements in psychological conditions such as anxiety, depression, pain, and posttraumatic stress. EcoMeditation was also shown to enhance flow states and transcendent experiences. The benefits identified were similar to those found in the existing literature and provide support for the use of EcoMeditation as an effective stress reduction method that improves psychological symptoms and enhances transcendent states.
... First, as a foundation of mind-body interaction, meditation and rhythmic breathing can effectively boost vitality and induce energy to flow through the body, which in turn drives body movement to alleviate pain (Zou et al., 2017b). Self-awareness combined with self-correction of posture and movement of the body, flow of breath, and mental stilling activates natural self-regulatory (self-healing) abilities and stimulates a balanced release of endogenous neurohormones and a variety of natural health recovery mechanisms (Jahnke et al., 2010;Linek et al., 2020). Multiple elements of health, including mood, pain, immunity, and peripheral autonomic nervous system function, can be regulated by concentration and mindful meditation (Wayne and Kaptchuk, 2008). ...
Article
Full-text available
Background Increasing lines of evidence indicate that traditional Chinese exercise (TCE) has potential benefits in improving chronic low back pain (CLBP) symptoms. To assess the clinical efficacy of TCE in the treatment of CLBP, we performed a systematic review of existing randomized controlled trials (RCTs) of CLBP and summarized the neural mechanisms underlying TCE in the treatment of CLBP. Methods A systematic search was conducted in four electronic databases: PubMed, Embase, the Cochrane Library, and EBSCO from January 1991 to March 2022. The quality of all included RCTs was evaluated by the Physiotherapy Evidence Database Scale (PEDro). The primary outcomes included pain severity and pain-related disability. Results A total of 11 RCTs with 1,256 middle-aged and elderly patients with CLBP were included. The quality of all 11 included RCTs ranged from moderate to high according to PEDro. Results suggested that TCE could considerably reduce pain intensity in patients with CLBP. Overall, most studies did not find any difference in secondary outcomes (quality of life, depression, and sleep quality). Conclusion The neurophysiological mechanism of TCE for treating CLBP could be linked to meditation and breathing, posture control, strength and flexibility training, and regulation of pain-related brain networks. Our systematic review showed that TCE appears to be effective in alleviating pain in patients with CLBP.
... To standardize the form and promotion of Health Qigong, the General Administration of Sports in China has released 11 categories of Health Qigong, such as Yijinjing and Baduanjin (29). Studies have shown that Qigong can effectively treat or delay various diseases, such as depression, insomnia, poor balance, and cognitive dysfunction (30). Therefore, the effect of Qigong on non-motor symptoms, especially cognitive impairment, in people with PD deserves further investigation. ...
Article
Parkinson's disease (PD) is an important health problem caused by the degeneration of brain neurons. Bradykinesia and lower balance ability seriously affect the quality of life of people with PD. Non-motor symptoms, such as cognitive impairment, accompany the course of the disease but still lack sufficient attention. In general, drugs combined with cognitive training are the most common ways to improve cognitive impairment in people with PD. However, long-term use of psychiatric drugs may lead to side effects such as brain death and movement disorders. Recently, mindfulness has been used by researchers in the treatment of cognitive impairment, because healthy older adults who engage in mind-body exercises for a long time have higher cognitive levels than normal aging populations. Mind-body exercise, as a therapy that combines concentration, breath control, and physical activity, is beneficial for improving practitioners' brain and mental health. Mind-body exercises such as Tai Chi, yoga, dance, and Pilates can improve cognitive performance in older adults with or without cognitive impairment. Therefore, mind-body exercise may be a feasible strategy for the treatment of cognitive impairment in people with PD. This study summarizes the latest evidence that mind-body exercises including Tai Chi, Qigong, yoga, and dance improve cognitive impairment associated with PD. We also explored the limitations of current mind-body exercise research, aiming to provide new ideas for improving mind-body exercise as a strategy to alleviate cognitive impairment in people with PD.
... Qigong, tai chi, and yoga are a few common forms of mind-body exercises that are rooted in Asian culture that have been accepted and practiced in Western countries in recent decades [15][16][17]. A well-established body of research using randomized controlled trials has demonstrated the clinically significant benefits of qigong, tai chi, and yoga on a variety of health outcomes, including but not limited to physical and cognitive function, quality of life, mental disorders, and chronic pain in diverse clinical and nonclinical populations in Western and non-Western countries [18][19][20][21][22]. Unlike traditional Western exercise, qigong exercise is characterized as low-to moderate-intensity, community-oriented with no or low cost, low-demand regarding space and equipment, and safe for all age groups and health conditions in Asian countries [22,23]. ...
