qigong y salud
DESCRIPTION
la influencia de oriente en la medicina occidentalTRANSCRIPT
Literature Review: Fitness
A Comprehensive Review of Health Benefits ofQigong and Tai ChiRoger Jahnke, OMD; Linda Larkey, PhD; Carol Rogers, APRN-BC, CNOR, PhD; Jennifer Etnier, PhD;Fang Lin, MS
AbstractObjective. Research examining psychological and physiological benefits of Qigong and Tai
Chi is growing rapidly. The many practices described as Qigong or Tai Chi have similartheoretical roots, proposed mechanisms of action, and expected benefits. Research trials andreviews, however, treat them as separate targets of examination. This review examines theevidence 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 intoelectronic 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 interventionsand published in peer-reviewed journals from 1993 to 2007.
Data Extraction. Country, type and duration of activity, number/type of subjects, controlconditions, 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 5 4), cardiopulmonary effects (n 5 19), physicalfunction (n 5 16), falls and related risk factors (n 5 23), quality of life (n 5 17), self-efficacy(n 5 8), patient-reported outcomes (n 5 13), psychological symptoms (n 5 27), and immunefunction (n 5 6).
Conclusions. Research has demonstrated consistent, significant results for a number ofhealth benefits in RCTs, evidencing progress toward recognizing the similarity and equivalenceof 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 publishedresearch has examined the healthbenefits of Tai Chi (also called Taiji), atraditional Chinese wellness practice.In addition, a strong body of researchis also emerging for Qigong, an evenmore ancient traditional Chinese well-ness practice that has similar charac-teristics to Tai Chi. Qigong and Tai Chihave been proposed, along with yogaand pranayama from India, to consti-tute a unique category or type ofexercise referred to currently as med-itative movement.1 These two forms ofmeditative movement, Qigong and TaiChi, are close relatives, having sharedtheoretical roots, common operationalcomponents, and similar links to thewellness and health-promoting aspectsof Traditional Chinese Medicine(TCM). They are nearly identical inpractical application in the health-enhancement context and share muchoverlap in what TCM describes as the‘‘three regulations’’: body focus (pos-ture and movement), breath focus, andmind focus (meditative, mindful com-ponents).1,2
Because of the similarity of Qigongand Tai Chi, this review of the state ofthe science for these forms of medita-tive movement will investigate thebenefits of both forms together. Inpresenting evidence for a variety ofhealth benefits, many of which areattributable to both practices, we willpoint to the magnitude of the com-bined literature and suggest underwhat circumstances Qigong and TaiChi may be considered as potentiallyequivalent interventions, with recom-mendations for standards and furtherresearch 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, arewith 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 HealthcareInnovation, 500 N 3rd Street, Phoenix, AZ 85004; [email protected].
This manuscript was submitted October 13, 2008; revisions were requested June 2, 2009; the manuscript was accepted forpublication July 21, 2009.
Copyright E 2010 by American Journal of Health Promotion, Inc.0890-1171/10/$5.00 + 0DOI: 10.4278/ajhp.081013-LIT-248
July/August 2010, Vol. 24, No. 6 e1
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OBJECTIVES
Previously published reviews havereported on specific outcomes of eitherTai Chi or Qigong, mostly addressingonly one of these practices, and rarelytaking into account the similarity of thetwo forms and their similar outcomes.These reviews have covered a widevariety of outcomes, with many focusedon specific diseases or symptoms, in-cluding hypertension,3 cardiovasculardisease,4,5 cancer,6–8 arthritic disease,9
stroke rehabilitation,10 aerobic capaci-ty,11 falls and balance,12,13 bone mineraldensity,14 and shingles-related immuni-ty,15 with varying degrees of supportnoted for outcomes in response toQigong or Tai Chi.
Other reviews have addressed a broadspectrum of outcomes to demonstratehow Qigong16–19 or Tai Chi20–26 hasdemonstrated improvements for par-ticipants with a variety of chronic healthproblems or with vulnerable olderadults. Although many of these reviewshave utilized selection criteria thatrestrict their focus to rigorous empiricalstudies, others have used less stringentcriteria. The purpose of this review is toevaluate the current evidence for abroad range of health benefits for bothQigong and Tai Chi using only ran-domized controlled trials (RCTs), andto evaluate the potential of treatingthese two forms of meditative move-ment as equivalent forms. A completedescription of Qigong and Tai Chi ispresented and the equivalence of theirtheoretical roots and their commonelements of practice are established.Then, the body of evidence for out-comes in response to Qigong and TaiChi is reviewed to examine the range ofhealth benefits. Finally, to more criti-cally evaluate similarities across studiesof the two practices, we discuss thepotential of treating them as equivalentinterventions in research and the in-terpretation of results across studies.
Research question 1: What healthbenefits are evidenced from RCTs ofQigong and Tai Chi?
Research question 2: In examiningthe Qigong and Tai Chi practicesincorporated in research, and theevidence for health benefits commen-surate with each, what claims can bemade for equivalence of these twoforms of practice/exercise that have
typically been considered to be sepa-rate and different?
Overview of Qigong and Tai Chi
Qigong is, definitively, more ancientin origin than Tai Chi, and it is theoverarching, more original disciplineincorporating widely diverse practicesdesigned to cultivate functional integ-rity and the enhancement of the lifeessence that the Chinese call Qi. BothQigong 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 eithergentle or vigorous body shaking. Mostimportantly, both incorporate the pur-poseful regulation of both breath andmind coordinated with the regulationof the body. Qigong and Tai Chi areboth based on theoretical principlesthat are inherent to TCM.1 In theancient teachings of health-orientedQigong and Tai Chi, the instructionsfor attaining the state of enhanced Qicapacity and function point to thepurposeful coordination of body,breath, and mind (paraphrased here):‘‘Mind the body and the breath, andthen clear the mind to distill theHeavenly elixir within.’’ This combina-tion of self-awareness with self-correc-tion of the posture and movement ofthe body, the flow of breath, andmindfulness, are thought to comprise astate that activates the natural self-regulatory (self-healing) capacity, stim-ulating the balanced release of endog-enous neurohormones and a wide arrayof natural health recovery mechanismsthat are evoked by the intentful inte-gration of body and mind.
Despite variations among the myriadforms, we assert that health-orientedTai Chi and Qigong emphasize thesame principles and practice elements.Given these similar foundations and thefashion in which Tai Chi has typicallybeen modified for implementation inclinical research, we suggest that theresearch literature for these two formsof meditative movement should beconsidered as one body of evidence.
Qigong
Qigong translates from Chinese tomean, roughly, to cultivate or enhancethe inherent functional (energetic)essence of the human being. It is
considered to be the contemporaryoffspring of some of the most ancient(before recorded history) healing andmedical practices of Asia. The earliestforms of Qigong make up one of thehistoric roots of contemporary TCMtheory and practice.2 Many branches ofQigong have a health and medicalfocus and have been refined for wellover 5000 years. Qigong purportedlyallows individuals to cultivate the nat-ural force or energy (Qi) in TCM thatis associated with physiological andpsychological functionality. Qi is theconceptual foundation of TCM inacupuncture, herbal medicine, andChinese physical therapy. It is consid-ered to be a ubiquitous resource ofnature that sustains human well-beingand assists in healing disease as well as(according to TCM theory) havingfundamental influence on all life andeven on the orderly function of celes-tial mechanics and the laws of physics.Qigong exercises consist of a series oforchestrated practices including bodyposture/movement, breath practice,and meditation, all designed to en-hance Qi function (that is, drawingupon natural forces to optimize andbalance energy within) through theattainment of deeply focused and re-laxed states. From the perspective ofWestern thought and science, Qigongpractices activate naturally occurringphysiological and psychological mecha-nisms of self-repair and health recovery.
Also considered part of the overalldomain of Qigong is ‘‘external Qigong,’’wherein a trained medical Qigong ther-apist diagnoses patients according to theprinciples of TCM and uses ‘‘emittedQi’’ to foster healing. Both internalQigong (personal practice) and externalQigong (clinician-emitted Qi) are seenas affecting the balance and flow ofenergy and enhancing functionality inthe body and the mind. For the purposesof our review, we are focused only on theindividual, internal Qigong practice ofexercises performed with the intent ofcultivating enhanced function, inner Qithat is ample and unrestrained. This isthe aspect of Qigong that parallelswhat is typically investigated in Tai Chiresearch.
There are thousands of forms ofQigong practice that have developedin different regions of China duringvarious historic periods and that have
e2 American Journal of Health Promotion
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been created by many specific teachersand schools. Some of these forms weredesigned for general health-enhance-ment purposes and some for specificTCM diagnostic categories. Some wereoriginally developed as rituals forspiritual practice, and others to em-power greater skill in the martial arts.An overview of the research literaturepertaining to internal Qigong yieldsmore than a dozen forms that havebeen studied as they relate to healthoutcomes (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 (andthat are addressed in this review)incorporate a range of simple move-ments (repeated and often flowing innature) or postures (standing or sit-ting) and include a focused state ofrelaxed awareness and a variety ofbreathing techniques that accompanythe movements or postures. A keyunderlying philosophy of the practiceis that any form of Qigong has an effecton the cultivation of balance andharmony of Qi, positively influencingthe human energy complex (Qi chan-nels/pathways) that functions as aholistic, coherent, and mutually inter-active system.
Tai Chi
Tai Chi translates to mean ‘‘GrandUltimate,’’ and in the Chinese culture,it represents an expansive philosoph-ical and theoretical notion thatdescribes the natural world (i.e., theuniverse) in the spontaneous state ofdynamic balance between mutuallyinteractive phenomena including thebalance of light and dark, movementand stillness, waves and particles. TaiChi, the exercise, is named after thisconcept and was originally developedboth as a martial art (Tai Chi Chuan ortaijiquan) and as a form of meditativemovement. The practice of Tai Chi asmeditative movement is expected toelicit functional balance internally forhealing, stress neutralization, longevi-ty, and personal tranquility. This formof Tai Chi is the focus of this review.
For numerous complex sociologicaland political reasons,2 Tai Chi hasbecome one of the best-known formsof exercise or practice for refining Qiand is purported to enhance physio-
logical and psychological function.The one factor that appears to differ-entiate Tai Chi from Qigong is thattraditional Tai Chi is typically per-formed as a highly choreographed,lengthy, and complex series of move-ments, whereas health-enhancementQigong is typically a simpler, easy-to-learn, more repetitive practice. How-ever, even the longer forms of Tai Chiincorporate many movements that aresimilar to Qigong exercises. Usually,the more complex Tai Chi routinesinclude Qigong exercises as a warm-up,and emphasize the same basic princi-ples for practice, that is, the threeregulations of body focus, breath focus,and mind focus. Therefore Qigongand Tai Chi, in the health promotionand wellness context, are operationallyequivalent.
Tai Chi as Defined in theResearch Literature
It is especially important to note thatmany of the RCTs investigating what isdescribed as Tai Chi (for healthenhancement) are actually not investi-gating the traditional, lengthy, com-plex practices that match the formaldefinition of traditional Tai Chi. TheTai Chi used in research on bothdisease prevention and used as acomplement to medical intervention isoften a ‘‘modified’’ Tai Chi (e.g., TaiChi Easy, Tai Chi Chih, or ‘‘shortforms’’ that greatly reduce the numberof movements to be learned). Themodifications generally simplify thepractice, making the movements morelike most health-oriented Qigong ex-ercises that are simple and repetitive,rather than a lengthy choreographedseries of Tai Chi movements that takemuch longer to learn (and, for manyparticipants, reportedly delay the ex-perience of ‘‘settling’’ into the relaxa-tion response). A partial list of exam-ples of modified Tai Chi forms fromthe RCTs in the review is: balanceexercises inspired by Tai Chi,30 Tai Chifor arthritis, five movements from SunTai Chi,31 Tai Chi Six Form,32 YangEight Form Easy,33,34 and Yang FiveCore Movements.34
In 2003, a panel of Qigong and TaiChi experts was convened by theUniversity of Illinois and the Blueprintfor Physical Activity to explore this verypoint.35 The expert panel agreed that it
is appropriate to modify (simplify) TaiChi to more efficiently disseminate thebenefits to populations in need of cost-effective, safe, and gentle methods ofphysical activity and stress reduction.These simplified forms of Tai Chi arevery similar to the forms of Qigongused in health research.
For this reason, it is not onlyreasonable but also a critical contribu-tion to the emerging research dialogueto review the RCTs that explore thehealth benefits resulting from both ofthese practices together, as one com-prehensive evidence base for the med-itative movement practices originatingfrom China.
METHODS
Data Sources
The following databases were usedto conduct literature searches forpotentially relevant articles: Cumula-tive Index for Allied Health andNursing (CINAHL), psychological lit-erature (PsycINFO), PubMed, GoogleScholar, and the Cochrane database.The key words included Tai Chi, Taiji,Tai Chi Chuan, and Qigong, combinedwith RCT or with clinical researchterms. Additional hand searches(based on word-of-mouth recommen-dations) completed the search forarticles.
Study Inclusion Criteria
Criteria for inclusion of articlesrequired that they (1) were publishedin a peer-reviewed English-languagejournal between 1993 and December2007; (2) were cited in nursing, med-ical, or psychological literature; (3)were designed to test the effects of TaiChi or Qigong; and (4) used an RCTresearch design. The literature searchresulted in the identification of 576articles to be considered for inclusion.The full texts of 158 articles appearingto meet initial criteria 1 through 4 wereretrieved for further evaluation and toverify which ones were, in fact, RCTs,resulting in a final set of 77 articlesmeeting all of our inclusion criteria.
Data Abstraction
Articles were read and results wereentered into a table according tocriteria established by the authors forcategorization and evaluation of thestudies and outcomes. Included in
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Table 1 for review and discussion aretype and number of patients random-ized, duration and type of interventionand control condition, measured out-comes, and results. As the informationwas entered into the table, it becameapparent that some of the authorsreported results from the same study inmore than one article. Thus, the 77articles selected actually represented66 unique studies, with one studyreporting a range of outcomes acrossfive articles, and five other studies’results published in two articles each.An additional two articles were notentered into the table36,37 because thesame results were reported in newerarticles. Other than these two droppedarticles, multiple articles are enteredinto the table as representing onestudy (see Table 1) so that the fullrange of outcomes reported across thearticles 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 diseaseoutcome. Many of the studies drewparticipants from a general, healthypopulation (n 5 16), so a categoryschema based on patient type ordisease would not have included all ofthe studies. The authors revisited thelong list of health benefits and out-comes assessed across the studies andgenerated broad categories that com-bined related health outcomes intolarger groups. These initial categorieswere defined based on identifying themost frequently measured primaryoutcomes, and then refining thegroups to develop an investigationframework that accommodated all ofthe research outcomes into at least oneof the categories. These categories ofoutcomes related to Qigong and TaiChi practice were discussed and con-tinually reworked until we had clear,nonoverlapping boundaries for eachcategory based on similar symptoms orhealth indicators related to a commonfunction or common target organsystem. These groupings are not in-tended to be conclusive taxonomiesbut rather are used for this review asconvenient and meaningful tools forevaluating similar groups of outcomes.
In this way, examining health out-comes across a variety of study designsand populations (including healthy,diseased, or at-risk patients) waspossible.
RESULTS
Study Description
A total of 6410 participants wereincluded across these reported studies.Although some of the studies com-pared Qigong or Tai Chi to otherforms of exercise (n 5 13), manycompared Qigong or Tai Chi to anonexercise treatment control groupsuch as education or usual care (n 5
43) and some used both exercise andnonexercise comparison groups toevaluate effects of Qigong or Tai Chiinterventions (n 5 11). Many studiesincluded healthy adults (n 5 16studies), while other studies includedparticipants based on specific riskfactors or diagnosis of disease, includ-ing arthritis (n 5 5), heart disease (n5 6), hypertension (n 5 5), osteopo-rosis risk (e.g., perimenopausal status;n 5 3), fall risk determined by age andsedentary lifestyle or poor physicalfunction and balance (n 5 18), breastcancer (n 5 1), depression (n 5 2),fibromyalgia (n 5 2), immune dys-function, including human immuno-deficiency virus/acquired immune de-ficiency syndrome and varicella historyor vaccine response (n 5 3), musculardystrophy (n 5 1), Parkinson’s disease(n 5 1), neck pain (n 5 1), sleepcomplaints (n 5 1), chronic disease (n5 1), and traumatic brain injury (n 5
1). Some of the studies (n 5 9)monitored adverse effects during theinterventions and none reported anadverse event.
The studies originated from 13 coun-tries (USA, n 5 34; China [includingHong Kong], n 5 9; Korea, n 5 4;Australia and New Zealand, n 5 5;Sweden, n 5 4; Great Britain, n 5 3; Italyand Taiwan, each n 5 2; Netherlands,Israel, Poland, and Spain, each n 5 1).
Outcomes
From all of the studies, 163 differentphysiological and psychological healthoutcomes were identified. Many of thestudies assessed outcomes across morethan one category (e.g., physical func-tion as well as a variety of psychosocial
and fitness outcomes), so some studiesare discussed in more than one sectionin the review of categories that follows.
The nine outcome category group-ings that emerged are bone density (n5 4); cardiopulmonary effects (n 5
19); physical function (n 5 16); falls,balance, and related risk factors (n 5
23); quality of life (QOL; n 5 17); self-efficacy (n 5 8); patient-reportedoutcomes (PROs; n 5 13); psycholog-ical symptoms (n 5 27); and immune-and inflammation-related responses (n5 6). Within each category of out-comes, there were both Qigong andTai Chi interventions represented.
Bone DensityResistance training and other
weight-bearing exercises are known toincrease bone formation38 and havebeen recommended for postmeno-pausal women for that purpose.39
Interestingly, most Qigong and Tai Chipractices involve no resistance and onlyminimal weight bearing (such as gentleknee bends), yet the four RCTs (totalsample size 5 427) included in thisreview reported positive effects onbone health. One study examined theeffect of Qigong40 and three examinedTai Chi.41–43 Bone loss was retardedand numbers of fractures were lessamong postmenopausal women prac-ticing Tai Chi compared to usualcare.41 In another study, bone loss wasless pronounced for postmenopausalfemales practicing Tai Chi or resis-tance training compared to no-exercisecontrols, but this effect was not foundin the older men participating in thestudy.43 Shen et al.42 compared Tai Chito resistance training and reportedsignificant changes in biomarkers ofbone health in both groups. Bonemineral density increased for womenfollowing Qigong exercises as com-pared to no-exercise controls.40 Insummary, current research suggests afavorable effect on bone health forthose practicing Tai Chi or Qigong.
Cardiopulmonary
Nineteen studies (Qigong, n 5 7;Tai Chi; n 5 12) reported favorablecardiovascular and/or pulmonary out-comes. Participants in this grouping ofstudies were generally older adults(mean age 5 61.02) and inclusioncriteria varied from history of diseaseto reported sedentary behavior. Mea-
e4 American Journal of Health Promotion
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sures of cardiopulmonary functionwere representative of cardiopulmo-nary fitness and cardiovascular diseaserisk and included blood pressure,heart rate, ejection fraction rates,blood lipids, 6-minute walk distance,ventilatory function, and body massindex (BMI).
One of the most consistent findingswas the significant reduction in bloodpressure reported in multiple studies,especially when Qigong44,45 or TaiChi46,47 were compared to inactivecontrol groups such as usual care,educational classes, or wait-list con-trols. Even when compared to activecontrol groups such as aerobic exerciseor balance training, Tai Chi showed asignificant reduction in blood pressurein two studies.48,49 Other studies, how-ever, that utilized active control inter-ventions expected to reduce bloodpressure (e.g., low to moderate physicalactivity interventions) showed positivechanges for both groups, but withoutsignificant differences between Qi-gong28 or Tai Chi50,51 and the compari-son group, thus providing preliminaryevidence that these meditative move-ment practices achieve similar results toconventional exercise.
Other indicators of cardiac healthhave been evaluated. Reduced heartrate is reported49,51,52 as well as in-creases in heart rate variability.53 Thesereported changes in blood pressure,heart rate, and heart rate variabilitysuggest that one or several of the keycomponents of Tai Chi and Qigong—body, breath, and mind—may affectsympathetic and parasympathetic bal-ance and activity.
Biomarkers of heart health havebeen shown to improve in response toQigong or Tai Chi practice. Yeh et al.34
reported significantly improved serumB-type natriuretic peptide levels inresponse to Tai Chi compared to usual-care controls, indicating improved leftventricular function. Lipid profilesimproved in two studies44,46 comparingQigong and Tai Chi to inactive con-trols, whereas another study of Qi-gong54 reported no change in choles-terol levels compared to inactive (wait-list) controls. Pippa et al.54 also re-ported no change in ejection fractionrates following a 16-week study ofQigong among participants with ahistory of chronic atrial fibrillation.
Urine catecholamine levels were sig-nificantly decreased in participantspracticing Tai Chi compared to wait-listcontrols,45 but a similar trend did notreach significance in another studywith only 15 participants per treatmentcondition.34
A variety of cardiopulmonary fitnessindicators have been examined forboth Qigong and Tai Chi. Participantswith a history of heart failure reportedsignificant improvements in the incre-mental shuttle walk following a com-bined Tai Chi/Qigong interventionimplemented in two studies incorpo-rating inactive control groups.34,55
Women treated for breast cancerachieved significantly increased dis-tances in the 6-minute walk test inresponse to Tai Chi compared to apsychosocial support control interven-tion56 and VO2max increased signifi-cantly more following a Tai Chi inter-vention compared to resistancetraining and usual-care controlgroups.53 In contrast to these consis-tent findings for cardiopulmonarybenefits, one study found no signifi-cant improvement in response toQigong, whereas aerobic training didachieve significant changes. In thissmall (n 5 11 in each arm of study)crossover study of patients with Par-kinson’s disease, participants practicedQigong or aerobic training in randomorder for 7 weeks (with 8 weeks’ rest inbetween intervention periods); resultson the 6-minute walk test, VO2peak, andVO2/Kg ratio were significantly im-proved for those who completed theaerobic exercise protocol, but no sig-nificant effects were found for thosepracticing Qigong.57
Most of the nonsignificant findingshave been found in studies with par-ticipants with some form of chronicillness or recovery from cancer at studyentry. For example, respiratory func-tion improved clinically, but not sig-nificantly, for patients with chronicheart failure practicing Tai Chi com-pared to usual care,34 and, as describedabove, was relatively unchanged for theQigong group with a history of Par-kinson’s disease compared to an aero-bic training control group.57 A groupof patients with muscular dystrophy58
showed a trend for improvement thatdid not reach significance compared toa wait-list control. Further, no change
in cardiovascular function was report-ed for sedentary participants with ahistory of osteoarthritis.59 Aerobic ca-pacity was shown to improve with TaiChi, though not significantly more sothan with inactive controls, in a smallstudy of breast cancer survivors.52,53,56 Itis important to point out that of thesefive studies that failed to demonstratesignificant improvements followingQigong or Tai Chi, four had 31 orfewer participants. It is difficult todiscern whether nonsignificant find-ings in cardiopulmonary fitness arebecause of some pattern of ineffec-tiveness with chronic and debilitatingillness or whether they are a result ofthe limited statistical power.
One of the key risk factors forcardiac disease is obesity. Qigong hasdemonstrated a greater reduction inBMI as compared to an exercisecontrol group in two studies,28,47 butthis difference was not significant.Another study demonstrated amarked but nonsignificant reductionin waist circumference with Tai Chicompared to usual care for olderadults.52 Conversely, one study usingQigong and two with Tai Chi (re-spectively)48,54,59 reported no changein BMI compared to usual care andanother implementing a Qigong in-tervention60 failed to maintain weightloss, suggesting the data are incon-clusive at this point as to whether ornot these practices may consistentlyaffect weight.
A few studies of both Qigong and TaiChi have examined level of intensity,indicating that some forms of thesepractices fall within the moderateintensity level,11,61 but for the mostpart, level of exercise intensity is notreported. Cardiopulmonary benefits ofQigong and Tai Chi may partially beexplained as a response to aerobicexercise, but with the wide range ofspeeds with which these exercises areexecuted, it would be important toassess this factor for a better under-standing of the elements that contrib-ute to outcomes. Regardless of themechanisms, the preponderance ofstudies on cardiopulmonary outcomesshow that Qigong and Tai Chi areeffective compared to inactive controls,or at least approximately equal to theexpected benefits of conventionalexercise.
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Tab
le1
Ran
do
miz
ed
Co
ntr
oll
ed
Tri
als
Testi
ng
Healt
hB
en
efi
tso
fQ
igo
ng
an
dT
ai
Ch
i
So
urc
e
Su
bje
cts
:N
o.
(Male
/Fem
ale
),D
escri
pti
on
,M
ean
Ag
eE
xerc
ise
Du
rati
on
Exerc
ise
Gro
up
Co
ntr
ol
Gro
up
Rep
ort
ed
Ou
tco
mes
Audette
et
al.5
327
(0/2
7),
sedenta
ry,
71.4
y
12
wk
(60
min
33
d/w
k)
TC
10-m
ove
ment
Yang
(n5
11)
BW
(n5
8);
UC
late
r
recru
ited
and
not
random
ized
(n5
8)
Card
iopulm
onary
:V
O2m
ax
qin
TC
more
than
BW
and
UC
*;heart
rate
variabili
ty,
hig
h
frequency
qand
low
frequencyQ
inT
C
only
*no
betw
een
gro
up
diffe
rence
Falls
and
bala
nce:
str
ength
,hand
grip
and
knee
exte
nsio
nq
TC
only
*and
left
knee
exte
nsio
nq
inT
Cm
ore
than
BW
*;
flexi
bili
ty,
only
toe
touch
flexi
bili
tyq
inT
C
more
than
BW
*;bala
nce,
only
nondom
inant
OLS
with
eyes
clo
sed
qin
TC
more
than
BW
*
Barr
ow
et
al.
55
52
(42/1
0),
old
er
adults
with
his
tory
of
chro
nic
heart
failu
re,
69.5
y
16
wk
(55
min
32
d/w
k)
TC
with
ChiK
ung
(n5
25)
UC
(n5
27)
Card
iopulm
onary
:in
cre
menta
lshuttle
walk
qin
TC
more
than
UC
ns
Patient-
report
ed
outc
om
es:
perc
eiv
ed
sym
pto
ms
of
heart
failu
reQ
inT
Cm
ore
than
UC
*
Psycholo
gic
al:
depre
ssio
n(S
CL-9
0-R
)Q
in
TC
more
than
UC
ns;
anxie
tyQ
inboth
gro
ups
ns
Brism
ee
et
al.