Article
Background: Older Latinos are disproportionally affected by various chronic conditions such as impairments in physical and cognitive function, which are essential for healthy aging and independent living. Objective: This study was: 1) to evaluate the feasibility and acceptability of FITxOlder, a 12-week mind-body exercise program, in community dwelling low-income predominantly older Latinos; and 2) to assess the preliminary effects of FITxOlder on health parameters relevant to healthy aging and independent living. Methods: This study is a 12-week single-arm Stage 1B feasibility study with a pre- and post- study design. 13 older adults (mean age=76.4±7.9; 85% Latinos) of a congregate meals program in a senior center were enrolled in the study. The FITxOlder was a tailored Chinese mind-body exercise using Five Animal Frolics, led by a bilingual community health worker (CHW) to practice twice a week at the senior center and facilitated by mobile health technology (mHealth) to practice at home with incremental goal from once a week to at least three times a week. Feasibility and acceptability of the study were examined using both quantitative and qualitative data. Healthy aging related outcomes (e.g., physical and cognitive function, activities of daily living) were assessed using paired t-tests. Qualitative interview data was analyzed using content analysis. Results: The attendance rate of the 24 exercise sessions was high (94.4%, 22.7/24), ranging from 93.0% (1.8/2) to 96.8% (1.9/2) over the 12 weeks. The participants were compliant to the incremental weekly home and program exercise goal with 54.6% (2.8 days/week) and 63.3% (4.7 days/week) meeting the home and program goal in the program, respectively. Approximately 82% (10/12) to 92% (11/12) participants provided favorable feedback on survey questions regarding the study and program such as the program content and support, delivery by CHW, enjoyment and appeal of Five Animal Frolics, study burden and incentives, and safety concerns. The qualitative interview data revealed that FITxOlder was well-accepted; participants perceived enjoyment and health benefits, and would like to continue to practice it and share with others. The 5-times sit to stand test (mean changes at posttest=-1.62, p<.001; Cohen's d=0.97) and SF-12 physical component scores (mean changes at posttest=5.71, p<.001; Cohen's d=0.88) exhibited changes with large effect size from baseline to 12 weeks; other parameters showed small or medium effect size. Conclusions: The research findings indicated that the CHW-led and mHealth-facilitated Chinese Qigong exercise program is feasible and acceptable among low-income older Latino adults. The trending health benefits of this 12-week FITxOlder program might be promising to promote physical activity engagement in underserved older populations to improve health outcomes for healthy aging and independent living. Future research with larger samples and longer interventions is warranted to assess the health benefits of FITxOlder program and its suitability. Clinicaltrial:
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Background Compared with optimal blood pressure (BP), the prehypertension increases the risk of incident hypertension, cardiovascular (CV) events, and death. Moderate intensity of regular physical activity can reduce BP. However, aerobic exercise has some limitations. As a safe, low-impact, enjoyable, and inexpensive form of exercise that requires minimal equipment and space, Tai Chi is expected as a viable alternative to aerobic exercise. The study aimed to assess the effect of Tai Chi intervention program, compared with aerobic exercise, on the BP in prehypertension patients. Methods This study is a 12-month, two-center, single-blind, parallel, randomized controlled trial. Three hundred forty-two patients with prehypertension [with a systolic blood pressure (SBP) in the range of 120 mmHg to 139 mmHg and/or a diastolic blood pressure (DBP) in the range of 80 mmHg to 89 mmHg] are randomized to one of two intervention groups in a 1:1 ratio: Tai Chi or aerobic exercise. BP monitoring methods of office blood pressure, ambulatory blood pressure monitoring (ABPM), and home blood pressure monitoring (HBPM) are used at the same time to detect BP in multiple dimensions. The primary outcome is the comparison of SBP change from baseline to 12 months in Tai Chi group and SBP change from baseline to 12 months in aerobic exercise group. The secondary endpoints are as following: (1) the comparison of DBP of office blood pressure change from baseline to 12 months between Tai Chi group and aerobic exercise group, (2) the comparison of BP and the variability of BP assessed through ABPM change from baseline to 12 months between Tai Chi group and aerobic exercise group, (3) the comparison of BP assessed through HBPM change from baseline to 12 months between Tai Chi group and aerobic exercise group. Discussion This will be the first randomized controlled trial to specifically study the benefits of Tai Chi on the blood pressure control in patients with prehypertension. The successful completion of this study will help to provide evidence for whether Tai Chi is more desirable than aerobic exercise. Trial registration Trial registration number: Chinese Clinical Trial Registry, ChiCTR1900024368. Registered on 7 July 2019, http://www.chictr.org.cn/edit.aspx?pid=39478&htm=4
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Eine Möglichkeit, wie man die natürlichen Selbstheilungskräfte des Körpers aktivieren, nachhaltig verbessern und wirkliche Ergebnisse erzielen kann, ist die Anwendung einer traditionellen chinesische Kunst, die sich Qigong nennt. Dieser Artikel stellt vor, was unter Qigong zu verstehen ist, zu welchen Zwecken es angewendet werden kann und welche Vorteile daraus resultieren. Der Beitrag schließt mit einer kurzen Einführung in praktische Übungen für den Alltag.