103
41
(7/3
4),
his
tory
of
knee
oste
oart
hritis,
70
y
12
wk
TC
and
6w
kno
train
ing
(40
min
33
d/w
k,
6w
kgro
up
train
ing,
6w
khom
etr
ain
ing,
6w
k
detr
ain
ing)
TC
Yang
24-f
orm
sim
plif
ied
(n5
18)
6w
kof
HL
follo
wed
by
no
activity
sam
e
as
exerc
ise
gro
up
(n5
13)
Physic
alfu
nct
ion:
WO
MA
Cq
inT
Cm
ore
than
HL*
with
Qfo
rdetr
ain
ing
period
Patient-
report
ed
outc
om
es:
pain
Qin
TC
more
than
HL*;
advers
eoutc
om
es
ns
Buriniet
al.
57
26
(9/1
7),
his
tory
of
Park
inson’s
dis
ease
,
65.2
y
7w
keach
of
aero
bic
s
(45
min
33
d/w
k)
and
QG
(50
min
33
d/w
k)
20
sessio
ns
each
with
8w
k
betw
een
inte
rvention
periods
QG
(n5
11)
AT
sess
ions
(n5
11)
Card
iopulm
onary
:6-m
inw
alk
and
Borg
scale
for
bre
ath
lessness
qand
spirom
etr
yand
card
iopulm
onary
exerc
ise
test
Qfo
rA
T
more
than
QG
*
Patient-
report
ed
outc
om
es:
Park
inson’s
Dis
ease
Questionnaire
ns
for
both
;U
nifie
d
Park
inson’s
Dis
ease
Rating
Scale
ns;
Bro
wn’s
Dis
abili
tyS
cale
ns
Psycholo
gic
al:
Beck
Depre
ssio
nIn
vento
ryns
Chan
et
al.4
1132
(0/1
32),
his
tory
of
postm
enopausaland
sedenta
ry,
54
y
12
mo
(45
min
35
d/w
k)
TC
Chuan
Yang
sty
le
(n5
54)
UC
(n5
54)
Bone
density:fr
actu
res
(1T
Cand
3U
C)
BM
D
measure
dby
dualenerg
yx-r
ay
absorp
tiom
etr
yin
fem
ora
lneck,
Qin
TC
less
than
UC
ns
and
trochante
rQ
both
ns;
periphera
lquantita
tive
com
pute
d
tom
ogra
phy
ofdis
tala
nd
ultra
dis
talt
ibia
Qle
ss
inT
Cth
an
UC
*
Channer
et
al.
51
126
(90/3
6),
his
tory
of
MI,
56
y
8w
k(2
d/w
k3
3w
k,
then
1d/w
k3
5w
k)
TC
Wu
Chia
n-C
h’u
an
(n5
31)
AE
(n5
30)
or
card
iac
SG
(n5
4)
dis
cussed
risk
facto
rm
odific
ation
and
pro
ble
ms
in
rehabili
tation
Card
iopulm
onary
:im
media
teS
BP
and
DB
P
QT
Cand
AE
ns
and
HR
qin
AE
more
than
TC
*;over
tim
e,
SB
PQ
both
ns
and
DB
Pand
resting
HR
Qin
TC
more
than
AE
*;S
Gto
osm
all
for
com
pariso
n
e6 American Journal of Health Promotion
Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.
Tab
le1,
Co
nti
nu
ed
So
urc
e
Su
bje
cts
:N
o.
(Male
/Fem
ale
),D
escri
pti
on
,M
ean
Ag
eE
xerc
ise
Du
rati
on
Exerc
ise
Gro
up
Co
ntr
ol
Gro
up
Rep
ort
ed
Ou
tco
mes
Chen
et
al.
40
87
(0/8
7),
his
tory
of
BM
D
T§
22.5
,45
y
12
wk
(stu
die
dfo
r
2w
k,
then
3d/w
k)
QG
Baduanjin
(n5
44)
NQ
(n5
43)
Bone
density:
BM
Dm
ain
tain
ed
inQ
Gand
Qin
NQ
*;
Imm
une/inflam
mation:
inte
rleukin
-6Q
inQ
G
and
qin
NQ
*
Cheung
et
al.2
888
(37/5
1),
old
er
adults
incom
munity
with
his
tory
of
hypert
ensio
n,
54.5
y
16
wk
(120
min
32
d/w
k3
4w
kth
en
month
lyand
encoura
ged
topra
ctice
60
min
inA.M
.and
15
min
in
P.M
.3
7d/w
k)
QG
Guolin
(n5
47)
E(n
541)
Card
iopulm
onary
:B
P,
HR
,w
ais
t
circum
fere
nce,
BM
I,to
talchole
stero
l,
renin
,and
24-h
urinary
pro
tein
excr
etion
Gand
Ens;
EC
GQ
Gand
Enc/n
s
QO
L:
SF
-36
QE
ns
Psy
cholo
gic
al:
Beck
Anxie
tyIn
vento
ryQ
and
Beck
Depre
ssio
nIn
vento
ryq
;Q
Gand
Ens
Choiet
al.
73
59
(15/4
4),
livin
gin
care
facili
ty,
am
bula
tory
with
his
tory
of
at
least
1fa
ll
risk
facto
r,
77.8
y
12
wk
(35
min
33
d/w
k)
TC
Sun
sty
le(n
529)
UC
(n5
30)
Falls
and
bala
nce:
FA
LLS
ns,
but
falls
eff
icacy
for
TC
qand
QU
C*;
knee
and
ankle
str
ength
,O
LS
eyes
open,
and
toe
reach
qand
6-m
walk
Qm
ore
than
UC
*;
OLS
eyes
open
nc
Self-e
ffic
acy:
falls
eff
icacy
for
TC
qand
QU
C*
Chou
et
al.
108
14
(7/7
),com
munity-
dw
elli
ng
Chin
ese,
his
tory
of
depre
ssio
n
from
apsyc
hogeriatr
ic
clin
ic,
72.6
y
3m
o(4
5m
in3
3d/w
k)
TC
Yang
sty
le18
form
(n5
7)
WL
(n5
7)
Psy
cholo
gic
al:
Cente
rfo
rE
pid
em
iolo
gic
al
Stu
die
sD
epre
ssio
nS
cale
QT
Cm
ore
than
WL*
Eld
er
et
al.6
092
(13/7
9),
his
tory
of
com
ple
ting
12-w
kw
eig
ht
loss
inte
rventio
nand
loss
ofatle
ast
3.5
kg,47.1
y
24
wk
(10
hovera
llw
ith
28-m
inQ
Gsess
ions)
QG
Em
ieZ
hen
Gong
(n5
22)
TA
T(n
527)
and
SD
S(n
524)
Card
iopulm
onary
:w
eig
ht
loss
main
tenance
for
TA
Tand
Gand
SD
S*
Faber
et
al.
30
238
(50/1
88)
frail
(51%
)
or
pre
frail
(48.9
%)
old
er
adults
livin
gin
care
facili
ty,
85
y
20
wk
(60
min
exerc
ise
and
30
min
socia
ltim
e
31
d/w
k3
4w
kfo
r
soci
aliz
ation,
then
32
d/w
kfo
r16
wk)
TC
(BE
inspired
by
TC
)
(n5
80)
FW
(n5
66)
or
UC
(92)
Falls
and
bala
nce:
falls
low
er
for
TC
more
than
FW
and
UC
ns;
when
FW
and
TC
com
bin
ed,fa
llrisk
Qand
physic
alf
unction
(6-m
walk
,tim
ed
chair
sta
nd,
TU
G,
and
FIC
SIT
-4)
qcom
pare
dto
UC
inpre
frail,
*
frail
ns,
als
oT
Ccom
pare
dto
FW
ns
Patient-
report
ed
outc
om
es:
Perf
orm
ance-
Oriente
dM
obili
tyA
ssessm
ent
qfo
rT
C
and
FW
and
exerc
ise
gro
ups
com
bin
ed
more
than
UC
*and
pre
frail,
*fr
ail
ns;
Gro
nin
gen
Activity
Restr
iction
Sca
leQ
for
FW
more
than
contr
ol*
TC
vs.
UC
ns
Fra
nsen
et
al.
31
152
(40/1
12)
old
er
adults
,
his
tory
of
chro
nic
sym
pto
matic
hip
or
knee
oste
oart
hritis,
70.8
y
12
wk
(60
min
32
d/w
k)
TC
for
Art
hritis
by
Dr.
Lam
from
Sun
Sty
le24
form
s
(n5
56)
H(n
555)
and
WL
contr
ol(n
541)
Physic
alf
unct
ion:W
OM
AC
:pain
and
function
QT
Cand
Hns
with
treatm
ent
eff
ect
for
physic
alfu
nct
ion
modera
te*;
pain
score
Qfo
rH
com
pare
dto
WL,*
TC
ns;
physic
al
perf
orm
ance:
TU
G,
50-f
oot
walk
,and
sta
ir
clim
bQ
more
for
Hth
an
WL*;
tim
ed
sta
ir
clim
bfo
rQ
TC
and
Hns
July/August 2010, Vol. 24, No. 6 e7
Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.
Tab
le1,
Co
nti
nu
ed
So
urc
e
Su
bje
cts
:N
o.
(Male
/Fem
ale
),D
escri
pti
on
,M
ean
Ag
eE
xerc
ise
Du
rati
on
Exerc
ise
Gro
up
Co
ntr
ol
Gro
up
Rep
ort
ed
Ou
tco
mes
QO
L:
SF
-12
Physic
al
qH
more
than
WL*
and
TC
more
than
WL
bord
erlin
e*;
SF
-12
Menta
lns
Patient-
report
ed
outc
om
es:
pain
and
funct
ion
QT
Cand
Hns
Psycholo
gic
al:
Depre
ssio
nA
nxie
ty&
Str
ess
21
Qin
H*
and
TC
ns
Gala
ntino
et
al.
66
38
(38/0
),his
tory
of
long
term
care
of
HIV
/AID
S,
betw
een
20
and
60
y
8w
k(6
0m
in3
2d/w
k)
TC
(n5
13)
AE
(n5
13)
and
UC
(n5
12)
Physic
alfu
nct
ion:
FR
,S
R,
sit-u
p,
and
physic
alperf
orm
ance
test
all
impro
ved
more
than
UC
*and
TC
com
pare
dto
AE
nc
QO
L:
Medic
alO
utc
om
es
Short
Form
-HIV
impro
ved
TC
and
AE
more
than
contr
ol*
;
spiritu
alw
ell-
bein
gim
pro
ved
TC
AE
and
UC
ns
Psycholo
gic
al:
Pro
file
of
Mood
Sta
tes
impro
ved
TC
and
AE
more
than
contr
ol*
Gatt
sand
Woolla
cott
65
19
(2/1
7),
bala
nce-
impaired
senio
rs,
77.5
y
3w
k(9
0m
in3
5d/w
k)
TC
Tw
elv
eC
lassic
alT
C
Postu
res
(n5
11)
TC
-based
and
axia
l
mobili
typro
gra
m;
sam
egro
up
pra
cticed
TC
aft
er
contr
oltim
e
(n5
8)
Falls
and
bala
nce:
TU
GQ
more
for
TC
than
contr
ol*
;F
Rq
for
TC
and
contr
ol;
OLS
and
tandem
sta
nce
both
legs
qm
ore
TC
than
contr
ol*
;tibia
lisante
rior
more
qfo
rT
C
than
contr
ol*
;gastr
ocnem
ius
qonly
TC
aft
er
contr
oltim
e*
Gem
mell
and
Leath
em
96
18
(9/9
),his
tory
of
traum
atic
bra
inin
jury
sym
pto
ms,
45.7
y
6w
k(4
5m
in3
2d/w
k)
TC
Chen
sty
le(n
59)
WL
UC
(n5
9)
QO
L:
SF
-36
and
Rosenberg
Self-E
ste
em
Sca
leno
diffe
rentns
exceptro
leem
otional
qT
Cm
ore
than
UC
*
Psycholo
gic
al:
Vis
ualA
nalo
gue
Mood
Scale
s
impro
ved
TC
more
than
UC
*;R
osenberg
Self-
Este
em
Sca
lenc,
ns
Gre
enspan
et
al.3
2
269
(0/2
69),
congre
gate
independent
livin
g,
transitio
nally
frail
with
at
least
1fa
llin
past
year,
.70
yand
50%
over
80
y
48
wk
(60
incre
asi
ng
to
90
min
32
d/w
k)
TC
6sim
plif
ied
form
s
(n5
103)
WE
(n5
102)
Physic
alfu
nct
ion:
Sic
kness
Impact
Pro
file
for
physic
alfu
nction
and
am
bula
tion
Qm
ore
TC
than
WE
*
Patie
nt-
report
ed
outc
om
es:
Sic
kness
Impact
Pro
file
and
physi
cala
nd
am
bula
tion
perc
eiv
ed
health
statu
sQ
TC
more
than
WE
*;se
lf-re
port
ed
health
nc
TC
and
WE
ns
Ham
mond
and
Fre
em
an
100
133
(13/1
20),
his
tory
of
fibro
myalg
iafr
om
a
rheum
ato
logy
outp
atie
nt
depart
ment,
48.5
3y
10
wk
(45
min
3
1d/w
k)
TC
for
art
hritis
(part
of
patient
ED
gro
up
inclu
din
g
fibro
myalg
iain
form
ation,
postu
raltr
ain
ing,
str
etc
hin
g,
and
weig
hts
)(n
552)
RG
(n5
49)
Self-e
ffic
acy
:A
rthritis
Self-E
ffic
acy
Scale
qT
Cm
ore
than
RG
at
4m
o*;
at
8m
ons
Patient-
report
ed
outc
om
es:
Fib
rom
yalg
ia
Impact
Questionnaire
QT
Cm
ore
than
RG
*at
4m
o*;
at
8m
ons
Psycholo
gic
al:
Anxie
tyand
depre
ssio
nT
C
and
RG
ns
Hart
et
al.
87
18
(16/2
),his
tory
of
str
oke,
com
munity
-dw
elli
ng,
54.7
7y
12
wk
(60
min
3
2d/w
k)
TC
C(n
59)
BE
(n5
9)
Falls
and
bala
nce:
BB
S,
OLS
,E
mory
Fra
ctio
nalA
mbula
tion
Pro
file
,R
om
berg
,
TU
Gim
pro
ved
inB
E,*
not
TC
Cns
e8 American Journal of Health Promotion
Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.
Tab
le1,
Co
nti
nu
ed
So
urc
e
Su
bje
cts
:N
o.
(Male
/Fem
ale
),D
escri
pti
on
,M
ean
Ag
eE
xerc
ise
Du
rati
on
Exerc
ise
Gro
up
Co
ntr
ol
Gro
up
Rep
ort
ed
Ou
tco
mes
QO
L:
Duke
Health
Pro
file
impro
ved
TC
,*not
BE
ns
Hart
man
et
al.
67
33
(5/2
8),
com
munity
-
dw
elli
ng
with
low
er
extr
em
ity
oste
oart
hritis,
68
y
12
wk
(60
min
3
2d/w
k)
TC
9-f
orm
Yang
(n5
18)
UC
with
phone
calls
every
2w
kto
dis
cuss
issues
rela
ted
to
oste
oart
hritis
(n5
15)
Physic
alfu
nction:
OLS
,50-f
tw
alk
,and
chair
rise
TC
and
UC
ns
with
sm
all
tom
odera
te
eff
ect
siz
efo
rT
Conly
QO
L:
Art
hritis
Impact
Measure
ment
Scale
II
(satisfa
ction
with
life)
qand
tensi
on
Qm
ore
for
TC
than
UC
*;pain
and
mood
both
ns
Self-e
ffic
acy:
art
hritis
self-e
ffic
acy
qT
C
more
than
UC
*
Hass
et
al.8
828
(not
report
ed),
old
er
adults
transitio
nin
gto
frailt
y,
79.6
y
48
wk
(60
min
3
2d/w
k)
TC
8of
24
sim
plif
ied
form
s(n
514)
WE
(n5
14)
Falls
and
bala
nce:
cente
rof
pre
ssure
during
S1
and
S2
impro
ved
for
TC
more
than
WE
*;S
3fo
rboth
ns
Irw
inet
al.
110
112
(41/7
1),
healthy
old
er
adults,
70
y
16
wk
(40
min
3
3d/w
k)
TC
Chih
(n5
59)
HE
(n5
53)
QO
L:
SF
-36
impro
ved
for
physic
al
functionin
g,bodily
pain
,vita
lity,and
menta
l
health
for
TC
more
than
HE
*;ro
le
em
otional
Qfo
rH
Em
ore
than
TC
*;ro
le
physic
al,
genera
lhealth,
and
socia
l
functionin
gboth
gro
ups
ns
Psy
cholo
gic
al:
Beck
Depre
ssio
nS
core
qT
C
and
HE
ns
Imm
une/inflam
mation:
varicella
zost
er
virus
responder-
cell
frequency
qT
Cm
ore
than
HE
*
Irw
inet
al.
90
36
(5/1
3),
healthy
old
er
adults,
70.5
y
15
wk
(45
min
3
3d/w
k)
TC
Chih
(n5
14)
WL
(n5
17)
QO
L:
SF
-36
only
role
physic
aland
physic
al
functionin
gim
pro
ved
more
for
TC
than
WL*
Imm
une/inflam
mation:
varicella
zost
er
virus
cell–
media
ted
imm
unity
qm
ore
for
TC
than
WL*
Jin
109
96
(48/4
8),
TC
pra
ctitio
ners
,36.2
y
His
tory
of
TC
46.4
mo
male
s/3
4m
ofe
male
s2
sess
ions
of
exposure
to
str
ess
follo
wed
by
respective
treatm
ent
TC
long
form
or
Yang
sty
le
(n5
24)
BW
(n5
24),
TC
M
(n5
24),
and
NR
(n5
24)
Psy
cholo
gic
al:
Pro
file
of
Mood
Sta
tes
impro
ved
all
treatm
ents
*w
ith
sta
teanxie
ty
Qin
TC
more
than
readin
g*;
BP
and
HR
qunder
str
ess
for
TC
and
BW
more
than
Mand
NR
*;adre
nalin
eQ
more
for
TC
than
M*;
nora
dre
nalin
eq
more
for
TC
than
NR
*;saliv
ary
cort
isol
qall
gro
ups*
Judge
et
al.7
421
(0/2
1),
sedenta
ry,
68
y
6m
o(2
0m
inw
alk
ing
plu
s
oth
er
exerc
ise
33
d/w
k
for
TC
and
no
exerc
ise
for
12
wk,
then
30
min
31
d/w
kfo
rF
T)
TC
sim
ple
with
str
ength
train
ing
and
walk
ing
(n5
12)
FT
(n5
9)
Falls
and
bala
nce:
OLS
qm
ore
for
TC
than
FT
ns;
knee
exte
nsio
nq
more
for
TC
than
FT
*;sitting
leg
pre
ss
impro
ved
TC
and
FT
ns
July/August 2010, Vol. 24, No. 6 e9
Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.
Tab
le1,
Co
nti
nu
ed
So
urc
e
Su
bje
cts
:N
o.
(Male
/Fem
ale
),D
escri
pti
on
,M
ean
Ag
eE
xerc
ise
Du
rati
on
Exerc
ise
Gro
up
Co
ntr
ol
Gro
up
Rep
ort
ed
Ou
tco
mes
Kutn
er
et
al.9
7130
(?/?
),T
CB
Tand
contr
ol,
mostly
wom
en,
health
yold
er
adults
,
76.2
y
15
wk
(45
min
tota
l3
2
d/w
kT
Cand
1d/w
kB
T
and
ED
)
TC
10
modifie
dfo
rms
from
108
(n5
51)
BT
(n5
39)
and
ED
contr
ol(n
540)
QO
L:
SF
-36
all
gro
ups
nc
Self-e
ffic
acy
:self-
confidence
qm
ore
for
TC
and
BT
than
EC
*
Psycholo
gic
al:
Rosenberg
self-
este
em
qm
ore
TC
than
BT
or
EC
ns
Lansin
ger
et
al.6
4122
(36/8
6)
his
tory
of
long
term
nonsp
ecific
neck
pain
,43.8
y
3m
o(1
h3
1–2
d/w
k
310–12
sess
ions)
QG
Biy
un
(n5
60)
ET
(n5
62)
Physic
alfu
nct
ion:
grip
str
ength
and
cerv
ical
RO
Mq
both
gro
ups
ns
Patient-
report
ed
outc
om
es:
neck
pain
and
Neck
Dis
abili
tyIn
dex
Qboth
gro
ups
ns
Lee
et
al.4
4,1
01
36
(14/2
2),
his
tory
of
hypert
ensio
n,
53.4
y
8w
k(3
0m
in3
2d/w
k)
QG
Shuxin
pin
gxuegong
(n5
17)
WL
(n5
19)
Card
iopulm
onary
44:
(2004a)
BP
Qm
ore
in
QG
than
WL*;
HD
Land
AP
O-A
1q
more
inQ
Gth
an
WL*;
hig
h-d
ensity
lipopro
tein
and
apolip
opro
tein
A1
qand
tota
l
chole
ste
rol
Qin
QG
pre
-post*
;
trig
lycerides
Qin
QG
and
qin
WL
ns
Self-e
ffic
acy
101:
Self-e
ffic
acy
and
perc
eiv
ed
benefits
qin
QG
and
Qin
WL*
Psycholo
gic
al1
01:
em
otionalsta
teq
inQ
G
and
Qin
WL*
Lee
et
al.4
5,1
07
58
(not
report
ed),
his
tory
of
hypert
ensio
n,
56.2
y
10
wk
(30
min
33
d/w
k)
QG
Shuxin
pin
gxuegong
(n5
29)
UC
WL
(n5
29)
Card
iopulm
onary
107:
HR
Qm
ore
inQ
Gth
an
WL*;
epin
ephrine
and
nore
pin
ephrine
Qfo
rQ
Gand
qfo
rW
L*;
cort
isol
Qfo
rQ
G
and
qfo
rW
Lns
Psycholo
gic
al1
07:
Self-
report
str
essQ
QG
more
than
WL*;
epin
ephrine
and
nore
pin
ephrine
Qfo
rQ
Gand
qfo
rW
L*;
cort
isol
Qfo
rQ
Gand
qfo
rW
Lns
Card
iopulm
onary
45:
BP
and
cate
chola
min
es
Qfo
rQ
Gand
qfo
rU
C*;
ventila
tory
funct
ion
qm
ore
for
QG
than
UC
*
Lee
et
al.9
1139
(45/9
6),
resid
ent
of
care
facili
ty,
am
bula
tory
,
Chin
ese,
82.7
y
26
wk
(60
min
3
3d/w
k)
TC
(n5
66)
UC
(n5
73)
QO
L:
health
-rela
ted
QO
Lq
TC
more
than
UC
*
Psycholo
gic
alsym
pto
ms:
self-e
ste
em
qT
C
more
than
UC
*
Liet
al.3
348
(not
report
ed),
old
er
adults
,68.8
8y
3m
o(3
d/w
k)
TC
Yang
8-f
orm
easy
TC
(n5
26)
SC
(n5
22)
Falls
and
bala
nce:
OLS
impro
ved
TC
more
than
SC
*
Physic
alfu
nct
ion:
SF
-12
physic
al,
instr
um
enta
lactivitie
sof
daily
livin
g,
50-f
t
walk
,and
chair
rise
all
impro
ved
TC
more
than
SC
*
Psycholo
gic
al:
SF
-12
menta
lq
more
TC
than
SC
*
e10 American Journal of Health Promotion
Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.
Tab
le1,
Co
nti
nu
ed
So
urc
e
Su
bje
cts
:N
o.
(Male
/Fem
ale
),D
escri
pti
on
,M
ean
Ag
eE
xerc
ise
Du
rati
on
Exerc
ise
Gro
up
Co
ntr
ol
Gro
up
Rep
ort
ed
Ou
tco
mes
Liet
al.1
05
118
(22/9
6),
his
tory
of
modera
tesle
ep
com
pla
ints
and
com
munity
-dw
elli
ng
adults
,75.4
y
24
wk
(60
min
3
3d/w
k)
TC
Yang
(n5
62)
EC
(n5
56)
Physic
alf
unct
ion:O
LS
and
SF
-12
physic
alq
and
chair
rise
and
50-f
tw
alk
QT
Cm
ore
than
EC
*
Patie
nt-
report
ed
outc
om
es:
sleep
dura
tion
and
effic
iency
qand
sle
ep
qualit
y,la
tency
,
dura
tion,
and
dis
turb
ance
s,E
pw
ort
h
Sle
epin
ess
Sca
le,
and
Pitt
sburg
Sle
ep
Qualit
yIn
dex
Qm
ore
for
TC
than
EC
*;
sleep
dys
funct
ion
both
and
medic
atio
nQ
TC
only
ns
Psy
cholo
gic
al:
SF
-12
menta
lqboth
ns
Liet
al.7
5,9
9256
(77/1
79),
sedenta
ry
77.4
8y
6m
o(6
0m
in3
2d/w
k)
TC
Yang
sty
le24
form
s
(n5
125)
SC
(n5
131)
Falls
and
bala
nce
75:
few
er
falls
and
few
er
inju
rious
falls
for
TC
than
SC
*;and
BB
S,
Dynam
icG
ait
Index,
FR
,and
OLS
qand
50-f
tw
alk
and
TU
GQ
more
for
TC
than
SC
*all
susta
ined
at
6m
ofo
llow
-up
Falls
and
bala
nce
99:
activitie
s-s
pecific
bala
nce
qm
ore
for
TC
than
SC
*
Self-e
ffic
acy
99:
falls
self-
eff
icacyq
(media
tor)
and
fear
of
falli
ng
(SA
FF
E)
Qm
ore
for
TC
than
SC
*
Psycholo
gic
al:
fear
of
falli
ng
(SA
FF
E)
Qm
ore
for
TC
than
SC
*
Liet
al.6
8,7
0,9
2,1
12,1
23
6401
(9/8
5),
sedenta
ry,
72.8
y
6m
o(6
0m
in3
2d/w
k)
TC
Yang
sty
le24
form
s
(n5
49)
WL
(n5
45)
Physic
alfu
nct
ion
68:
SF
-20
physic
alfu
nct
ion
qam
ong
TC
more
than
WL
over
tim
e*
r
score
s
Self-e
ffic
acy
68:
self-e
ffic
acy
qam
ong
TC
more
than
WL
over
tim
e*
rscore
s
QO
L92:
SF
-20
(genera
lhealth
surv
ey)
qm
ore
for
TC
than
WL*;
TC
with
low
er
levels
of
health
perc
eption,
physic
al
funct
ion,
and
hig
hdepre
ssio
nat
baselin
e
and
move
ment
confidence
q5
qphysic
alfu
nction*
Psycholo
gic
al1
12:
Physic
alfu
nction
self-
este
em
and
Rosenberg
self-
este
em
qm
ore
for
TC
than
WL*
Self-e
ffic
acy
123:barr
ier
and
perf
orm
ance
self-
eff
icacy
qT
Cm
ore
than
WL*;
exerc
ise
adhere
nce
qT
Cth
an
WL*;
and
SE
conditio
ns
rela
ted
toadhere
nce
for
TC
Macia
szek
et
al.7
649
(49/0
),se
denta
ry,
his
tory
of
ost
eopenia
or
ost
eoporo
sis,
70.2
y
18
wk
(45
min
3
2d/w
k)
TC
24
form
(n5
25)
UC
(n5
24)
Falls
and
bala
nce:
Postu
rogra
phic
Pla
tform
(tim
eQ
;%
task
perf
orm
ance
and
tota
l
length
of
path
qfo
rT
C*;
and
%ta
sk
perf
orm
ance
and
tota
lle
ngth
of
path
qm
ore
for
TC
than
UC
*
July/August 2010, Vol. 24, No. 6 e11
Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.