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Tai chi chuan (TCC) is a Chinese conditioning exercise and is well known for its slow and graceful movements. Recent investigations have found that TCC is beneficial to cardiorespiratory function, strength, balance, flexibility, microcirculation and psychological profile. The long-term practice of TCC can attenuate the age decline in physical function, and consequently it is a suitable exercise for the middle-aged and elderly individuals. TCC can be prescribed as an alternative exercise programme for selected patients with cardiovascular, orthopaedic, or neurological diseases, and can reduce the risk of falls in elderly individuals. The exercise intensity of TCC depends on training style, posture and duration. Participants can choose to perform a complete set of TCC or selected movements according to their needs. In conclusion, TCC has potential benefits in health promotion, and is appropriate for implementation in the community.
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The article describes a randomized, controlled trial conducted to examine the effects of a Tai Chi intervention program on perceptions of personal efficacy and exercise behavior in older adults. The sample comprised 94 low-active, healthy participants (mean age = 72.8 years, SD = 5.1) randomly assigned to either an experimental (Tai Chi) group or a wait-list control group. The study length was 6 months, with self-efficacy responses (barrier, performance efficacies) assessed at baseline, at Week 12, and at termination (Week 24) of the study. Exercise attendance was recorded as an outcome measure of exercise behavior. Random-effects models revealed that participants in the experimental group experienced significant improvements in self-efficacy over the course of the intervention. Subsequent repeated-measures ANOVA revealed that participants' changes in efficacy were associated with higher levels of program attendance. The findings suggest that self-efficacy can be enhanced through Tai Chi and that the changes in self-efficacy are likely to improve exercise adherence.
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Weight-bearing physical activity has beneficial effects on bone health across the age spectrum. Physical activities that generate relatively high-intensity loading forces, such as plyometrics, gymnastics, and high-intensity resistance training, augment bone mineral accrual in children and adolescents. Further, there is some evidence that exercise-induced gains in bone mass in children are maintained into adulthood, suggesting that physical activity habits during childhood may have long-lasting benefits on bone health. It is not yet possible to describe in detail an exercise program for children and adolescents that will optimize peak bone mass, because quantitative dose-response studies are lacking. However, evidence from multiple small randomized, controlled trials suggests that the following exercise prescription will augment bone mineral accrual in children and adolescents: Mode: impact activities, such as gymnastics, plyometrics, and jumping, and moderate intensity resistance training; participation in sports that involve running and jumping (soccer, basketball) is likely to be of benefit, but scientific evidence is lacking Intensity: high, in terms of bone-loading forces; for safety reasons, resistance training should be <60% of 1-repetition maximum (IRM) Frequency: at least 3 d·wk-1 Duration: 10-20 min (2 times per day or more may be more effective) During adulthood, the primary goal of physical activity should be to maintain bone mass. Whether adults can increase bone mineral density (BMD) through exercise training remains equivocal. When increases have been reported, it has been in response to relatively high intensity weight-bearing endurance or resistance exercise; gains in BMD do not appear to be preserved when the exercise is discontinued. Observational studies suggest that the age-related decline in BMD is attenuated, and the relative risk for fracture is reduced, in people who are physically active, even when the activity is not particularly vigorous. However, there have been no large randomized, controlled trials to confirm these observations, nor have there been adequate dose-response studies to determine the volume of physical activity required for such benefits. It is important to note that, although physical activity may counteract to some extent the aging-related decline in bone mass, there is currently no strong evidence that even vigorous physical activity attenuates the menopause-related loss of bone mineral in women. Thus, pharmacologic therapy for the prevention of osteoporosis may be indicated even for those postmenopausal women who are habitually physically active. Given the current state of knowledge from multiple small randomized, controlled trials and large observational studies, the following exercise prescription is recommended to help preserve bone health during adulthood: Mode: weight-bearing endurance activities (tennis; stair climbing; jogging, at least intermittently during walking), activities that involve jumping (volleyball, basketball), and resistance exercise (weight lifting) Intensity: moderate to high, in terms of bone-loading forces Frequency: weight-bearing endurance activities 3-5 times per week; resistance exercise 2-3 times per week Duration: 30-60 min·d -1 of a combination of weight-bearing endurance activities, activities that involve jumping, and resistance exercise that targets all major muscle groups It is not currently possible to easily quantify exercise intensity in terms of bone-loading forces, particularly for weight-bearing endurance activities. However, in general, the magnitude of bone-loading forces increases in parallel with increasing exercise intensity quantified by conventional methods (e.g., percent of maximal heart rate or percent of 1RM). The general recommendation that adults maintain a relatively high level of weight-bearing physical activity for bone health does not have an upper age limit, but as age increases so, too, does the need for ensuring that physical activities can be performed safely. In light of the rapid and profound effects of immobilization and bed rest on bone loss, and the poor prognosis for recovery of mineral after remobilization, even the frailest elderly should remain as physically active as their health permits to preserve skeletal integrity. Exercise programs for elderly women and men should include not only weight-bearing endurance and resistance activities aimed at preserving bone mass, but also activities designed to improve balance and prevent falls. Maintaining a vigorous level of physical activity across the lifespan should be viewed as an essential component of the prescription for achieving and maintaining good bone health.