Tab
le1,
Co
nti
nu
ed
So
urc
e
Su
bje
cts
:N
o.
(Male
/Fem
ale
),D
escri
pti
on
,M
ean
Ag
eE
xerc
ise
Du
rati
on
Exerc
ise
Gro
up
Co
ntr
ol
Gro
up
Rep
ort
ed
Ou
tco
mes
Mannerk
orp
iand
Arn
dorw
69
36
(0/3
6),
his
tory
of
fibro
myalg
ia,
45
y
3m
o(2
0m
in3
1d/w
k)
QG
with
Body
Aw
are
ness
(n5
19)
UC
(n5
17)
Physic
alfu
nction:
chair
sta
nd
and
hand
grip
TC
and
UC
ns
Patient-
report
ed
outc
om
es:
body
aw
are
ness
qT
Cm
ore
than
UC
*;fibro
myalg
ia
sym
pto
ms
TC
and
UC
ns
Manzaneque
et
al.1
13
29
(14/1
5),
healthy
young
adults
,18–21
y
1m
o(3
0m
in3
5d/w
k)
QG
Eig
ht
Pie
ces
of
Bro
cade
(low
inte
nsity)
(n5
16)
UC
(n5
13)
Imm
une/in
flam
matio
n:le
uko
cyte
s,
eoso
inophils
,m
onocy
tes,
and
C3
leve
lsQ
TC
than
UC
*;tr
end
for
neutr
ophils
;to
tal
lym
phocy
tes,
Tly
mphocy
tes,
thelp
er
lym
phocy
tes,
conce
ntr
atio
ns
ofco
mple
ment
C4
or
imm
unoglo
bulin
sns
McG
ibbon
et
al.
85
36
(16/2
0),
his
tory
of
vest
ibulo
path
y,
59.5
y
10
wk
(70
min
3
1d/w
k)
TC
Yang
(n5
19)
VR
(n5
17)
Falls
and
bala
nce
:gait
speed
qT
Cm
ore
than
VR
*;st
ep
length
qfo
rT
Cand
VR
*;st
ance
dura
tion
QV
R*
more
than
TC
;ste
pw
idth
qV
Rand
TC
ns:
mech
anic
alenerg
y
exp
enditu
re(h
ipQ
TC
more
than
VR
*;ankl
e
qm
ore
for
TC
than
VR
*;kn
ee
and
leg
both
ns)
;peak
trunk
forw
ard
velo
city
qT
Cm
ore
than
VR
*;fo
rward
velo
city
range
and
peak
or
range
ofla
tera
ltr
unk
velo
city
TC
and
VR
ns;
peak
trunk
angula
rve
loci
tyq
more
for
VR
than
TC
*;tr
unk
angula
rve
loci
tyin
fronta
l
pla
ne
and
change
inpeak
and
range
TC
and
VR
ns;
trunk
velo
city
peak
and
range
posi
tively
corr
ela
ted
with
change
inle
g
mech
anic
alenerg
yexp
enditu
refo
rT
C*
and
VR
negativ
ere
latio
nsh
ip
McG
ibbon
et
al.8
6
26
(11/1
5),
his
tory
of
vestibulo
path
y,
56.2
y
10
wk
(70
min
3
1d/w
k)
TC
Yang
(n5
13)
VR
(n5
13)
Falls
and
bala
nce:
gaze
sta
bili
tyq
more
for
VR
than
TC
*;w
hole
-body
sta
bili
tyand
foot
fall
sta
bili
tyq
more
for
TC
than
VR
*;
corr
ela
tion
betw
een
change
ingaze
sta
bili
tyand
whole
-body
sta
bili
ty,and
foot-
fall
sta
bili
tyand
gaze
sta
bili
tyfo
rV
Rnot
TC
*;corr
ela
tion
betw
een
foot-
fall
sta
bili
ty
and
whole
-body
sta
bili
tyfo
rV
Rand
TC
*
Motivala
et
al.5
032
(14/1
8),
out
of
63
who
com
ple
ted
RC
T
for
herp
es
zoste
rrisk
in
agin
gstu
dy,
68.5
y
37
wk
TC
(?m
in3
1d/w
k)
TC
Chih
(n5
19)
PR
and
slo
w
movi
ng
physic
al
move
ment
(n5
13)
Card
iopulm
onary
:pre
-eje
ctio
nperiod
qpost
task
more
for
TC
than
PR
*;B
Pand
HR
TC
and
PR
ns
Mustian
et
al.5
6,9
3
21
(0/2
1),
his
tory
of
bre
ast
cancer
52
y
12
wk
(60
min
3
3d/w
k)
TC
Yang
and
Chi
Kung
(n5
11)
PS
(n5
10)
Card
iopulm
onary
56:
6-m
inw
alk
qfo
rT
Cand
Qfo
rP
S*;
aero
bic
capaci
tyq
forT
Cand
Qfo
rP
Sns
Physic
alfu
nction
56:
(2006)
muscle
str
ength
(hand
grip
qfo
rT
Cand
Qfo
rP
S*)
;and
flexi
bili
ty(a
bductio
nq
TC
and
PS
,flexi
on,
exte
nsio
n,
horizo
nta
ladduction
and
abduction
qm
ore
for
TC
than
PS
*;and
body
fat
mass
Qfo
rT
Cand
qfo
rP
Sns
e12 American Journal of Health Promotion
Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.
Tab
le1,
Co
nti
nu
ed
So
urc
e
Su
bje
cts
:N
o.
(Male
/Fem
ale
),D
escri
pti
on
,M
ean
Ag
eE
xerc
ise
Du
rati
on
Exerc
ise
Gro
up
Co
ntr
ol
Gro
up
Rep
ort
ed
Ou
tco
mes
QO
L93:
health
-rela
ted
QO
Lq
for
TC
*and
QP
Sns
Psycholo
gic
al9
3:
Self-
este
em
qfo
rT
Cand
Qfo
rP
S*
Now
alk
et
al.
84
110
(15/9
5),
long
term
care
resid
ents
,84
y
13–28
mo
(3d/w
k)
TC
with
behavio
ral
com
ponent
(n5
38)
Physic
alth
era
py
weig
ht
train
ing
(n5
37)
and
ED
Contr
ol(n
535)
Falls
and
bala
nce:fa
llsno
diffe
rence
betw
een
gro
ups
Pip
pa
et
al.
54
43
(30/1
3),
his
tory
of
sta
ble
chro
nic
atr
ialfibrilla
tion,
68
y
16
wk
(90
min
3
2d/w
k)
QG
(n5
22)
WL
contr
ol
(n5
21)
Card
iopulm
onary
:6-m
inw
alk
qfo
rQ
Gand
Qfo
rW
L*;
Eje
ction
fraction,
BM
I,
chole
stero
lns
Satt
inet
al.7
7311
(20/2
91),
transi
tionally
frail
with
his
tory
of1
or
more
falls
inpast
year
(55
Afric
an
Am
erica
ns)
,80.1
y
48
wk
(60–90
min
32
d/w
k)
TC
6of
24
Sim
plif
ied
(n5
158)
WE
(n5
153)
Falls
and
bala
nce:
activiti
es-s
pecifi
cbala
nce
qm
ore
am
ong
TC
than
WE
*
Psycholo
gic
al:
Falls
Eff
icacy
Sca
leQ
more
am
ong
TC
than
WE
*
Shen
et
al.4
228
(7/2
1),
sedenta
ryfr
om
asenio
rliv
ing
facili
ty,
79.1
y
24
wk
(40
min
3
3d/w
k)
TC
Yang
Sty
le
Sim
plif
ied
24
form
s
(n5
14)
RT
(n5
14)
Bone
densi
ty:sedenta
ryold
er
adults
on
bone
meta
bolis
m(s
eru
mbone-s
pecific
alk
alin
e
phosp
hata
se/u
rinary
pyridin
olin
e)
qm
ore
for
TC
than
RT
at6
wk*
and
TC
retu
rned
to
baselin
eand
RT
less
than
baselin
e*;
para
thyro
idhorm
one
qm
ore
for
TC
than
RT
at
12
wk*;
seru
m1,2
5-v
itam
inD
3T
C
and
RT
ns;
seru
mcalc
ium
qm
ore
for
TC
than
RT
at
12
wk
com
pare
dto
6w
k*;
urinary
calc
ium
Qfo
rT
C*
not
RT
;seru
m
and
urinary
PiT
Cand
RT
ns
Song
et
al.5
9,1
04
43
(0/7
2),
his
tory
of
oste
oart
hritis
and
no
exerc
ise
for
1y
prior,
63
y
12
wk
(60
min
3
3d/w
kfo
r2
wk
then
31
d/w
kfo
r10
wk)
TC
Sun
Sty
lem
odifie
d
for
art
hritics
(n5
22)
UC
(n5
21)
Card
iopulm
onary
59:
BM
I,13-m
inerg
om
ete
r
TC
and
UC
ns
Falls
and
bala
nce
59:
OLS
,tr
unk
flexio
nand
sit-u
ps
qm
ore
for
TC
than
UC
*;flexib
ility
and
knee
str
ength
TC
and
UC
ns
Patient-
report
ed
outc
om
es
104:
pain
and
stiff
ness
Qand
perc
eiv
ed
benefits
qm
ore
for
TC
than
UC
*;T
Cperf
orm
ed
more
health
behavio
rsth
an
UC
*
Ste
nlu
nd
et
al.8
295
(66/2
9),
his
tory
of
coro
nary
art
ery
dis
ease
,77.5
y
12
wk
(60
min
QG
and
120
min
dis
cussi
on
on
various
them
es)
QG
(TC
&M
edic
insk
QG
)(n
548)
UC
(n5
47)
Falls
and
bala
nce:
Falls
Eff
icacy
Scale
,
tandem
sta
ndin
g,O
LS
left
,clim
bboxes
left
TC
and
UC
ns;
OLS
right
and
clim
bboxes
right
qm
ore
for
TC
than
UC
*;and
coord
ination
Qm
ore
for
UC
than
TC
*;and
self-r
eport
ed
activity
level
qfo
rT
Cm
ore
than
UC
*
Pyscholo
gic
al:
fear
of
falli
ng
betw
een
TC
and
UC
ns
July/August 2010, Vol. 24, No. 6 e13
Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.
Tab
le1,
Co
nti
nu
ed
So
urc
e
Su
bje
cts
:N
o.
(Male
/Fem
ale
),D
escri
pti
on
,M
ean
Ag
eE
xerc
ise
Du
rati
on
Exerc
ise
Gro
up
Co
ntr
ol
Gro
up
Rep
ort
ed
Ou
tco
mes
Thom
as
et
al.
52
207
(113/9
4),
healthy,
com
munity-d
welli
ng,
68.8
y
12
mo
(60
min
33
d/w
k)
TC
Yang
sty
le24
form
s(n
564)
PS
(n5
65)
or
UC
(n5
78)
Card
iopulm
onary
:energ
yexpenditu
req
for
TC
and
RT
more
than
UC
ns;
wais
t
circum
fere
nce
and
HR
Qm
ore
TC
and
RT
than
UC
ns;
insulin
sensiti
vity
Qm
ore
for
RT
than
UC
*and
more
for
TC
than
UC
ns;
BM
I,body
fat,
BP
,chole
ste
rol,
and
glu
cose
TC
,R
T,
and
UC
ns
Tsaiet
al.
46
76
(38/3
8),
sedenta
ry
with
pre
hypert
ensio
n
or
sta
ge
I,52
y
12
wk
(50
min
33
d/w
k)
TC
Yang
(n5
37)
UC
(n5
39)
Card
iopulm
onary
:B
Pand
tota
lchole
stero
lQ
for
TC
*and
qfo
rU
Cns;
BM
Iand
HR
TC
and
UC
ns;tr
igly
ceride
QT
C*
and
qU
C*;
LD
LQ
TC
*and
qU
Cns;
hig
h-d
ensity
lipopro
tein
qT
C*
and
QU
Cns
Psycholo
gic
al:
trait
and
sta
teanxie
tyQ
TC
*more
than
UC
ns
Tsang
et
al.9
582
(16/6
6),
his
tory
of
depre
ssio
nand
chro
nic
illness,
82.4
y
16
wk
(30–45
min
33
d/w
k)
QG
Baduanjin
(n5
48)
NR
gro
up
with
sam
e
inte
nsity
(n5
34)
QO
L:
pers
onalw
ell-
bein
gq
for
QG
and
QN
R*;
genera
lhealth
questionnaire
G
and
qN
R*;
and
self-c
oncept
Qm
ore
TC
than
NR
*
Self-e
ffic
acy:
Chin
ese
Genera
lS
elf-E
ffic
acy
and
Perc
eiv
ed
Benefits
Questionnaire
qm
ore
for
QG
than
NR
*
Psycholo
gic
al:
Geriatr
icD
epre
ssio
nS
cale
Qm
ore
for
QG
than
NR
*
Tsang
et
al.9
450
(26/2
4),
his
tory
of
chro
nic
dis
ease,
74.6
y
12
wk
(60
min
32
d/w
k)
QG
Eig
ht-
Sectio
nB
rocades
(n5
24)
BR
activ
itie
s(n
526)
QO
L:
physic
alhealth
,activ
itie
sof
daily
livin
g
psycholo
gic
alhealth
and
socia
l
rela
tionship
sim
pro
ved
for
QG
*;self-
concept
and
WH
OQ
OL-B
RE
FQ
Gand
BR
ns
Psycholo
gic
al:
Geriatr
icD
epre
ssio
nS
cale
QT
Cand
BR
ns
Tsang
et
al.7
238
(8/3
0),
sedenta
ry,
com
munity-d
welli
ng,
type
2dia
betics,
65.4
y
16
wk
(45
min
32
d/w
k)
TC
for
dia
bete
s(1
2-
movem
ent
hybrid
from
Yang
and
Sun)
(n5
17)
Sham
exerc
ise
(seate
d
calis
thenic
s
and
str
etc
hin
g)
(n5
20)
Physic
alfu
nct
ion:
6-m
inw
alk
,habitualand
maxi
malgait
speed,
muscle
str
ength
,and
peak
pow
er
qT
Cm
ore
than
SE
ns;
endura
nce
Qm
ore
for
SE
than
TC
ns;and
habitu
alp
hysic
ala
ctiv
ity
qT
Cand
QS
E*
Falls
and
bala
nce:
bala
nce
index
QT
Cand
SE
ns;
OLS
open
qT
Cand
nc
SE
ns;
OLS
clo
sed
and
tandem
walk
QT
Cand
SE
ns;
Falls
0–2
TC
and
SE
ns
QO
L:
SF
-36
(exce
pt
Socia
lF
unction
qfo
r
TC
and
QS
E*)
and
Dia
bete
sIn
tegra
tion
Scale
TC
and
SE
ns
e14 American Journal of Health Promotion
Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.
Tab
le1,
Co
nti
nu
ed
So
urc
e
Su
bje
cts
:N
o.
(Male
/Fem
ale
),D
escri
pti
on
,M
ean
Ag
eE
xerc
ise
Du
rati
on
Exerc
ise
Gro
up
Co
ntr
ol
Gro
up
Rep
ort
ed
Ou
tco
mes
Voukela
tos
et
al.7
8
702
(112/5
90)
com
munity
dw
elli
ng,
69
y
16
wk
(60
min
31
d/w
k)
TC
38
pro
gra
ms
most
ly
Sun-s
tyle
(83%
)Y
ang
(3%
)(n
5271)
WL
(n5
256)
Falls
and
bala
nce:
sw
ay
on
floor
and
foam
mat,
late
ralsta
bili
ty,
coord
inate
dsta
bili
ty,
and
choic
este
ppin
gre
action
tim
e
impro
ved
TC
more
than
WL*;
maxim
al
leanin
gbala
nce
range
qT
Cm
ore
than
WL
ns;fa
llra
tes
less
for
TC
(n5
347)
than
WL
(n5
337)*
Wang
et
al.7
120
(5/1
5),
com
munity-
dw
elli
ng
with
rheum
ato
id
art
hritis
cla
ss
Ior
II,
49.5
y
12
wk
(60
min
32
d/w
k)
TC
Yang
sty
le(n
510)
Str
etc
hin
gand
WE
(n5
10)
Physic
alfu
nct
ion:
chair
sta
nd
and
50-f
tw
alk
qT
Cand
WE
ns;
Am
erican
Colle
ge
of
Rheum
ato
logy
20
QT
Cm
ore
than
WE
*;
hand
grip
notre
port
ed;H
ealth
Assess
ment
Questionnaire
qm
ore
TC
than
WE
*;E
SR
and
C-r
eactive
pro
tein
ns
QO
L:
SF
-36
qm
ore
TC
than
WE
with
only
vitalit
y*
Patient-
report
ed
outc
om
es:
pain
QT
Cand
qW
Ens
Psycholo
gic
al:
Cente
rfo
rE
pid
em
iolo
gic
al
Stu
die
sD
epre
ssio
nS
cale
qm
ore
TC
than
WE
*
Imm
une/infla
mm
ation:
ES
Rand
C-r
eact
ive
pro
tein
ns
(note
TC
hig
her
levelat
baselin
e)
Wenneberg
et
al.5
8
36
(19/1
7),
his
tory
of
musc
ula
rdystr
ophy,
55.3
y
12
wk
(weekend
imm
ers
ion,
then
45–50
min
31
d/w
k
for
4w
k,
then
every
oth
er
week
for
8w
k)
QG
(n5
16)
WL
contr
ol(n
515)
Card
iopulm
onary
:F
orc
ed
vitalcapacity
and
expirato
ryvolu
me
Gand
WL
ns
Falls
and
bala
nce:
BB
Sunchanged
for
QG
and
QW
Lns
for
inte
rvention
period;
subgro
up
A
QO
L:S
F-3
6genera
lhealth
unch
anged
for
QG
and
QW
L*
and
oth
er
dim
ensi
ons
ns;
Ways
of
Copin
gposi
tive
reappra
isalco
pin
gQ
for
QG
and
unch
anged
for
WL,*
confr
onta
tive
copin
gq
QG
and
QW
Lns,
and
oth
er
dim
ensi
ons
ns
Psycholo
gic
al:
Montg
om
ery
Asb
erg
Depre
ssio
nR
ating
Sca
leQ
Gand
WL
ns
Win
sm
ann
106
47
(47/0
),vete
rans.
49.5
5y
4w
k(7
5m
in3
2d/w
k)
TC
Chuan
Yang
Sty
le
(n5
23)
UC
inclu
ded
gro
up
thera
py
(n5
24)
Patient-
report
ed
outc
om
es:
Dis
socia
tive
Exp
eriences
and
Sym
pto
mC
hecklis
t90
QT
Cm
ore
than
UC
ns
Wolf
et
al.
47
311
(20/2
91),
transi
tionally
frail
with
ave
rage
of5.6
com
orb
iditi
es,
80.9
y
48
wk
(60–90
min
3
2d/w
k)
TC
6of
24
sim
plif
ied
form
s(n
5158)
WE
(n5
153)
Card
iopulm
onary
:B
MI
QT
Cand
qW
E*;
SB
Pand
HR
QT
Cand
qW
E*;
DB
PQ
TC
more
than
WE
*
Phys
icalfu
nct
ion:
gait
speed
and
FR
qT
C
and
WE
ns;
chair
stands
Q12.3
%T
Cand
q13.7
%W
E*;
360u
turn
and
pic
kup
obje
ct
sim
ilar
change
TC
and
WE
ns;
OLS
nc
July/August 2010, Vol. 24, No. 6 e15
Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.
Tab
le1,
Co
nti
nu
ed
So
urc
e
Su
bje
cts
:N
o.
(Male
/Fem
ale
),D
escri
pti
on
,M
ean
Ag
eE
xerc
ise
Du
rati
on
Exerc
ise
Gro
up
Co
ntr
ol
Gro
up
Rep
ort
ed
Ou
tco
mes
Wolf
et
al.
79
286
(17/2
69),
transitio
nally
frail
with
avera
ge
of
5.6
com
orb
iditie
s,
80.9
y
48
wk
(60–90
min
32
d/w
k)
TC
6of
24
sim
plif
ied
form
s(n
5145)
WE
(n5
141)
Falls
and
bala
nce:
TC
low
er
risk
for
falls
from
mo
4to
12;R
Rfa
llsT
Cand
WE
0.7
5(C
I5
0.5
2–1.0
8)
ns
Wolf
et
al.
80
72
(12/6
0),
sedenta
ry,
77.7
y
15
wk
(60
min
3
2d/w
kT
Cgro
up)
TC
108
form
ssim
plif
ied
to10
form
s(n
519)
BT
(n5
16)
and
ED
contr
ol(n
519)
Falls
and
bala
nce:
bala
nce:
dis
pers
ion
for
OLS
(eyes
open),
toes
up
(eyes
open
and
clo
sed),
cente
rof
bala
nce
Xw
ith
toes
up
(eyes
open)
and
cente
rof
bala
nce
Y(O
LS
eyes
open
and
clo
sed)
Qm
ore
BT
than
ED
and
TC
*;dis
pers
ion
for
toes
up
(eye
s
open),
cente
rofbala
nce
XO
LS
(eye
sopen
and
clo
sed)
and
toes
up
(eyes
close
d),
and
cente
rofbala
nce
Yfo
rto
es
up
(eyes
open
and
clo
sed)
TC
,B
T,and
ED
ns
Psycholo
gic
al:
fear
of
falli
ng
Qm
ore
for
TC
than
BT
and
ED
*
Wolf
et
al.
49
200
(39/1
61),
com
munity
-
dw
elli
ng,
76.2
y
15
wk
(45
min
31
d/w
kin
cla
ss
plu
s
15
min
23
daily
)
TC
(n5
72)
BT
(n5
64)
and
ED
contr
ol
(n5
64)
Card
iopulm
onary
:B
PQ
more
for
TC
than
BT
and
ED
*;12-m
inw
alk
q0.0
1m
ilefo
rB
T
and
ED
and
Q0.0
2fo
rT
C*;
body
com
posi
tion
changes
forT
C,B
Tand
ED
ns
Physic
alfu
nct
ion:
left
hand
grip
str
ength
Qm
ore
inB
Tand
ED
than
TC
*;str
ength
of
hip
,knee
and
ankle
via
Nic
hola
sM
MT
0116
muscle
teste
r,lo
wer
extr
em
ity
RO
M
changes
TC
,B
T,
and
ED
ns
Falls
and
bala
nce:
intr
usiv
enessQ
more
for
TC
than
ED
ns;R
Rfo
rfa
llsin
TC
0.6
32
(CI
0.4
5–0.8
9)*
usin
gF
ICS
ITfa
lldefinitio
n;fo
r
BT
and
oth
er
fall
definitio
ns
ns
Psycholo
gic
al:
fear
of
falli
ng
Qm
ore
for
TC
than
BT
and
ED
*
Woo
et
al.4
3180
(90/9
0),
com
munity-
dw
elli
ng,
68.9
1y
12
mo
(?m
in3
3d/w
k)
TC
Yang
sty
le24
form
s(n
558)
RT
(n5
59)
and
UC
(n5
59)
Falls
and
bala
nce:
musc
lestr
ength
(grip
str
ength
and
quadriceps)
ns;
bala
nce
(SM
AR
TB
ala
nce
Maste
r,sta
nce
tim
e,gait
velo
city
,and
bend
reach)
and
falls
for
TC
,
RT
and
UC
ns
Bone
densi
ty:
wom
en:
BM
Dlo
ss
at
hip
less
for
TC
and
RT
than
UC
*;B
MD
loss
at
spin
ele
ss
for
TC
and
RT
than
UC
ns;m
en:
no
diffe
rence
in%
change
inB
MD
Yang
et
al.8
349
(10/3
9),
health
yadults,
80.4
y
6m
o(6
0m
in3
3d/w
k)
QG
(sitting
and
sta
ndin
g)
and
Taiji
Chen
sty
le
Ess
entia
l48
form
(n5
33)
WL
(n5
16)
Falls
and
bala
nce:S
ensory
Org
aniz
ation
Test
vestibula
rra
tios
and
base
of
support
measure
sq
more
for
TC
than
WL*q
;
Senso
ryO
rganiz
ation
Test
vis
ualra
tios
and
feet
openin
gangle
for
TC
and
WL
nc
e16 American Journal of Health Promotion
Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.
Tab
le1,
Co
nti
nu
ed
So
urc
e
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July/August 2010, Vol. 24, No. 6 e17
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Physical Function
Decreased physical activity is relatedto declining physical function in allpopulations, and that decline is com-pounded by the natural process ofaging.62,63 Changes in physical functionwere assessed in 16 studies (Qigong, n5 2; Tai Chi, n 5 14). Most of thestudies were conducted with olderadults (i.e., studies in which mean age5 55 years or older, n 5 13) andseveral recruited specifically for partic-ipants with chronic pain (e.g., osteo-arthritis, neck pain, or fibromyalgia, n5 5). A number of behavioral mea-sures of physical function performancewere included in this category ofoutcomes, which also includes self-reported responses on scales repre-senting physical function. Althoughfitness outcomes, such as the 6-minutewalk test, might also be seen asassessing overall physical function, wedid not include tests already discussedin the cardiopulmonary fitness catego-ry, but rather focused on functionaltests that are usually used to assesscapacity for daily living. Studies thatassessed changes in overall physicalactivity levels are also included as anoutcome pertaining to physical func-tion.
Physical function measured with awide variety of performance indica-tors, including chair rise, 50-ft walk,gait speed, muscle contractionstrength, hand grip, flexibility, andfunction as measured on the WesternOntario and McMaster UniversitiesOsteoarthritis Index (an osteoarthritis-specific assessment for function, stiff-ness, and pain), were variously foundto be significantly improved in fivestudies comparing Tai Chi to minimalactivity (usual or stretching activity,psychosocial support, or education)comparison groups56,64–66 and onestudy of Tai Chi compared to anexercise therapy control interven-tion.64 One of these studies combinedfunctional walking with Tai Chi toachieve significant improvements withprefrail elders compared to usualcare.30
In contrast, in seven studies includ-ing participants with osteoarthritis ormultiple comorbidities, some of thephysical function measures were notsignificantly different for Tai Chi orQigong in comparison to inactive
controls. This was the case for gaitspeed,47 timed up and go, 50-ft walkand stair climb31 and 50-ft walk andchair stand.67,68 In one study of 30patients with osteoarthritis practicingTai Chi twice per week67 and anotherwith 36 participants with fibromyalgiathat utilized hand grip and chair standto test a 20-minutes-per-week Qigongintervention,69 neither achieved signif-icant improvements compared to usualcare. In one exception to this trend,one measure of functional perfor-mance, time to complete chair rise, wassignificantly improved in transitionallyfrail elders in the Tai Chi groupcompared to a wellness educationcontrol group.47
Studies using self-report measuresconsistently show positive results forTai Chi. Self-reported improvement inphysical function for sedentary olderadults was demonstrated for Tai Chicompared to wait-list controls68,70 and astretching exercise control.33
Results in this category of outcomesare inconsistent, with a preponderanceof studies recruiting sedentary orchronically ill or frail elder partici-pants. Even so, a handful of thesestudies successfully demonstrated po-tential for Qigong and Tai Chi to buildperformance, even with health-com-promised individuals. Further studiesare needed to examine the factors thatare important to more critically evalu-ate these interventions (such as powerconsiderations or dose and frequencyof the interventions), or learn if thereare particular states of ill health thatare less likely to respond to this form ofexercise.
Falls and Balance
Another large grouping of studiesfocused primarily on falls prevention,balance, and physical function testsrelated to falls and balance (such asone-leg stance). Although there maybe some crossover of implied benefitsto the more general physical functionmeasures reported above, this separatecategory was established to report onthe studies of interventions primarilytargeting falls and related measures.Fear of falling is reported with thepsychological outcomes and falls self-efficacy is reported in the self-efficacyoutcomes rather than in this categoryof falls and balance.
Outcomes related to falls such asbalance, fall rates, and improvedstrength and flexibility were reportedin 24 articles (Qigong, n 5 2; Tai Chi,n 5 20; and two studies that includedboth practices). Scores directly assess-ing balance (such as one-leg stance) orother closely related measures wereconsistently, significantly improved in16 Tai Chi studies that included onlyparticipants who were sedentary ordeemed at risk for falls at base-line.33,43,49,53,59,65,71–81
Qigong has been less studied inrelationship to balance-related out-comes; however, results suggest thatthere was a trend to maintain balanceusing Qigong in a population ofpatients with muscular dystrophy.58 Intwo studies that used both Qigong andTai Chi, several measures of balancewere significantly improved with sed-entary women82 and with elderlyhealthy adults (mean age 80.4 years)compared to wait list controls.83
Another set of studies shows theeffect of Tai Chi on balance to besimilar to that of conventional exerciseor physical therapy control interven-tions aimed at improving physicalfunction related to balance53,72,84 orvestibular rehabilitation.85,86 On theother hand, in a study of strokesurvivors comparing Tai Chi to balanceexercises, significant improvements inbalance were achieved in the exercisecontrol group, but not for Tai Chi.87
Although knee extension was signifi-cantly improved, balance was not im-proved significantly in a Tai Chiintervention with sedentary womencompared to a flexibility training con-trol group.74
Mechanisms of gait performance,which are important to understandinghow Tai Chi affects balance, were alsostudied. Reported improvements werefound in four studies.80,85,86,88 Strengthand flexibility are also important to fallprevention. Four studies found signif-icant improvements in these factorswhen Tai Chi was compared to anactive control (brisk walking)33,53,59,73,81
or inactive controls.59,73,81
Eight studies directly monitored fallrates. Studies that incorporate educa-tional or less active control interven-tions (e.g., stretching) variously dem-onstrated significant falls reduction forTai Chi30,75,78,79 or nonsignificant re-
e18 American Journal of Health Promotion
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ductions compared to control.43,49 In astudy comparing Tai Chi to an activephysical therapy intervention designedto improve balance, results were simi-lar (nonsignificant differences) be-tween the two groups.84 The results aredifficult to interpret because someparticipants may fall more becausetheir level of activity has increased andsome interventions are not monitoredlong enough to detect changes in fallrates.73
This category of outcomes has alarge body of research supporting theefficacy of Tai Chi on improvingfactors related to falls, and growingevidence that falls may be reduced.Longer-term studies to examine fallrates, and parallel studies that utilizeQigong as the intervention, may fur-ther clarify the potential of theseforms of exercise to affect falls andbalance.
Quality of Life
QOL outcomes were reported in 17articles (Qigong, n 5 4; Tai Chi, n 5
13). QOL is a broad-ranging conceptderived in a complex process frommeasures of a person’s perceivedphysical health, psychological state,personal beliefs, social relationships,and relationship to relevant features ofthe person’s environment.89 In 13studies of a wide range of participants(including healthy adults, patients withcancer, poststroke patients, patientswith arthritis, etc.) at least one of thecomponents of QOL was reported tobe significantly improved by Tai Chicompared to inactive34,66,67,71,90–93 oractive controls,87 and by Qigong com-pared to inactive94,95 or active controlgroups.72 Qigong also showed im-provements in QOL compared to anexercise intervention, but not signifi-cantly so.72
Conversely, two studies reported nochange in QOL, both with severelyhealth-compromised individuals. Onewas of short duration (6 weeks),conducted with patients with traumaticbrain injury.96 Some improvement incoping was shown with muscular dys-trophy patients in response to a Qi-gong intervention58; however, thisfinding was not significant, and directQOL measures remained unchanged.One study reported no change in QOLwhen Tai Chi was compared to balance
training and an education controlamong healthy older adults.97
With a few exceptions, the prepon-derance of studies indicate that Qi-gong and Tai Chi hold great potentialfor improving QOL in both healthyand chronically ill patients.
Self-Efficacy
Self-efficacy is the confidence aperson feels in performing one orseveral behaviors and the perceivedability to overcome the barriers associ-ated with the performance of thosebehaviors.98 Although this is not ahealth outcome itself, it is often asso-ciated directly with health behaviorsand benefits (e.g., falls self-efficacyassociated with reduced falls) or withpsychological health. Significant im-provements in this outcome werereported in eight studies (Qigong, n 5
2; Tai Chi, n 5 6). Self-efficacy wasgenerally assessed in the RCTs as asecondary outcome and reflected the‘‘problem’’ area under investigation,such as falls self-efficacy (i.e., feelingconfident that one will not fall) orefficacy to manage a disease (arthritis,fibromyalgia) or symptom (pain). Self-efficacy for falls was significantly in-creased as a result of participation inTai Chi in three studies with adults atrisk for falls compared to wait-list orusual-care, sedentary controlgroups.68,73,99,123 In studies with clinicalpopulations, persons with arthritis ex-perienced improvements in arthritisself-efficacy67 and fibromyalgia patientsexperienced improvements in theability to manage pain100 after partici-pating in Tai Chi as compared toinactive control groups that providedsocial interaction (telephone calls andrelaxation therapy, respectively). Last-ly, the perceived ability to handle stressor novel experiences95,101 and exerciseself-efficacy97,101 were enhanced rela-tive to inactive control groups as afunction of participation in Qigong orTai Chi.
Patient-Reported Outcomes
PROs include reports of symptomsrelated to disease as perceived by thepatient. The definition of PROs as ‘‘ameasurement of any aspect of a pa-tient’s health status that comes directlyfrom the patient, without the inter-pretation of the patient’s responses bya physician or anyone else,’’102 has
developed over the past decade as animportant indicator of treatment out-comes that matter to the patient,including an array of symptoms such aspain, fatigue, and nausea. AlthoughPRO lists often include factors such asanxiety and depression, these are notincluded here, but rather in a separatesection to address a range of psycho-logical effects.
Thirteen studies are included in thiscategory (Qigong, n 5 3; Tai Chi, n 5
10). Arthritic pain31,71,103,104 decreasedsignificantly in response to Tai Chicompared to inactive (health educa-tion or usual-care) controls. Self-re-ported neck pain and disability64 im-proved to a similar degree for Qigongand an exercise comparison interven-tion, but the difference betweengroups was not significant. Fibromyal-gia symptoms improved significantly inone study comparing Tai Chi to arelaxation intervention,100 whereas an-other study reported slight improve-ments in symptoms for both Qigongand a usual-care control group with nosignificant difference between thegroups.69 Perceived symptoms of heartfailure,55 disability,30 and sickness im-pact scores32 decreased in response toTai Chi interventions as compared toinactive controls (either usual care oreducational interventions) and sleepquality improved for Tai Chi even ascompared to an exercise interven-tion.105 With Tai Chi, dissociative ex-periences and symptoms improvedclinically, but were not statisticallydifferent from gains achieved by asupport group among male veterans.106
Parkinson’s disease symptoms and dis-ability were not significantly changedfollowing a 7-week session of Qigongcompared to aerobic trainingsessions.57
With the wide range of symptomsand irregular outcomes of these PROsstudies, it is difficult to draw meaning-ful conclusions about this category.Pain consistently responded to Tai Chiin four studies, but other symptomswere not uniformly assessed.
Psychological
Twenty-seven articles (Qigong, n 5
7; Tai Chi, n 5 19; and one study usingboth Qigong and Tai Chi) reported onpsychological factors such as anxiety,depression, stress, mood, fear of fall-
July/August 2010, Vol. 24, No. 6 e19
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ing, and self-esteem. Most of thesestudies examined psychological factorsas secondary goals of the study, andconsequently, they often did not in-tentionally recruit participants withappreciable psychological distress.Nevertheless, a number of substantialfindings dominate this category.
Anxiety decreased significantly forparticipants practicing Qigong com-pared to an active exercisegroup.28,46,107 Depression was shown toimprove significantly in studies com-paring Qigong to an inactive control,newspaper reading,95 and for Tai Chicompared to usual-care, psychosocialsupport, or stretching/education con-trols.56,71,108 General measures of mood(e.g., Profile of Mood States) wereimproved significantly for participantspracticing Tai Chi compared to usual-care controls.66,96,101,109
Depression improved, but not sig-nificantly, for both Qigong and exer-cise comparison groups28,94 and for TaiChi compared to an educational in-tervention.110 One study reported im-proved depression, anxiety, and stressamong patients with osteoarthritis forboth Tai Chi and hydrotherapy groupscompared to a wait-list control, butonly significantly so for hydrotherapy.31
Nonsignificant changes in anxietywere reported in a study of Tai Chicompared to a relaxation interven-tion100 and two other studies did notdetect significant differences in de-pression in response to Tai Chi55,100 orQigong58 compared to usual-care orinactive controls. Fear of falling de-creased significantly in most stud-ies49,80,81,99,111 except for one thatshowed no change.82 Reports of self-esteem significantly improved in testsof Tai Chi compared to usual care91,112
and psychosocial support,93 but theincrease in self-esteem compared toexercise and education controls wasnot significant.97
Jin109 specifically created a stressfulsituation and measured the responsein mood, self-reported stress levels, andblood pressure across four interven-tions, including Tai Chi, meditation,brisk walking, and neutral reading.Significant improvements were shownin adrenaline, heart rate, and nor-adrenaline in Tai Chi compared to aneutral reading intervention, and allgroups showed improvements in corti-
sol. In another study examining bloodmarkers related to stress response,norepinephrine, epinephrine, andcortisol blood levels were significantlydecreased in response to Qigong com-pared to a wait-list control group.117
This category of symptoms, particu-larly anxiety and depression, showsfairly consistent responses to both TaiChi and Qigong, especially when thecontrol intervention does not includeactive interventions such as exercise. Inparticular, with a few studies indicatingthat there may be changes in bio-markers associated with anxiety and/ordepression in response to the inter-ventions, this category shows promisefor examining potential mechanismsof action for the change in psycholog-ical state.
Immune Function and Inflammation
Immune-related responses have alsobeen reported in response to Qigong(n 5 3) and Tai Chi (n 5 3) studies.Manzaneque et al.113 reported im-provements in a number of immune-related blood markers, including totalnumber of leukocytes, number ofeosinophils, and number and percent-age of monocytes, as well as comple-ment C3 levels, following a 1-monthQigong intervention compared tousual care. Antibody levels in responseto flu vaccinations were significantlyincreased among a Qigong groupcompared to usual care.114 Varicellazoster virus titers and T cells increasedin response to vaccine among Tai Chipractitioners.110 An earlier study con-ducted by Irwin et al.90 reported anincrease in varicella zoster virus–spe-cific cell-mediated immunity amongthose practicing Tai Chi compared towait-list controls.
Immune function and inflammationare closely related, and are oftenassessed using a variety of blood mark-ers, particularly certain cytokines and C-reactive protein. Interleukin-6, an im-portant marker of inflammation, wasfound to be significantly modulated inresponse to practicing Qigong, com-pared to a no-exercise control group.40
On the other hand, C-reactive proteinand erythrocyte sedimentation ratesremained unchanged among a group ofrheumatoid arthritis patients who par-ticipated in a Tai Chi class compared tostretching and wellness education.71
A number of studies not utilizing anRCT design have examined bloodmarkers prior to and after Tai Chi orQigong interventions, providing someindication of factors that might beimportant to explore in future RCTs(and not reported in the table). Forexample, improvements in thyroid-stimulating hormone, follicle-stimulat-ing hormone, triiodothyronine,115 andlymphocyte production116 have beennoted in response to Tai Chi comparedto matched controls. Pre-post Tai Chiintervention designs have also shownan improvement in immunoglobulinG117 and natural killer cells,118 andsimilar non-RCTs have suggested thatQigong improves immune functionand reduces inflammation profiles asindicated by cytokine and T-lympho-cyte subset proportions.119–121
As with the category of psychologicaloutcomes, these immune- and inflam-mation-related parameters fairly con-sistently respond to Tai Chi andQigong, while also providing potentialfor examining mechanisms of action.
DISCUSSION
In answering research question 1, wehave identified nine categories ofhealth benefits related to Tai Chi andQigong interventions, with varyinglevels of support. Six domains ofhealth-related benefits have dominatedthe research with 16 or more RCTspublished for each of these outcomes:psychological effects (27), falls/bal-ance (23), cardiopulmonary fitness(19), QOL (17), PROs (18), andphysical function (16). These areasrepresent most of the RCTs reviewed,with many of the studies includingmultiple measured outcomes spanningacross several categories (n 5 42).Substantially fewer RCTs have beencompleted in the other three catego-ries, including bone density (4), self-efficacy (8), and studies examiningmarkers of immune function or in-flammation (6).
The preponderance of studiesshowed significant, positive results onthe tested health outcomes, especiallywhen comparisons were made withminimally active or inactive controls (n5 52). For some of the outcomesaddressed in this review, there werestudies that did not demonstrate sig-
e20 American Journal of Health Promotion
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nificant improvements for the Tai Chior Qigong intervention as compared tothe control condition. For the mostpart, however, these nonsignificantfindings occurred in studies in whichthe control design was actually atreatment type of control expected toproduce similar benefits, such as aneducational control group interven-tion producing similar outcomes to TaiChi for self-esteem,97 aerobic exerciseshowing similar results to Qigong inreducing depression,28,57 an acupres-sure group successfully maintainingweight loss compared to no interven-tion effect for Qigong,60 or resistancetraining producing similar (nonsignif-icant) effects as Tai Chi for musclestrength, balance, and falls.43,66 It isimportant to note that although theTai Chi and Qigong interventions didnot produce larger benefits than theseactive treatment controls, in most casessubstantial 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 thecontrol group suffered from (1) studydesigns of shorter duration (4–8 weeks,rather than the usual 12 or moreweeks),51,96 although there were someexceptional studies with significantresults after only 8 weeks44,81,101; (2)selection of very health-compromisedparticipants or individuals with condi-tions that do not generally respond toother conventional treatments ormedicines, such as muscular dystro-phy,58 multiple morbidities,47 fibromy-algia,69 or arthritis;71 or (3) the out-come measured was not noted asparticularly problematic nor set as aneligibility criteria for poor startinglevels at baseline (n 5 5).28,94
On the other hand, in the areas ofresearch that address outcomes typi-cally associated with physical exercise,such as cardiopulmonary health orphysical function, results are fairlyconsistent in showing that positive,significantly larger effects are observedfor both Tai Chi and Qigong whencompared to no-exercise controlgroups and similar health outcomesare found when compared to exercisecontrols. Even with the very wide rangeof study design types and strength ofcontrol interventions, and the entry
level of the health status of studyparticipants, there remains a numberof remarkable and persistent findingsof health benefits in response to bothQigong and Tai Chi.
In response to research question 2,we have noted in earlier sections theways in which Qigong and Tai Chi areconsidered equivalent, and now ad-dress how studies identifying similaroutcomes in response to these practic-es may provide additional evidence forequivalence. On the surface, researchthat examines the effects of Qigong onhealth outcomes appears to be of lessermagnitude than the research on whatis typically called Tai Chi. For eachcategory of outcomes described above,we noted how many RCTs had beenconducted for each, Tai Chi andQigong, and for the most part, therewere many fewer reports on Qigongthan for what is named Tai Chi for anygiven outcome examined. Neverthe-less, across the outcomes examined inRCTs, the findings are often similar,with no particular trends indicatingthat one has different effects than theother.
As noted earlier, however, it is notunusual for the intervention used in astudy or trial to be named Tai Chi, butto actually apply a set of activities that ismore a form of Qigong, that is, easy-to-learn movements that are simple andrepeatable rather than the long com-plex sequences of traditional Tai Chimovements that can take a long time tolearn. For example, a large number ofstudies examining Tai Chi effects onbalance use a modified, repetitive formof Tai Chi that is more like Qigong.Thus, although it appears that fewerstudies have been conducted to testwhat is called Qigong, it is also clearthat when a practice called Tai Chi ismodified to focus especially on balanceenhancement, for example, it actuallymay be Tai Chi in name only.
Given the apparent similarity ofpractice forms utilized in research, thediscussion of equivalence of Tai Chiand Qigong extends beyond the earlierobservation that they are similar inpractice and philosophy. Because re-search designs often incorporateblended aspects of both Qigong andTai Chi, it is unreasonable to claim thatthe evidence is lacking for one or theother and it becomes inappropriate
not to claim their equivalence. Wesuggest that the combined currentresearch provides a wider base ofgrowing evidence indicating that thesetwo forms produce a wide range ofhealth-related benefits.
The problem with claiming equiva-lence, then, does not lie within thesmaller number of studies using a formcalled Qigong, but rather in the lack ofdetail reported across the studies re-garding whether or not the interven-tions contain the key elements philo-sophically and operationally thoughtto define meditative movement prac-tices such as Tai Chi and Qigong. Inprevious publications, and in thisreview, we note that the roots of bothof these TCM-based wellness practicesrequire that the key elements ofmeditative 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) toachieve a meditative state. Given theequivalence noted in foundationalprinciples and practice, the differencesamong interventions and resultanteffects on outcomes would perhapsmore purposefully be assessed forintervention fidelity (i.e., adherence tothe criteria of meditative movement).
Beyond the meditative movementfactors that tie the practices andexpected outcomes together, other,more conventional factors would beimportant to assess, each potentiallycontributing to variations in outcomesachieved. For example, dosing (i.e.,frequency, duration, and level of in-tensity, including estimate of aerobiclevel or metabolic equivalents) may beimportant in whether or not benefitsaccrue. Or a focus on particular musclegroups may be critical to understand-ing changes relative to certain goals(e.g., how many of the exerciseschosen for a study protocol developquadriceps strength likely to produceresults for specific physical functiontests?). Beyond the important similari-ties of movement and a focus onbreath and mind to achieve meditativestates, there are other aspects that varygreatly within the wide variety of bothTai Chi and Qigong exercises, includ-ing speed of execution, muscle groupsused, and range of motion, all of whichmay provide differences in the physio-
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logically oriented outcomes (similar tothe differences that could be noted inthe wide variety of exercises consideredunder the aerobic umbrella).
While equivalence of Qigong andTai Chi is established for philosophyand practice, there is still work to bedone to test for similarity of effects.With consistent reporting on adher-ence to the above mentioned aspectsof practice, not only could a level ofstandardization be implemented, butalso measures that control for variationof interventions could be used tobetter understand differences andsimilarities in effects.1
LIMITATIONS
For purposes of this review, a studywas selected if it was designed as anRCT and compared the effects ofeither Tai Chi or Qigong to those of acontrol condition on a physical orpsychological health outcome. Howev-er, there was no further grading of thequality of the research design. As aresult of this relatively broad inclusioncriterion, the studies represent a widevariety in methods of controlling forbalanced randomization and intent totreat analyses, in the specific methodsof implementing Tai Chi and Qigong,in the outcomes assessed, in themeasurement tools used to ascertainthe outcomes, and in the populationsbeing studied.
One difficulty in examining such abroad scope of studies is that the largenumber of studies required that welogically, but artificially, construct cat-egories within which to discuss eachgroup of outcomes. However, bychoosing to categorize by health out-comes, rather than participant, patient,or disease types, we have provided oneparticular view of the data, and mayhave obscured other aspects. For ex-ample, in a recently published review,the authors analyzed studies that wereconducted with community-dwellingadults over the age of 55.122 Resultsshowed that interventions utilizing TaiChi and Qigong may help older adultsimprove physical function and reduceblood pressure, fall risk, depression,and anxiety. Another view of these datamay emerge if only studies of chroni-cally ill participants are evaluated.Thus, there may be other ways to
examine the RCTs reported in thecurrent review such that specific dis-eases or selected study populationsmay reveal more consistent findings(positive or negative) for certain out-comes that are clearly tied to entrylevel values.
CONCLUSION
Our intent has been to recognize thecommon critical elements of Qigongand Tai Chi, based on their similaritiesin philosophy and principles as well ascommon practice components. Withthis established, we thoroughly explorethe range of findings for similar healthoutcomes and treat the two as equiva-lent aspects of one form of mind-bodypractice.
The preponderance of findings arepositive for a wide range of healthbenefits in response to Tai Chi, and agrowing evidence base for similarbenefits for Qigong. As described,there are foundational similarities be-tween Qigong and Tai Chi interven-tion protocols, as traditional Tai Chi istypically modified and adapted for easeof dissemination to more closely re-semble forms of Qigong. This supportsthe rationale that outcomes can betabulated across both types of studies,further supporting claims of theequivalence of Qigong and Tai Chi.
A compelling body of researchemerges when Tai Chi studies and thegrowing body of Qigong studies arecombined. The strongest, most consis-tent evidence is demonstrated foreffects on bone health, cardiopulmo-nary fitness, some aspects of physicalfunction, QOL, self-efficacy, and fac-tors related to falls prevention, whilefindings are mixed for effects of TaiChi or Qigong on psychological factorsand PROs. Study design factors thatappear to yield mixed findings are (a)the frequent choice of physical activityas a control group intervention, re-sulting in limited power to detectsignificant differences, (b) selection ofparticipants who do not demonstratedeficiencies in baseline levels of theoutcomes to be assessed, and (c) theuse of study participants with severe,chronic, progressive illnesses who maybe slower to respond or may notrespond at all to the practices. Otherstudies, however, suggest that Tai Chi
or Qigong may improve or slow theprogression of such illnesses. This maybe especially likely when the practicesare implemented early as an aspect ofwellness, prevention, or disease man-agement in a proactive, risk reductioncontext. In a recent review addressingTai Chi and Qigong research amongolder adults, it was pointed out that noadverse events were reported acrossstudies.122 The substantial potential forachieving health benefits, the minimalcost incurred by this form of self-care,the potential cost efficiencies of groupdelivered care, and the apparent safetyof implementation across populations,points to the importance of widerimplementation and dissemination.
SO WHAT? Implications for Health
Promotion Practitioners and
Researchers
What is already known on this topic?
The current state of researchsplinters these TCM-based wellnesspractices by identifying them withdifferent names, and treating themas distinct fields of inquiry, reducingthe potential for evaluating healthoutcomes across Qigong and TaiChi research.What does this article add?
This review has identified nu-merous outcomes with varying levelsof evidence for the efficacy forQigong and Tai Chi. The strongerevidence base for bone health,cardiorespiratory fitness, physicalfunction/balance and QOL, andthe potential demonstrated for psy-chological benefits and falls pre-vention, is sufficient to suggest thatTai Chi and Qigong be promoted asa viable, accessible alternative, es-pecially for individuals who mightprefer these activities over moreconventional or vigorous forms ofexercise. In addition to the healthpromotion and dissemination im-plications, the current state of thescience outlines the challenges forresearchers.What are the implications for health
promotion practice or research?
The wide variations in popula-tions and outcomes studied, thefrequently lacking descriptions ofinterventions or dose, and the con-
e22 American Journal of Health Promotion
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Acknowledgments
This research is supported in part by NIH/NCCAM grantU01 AT002706-03 (PI:Larkey) and NIH/NINR grant1F31NR010852-01 and a John A. Hartford BAGNCScholarship, 2008–2010 (PI:Rogers).
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July/August 2010, Vol. 24, No. 6 e25
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Editor in ChiefMichael P. O’Donnell, PhD, MBA, MPH
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Lucy N. Marion, PhD, RNNutrition
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Cary Cooper, CBEMind-Body Health
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Larry S. Chapman, MPH
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David R. Anderson, PhD, LP
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Ron Z. Goetzel, PhDMeasurement Issues
Shawna L. Mercer, MSc, PhD
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