Health Care Professional Information

Common Name

Chi Kung; may also be known by names of the commonly practiced forms, like Chan Chuang, Yì Jīn Jīng, Yan Xin, Wu Qin Xi, Liu Zi Jue, and Ba Duan Jin

Clinical Summary

Developed nearly 5000 years ago in China, qigong integrates methods of body movement, muscle relaxation, meditation, and respiratory exercise to improve physical, emotional, and psychological health. Proponents of Traditional Chinese Medicine contend that qigong works to promote a healthy, balanced flow of energy – called “qi” – within the body. Many believe that a disturbed or blocked flow of qi produces discomfort and illness within an individual; conversely, with a balanced, free flow of qi, one is believed to be in better health (1) (2).

There are many interpretations on the relationship between qigong and tai chi (or taiji), as both are mind–body–spirit integrative exercises (3). Static qigong refers to meditation in sitting, standing, and lying-down postures. These are the most fundamental, and therefore the most essential qigong training methods. Dynamic qigong refers to moving meditation, which can take on many forms (4). With many variations of “external qigong,” a professionally trained instructor directs the experience to a recipient (5). However, one might also practice “internal qigong” by oneself.

In several small studies, regular qigong practice has been shown to provide long-term benefits for patients with hypertension (6), fibromyalgia (7), chronic fatigue (8), tinnitus (9), and other chronic medical illnesses (10). It appears to have “dose-dependent” positive effects on sleep quality and climacteric symptoms in perimenopausal women (11). It may also have specific health-preserving effects, as it improved muscle endurance, waist-to-hip ratio (WHR), and body mass index (BMI) in middle-aged women (12).

Qigong also improves respiratory function and activity tolerance in patients with chronic obstructive pulmonary disease (COPD) (13), cardiorespiratory function and expiratory capacity in patients with hypertension (14), and reduced stress levels with improved sleep quality, activity levels, immune response, and balance in older adults (15) (16) (17). As a physical activity, qigong along with tai chi can be considered a low-intensity exercise, and as such may be beneficial in cardiopulmonary rehabilitation (18) (19). Data on qigong's effects on depression are inconclusive (33).

Earlier in vitro and animal studies in China using a form of external qigong suggest it can inhibit cancer cell growth. However, these studies are not reproducible due to variety of methods and practitioners (23). One study even found qigong to be effective in attenuating lymphoma growth in mice (24). More recent studies also indicate these effects in various cell lines, but the inability to specifically qualify and quantify the delivery of qi in these studies poses some basic challenges when evaluating qigong in this way. (25) (26).

Recently, qigong has been found to be an effective complementary therapy for cancer patients. Clinical studies have found that it positively affects psychological and emotional symptoms including anxiety, mood, depression and quality of life (1) (20) (34). Qigong has also demonstrated effectiveness in ameliorating physical symptoms experienced by cancer patients such as pain, numbness, dizziness, fatigue, inflammation, and cognitive function (1) (21) (22).
Preliminary findings suggest that it may help reduce upper limb lymhedema in breast cancer survivors (35).

More research is needed to not only confirm these findings, but to more fully elucidate the mechanisms by which qigong exerts its positive effects.
Patients should be aware that qigong is not a cancer treatment per se, but can be practiced to help alleviate symptoms associated with cancer.

Purported Uses
  • Anxiety
  • Cognitive functioning
  • Depression
  • Fatigue
  • Fibromyalgia
  • Health maintenance
  • Hypertension
  • Inflammation
  • Mood
  • Numbness
  • Pain
  • Respiratory functioning
  • Sleep disturbance
  • Stress
Mechanism of Action

Qigong incorporates methods of muscle relaxation, breathing exercises, meditation, and body movements to foster a free, stabilized, and unobstructed internal flow of qi (2). Through this mind-body dynamic, qigong can play an integral role in hypothalamic activity, easing both parasympathetic and sympathetic nervous systems (PNS, SNS) towards a state of homeostasis (1) (27). Since blood pressure (BP) level is directly linked to the SNS, the lower BP levels exhibited following qigong exercise are compatible with the stabilization of SNS activity (6) (14). Practice of qigong also modulates urinary catecholamine levels suggesting a positive effect on BP (14). The pulmonary benefits observed are likely due to the focus of deep breathing exchange that is powered by the muscles in ; the lower abdomen, in an area called tantien (pronounced dawn-dee-in) considered the body’s main energy center). This places less pressure on lungs and increases lung capacity (13), as well as the overall improvement seen in ventilatory function (14) and breathing efficiency (19). The potential to reduce BMI and WHR may also be related to tantien contractions, which strengthens the waist and increases calorific consumption (12). The downregulation of hyperactivity in the hypothalamic–pituitary–adrenal axis is a proposed mechanism for qigong’s antidepressive effect (10). Qigong may modify inflammation by affecting immune responsiveness through neuroendocrine factors (1) (28). Its positive effect on balance is attributed to the improved use of vestibular input and wider stances (16).
The effect of qigong on numbness in breast cancer patients receiving chemotherapy may be due to its stimulatory action as an upper extremity exercise, which is often recommended for post-surgery patients (21).

Contraindications

Patients who are especially weak – particularly due to chemotherapy – should consult a physician before taking on more strenuous forms of qigong (27).

Adverse Reactions

Cases of qigong-induced mental disorders have been reported in China. These were thought to be caused by inappropriate training and practice of extreme forms of meditation. Such reports are rare in the Western world (29) (30) (31).

Literature Summary and Critique

Oh B, et al. Effect of medical Qigong on cognitive function, quality of life, and a biomarker of inflammation in cancer patients: a randomized controlled trial. Support Care Cancer. 2012;20:1235-1242.
A total of 81 cancer patients were randomly assigned to either a 10-week medical qigong program in addition to usual care (intervention), or usual care (control). Quality of life (QoL), cognitive function, and inflammation as measured by the presence of C-reactive protein (CRP) were assessed for all patients before and after the 10-week period. Patients in the intervention group who completed the study had significantly lower CRP levels and significantly higher QoL and cognitive function scores than their control-group counterparts. Even though much of the data from this study relies on self-report, with the exception of CRP levels, it does suggest a significant role for qigong in the lives of cancer patients, where there is a high incidence of self-reported cognitive dysfunction during and after treatment.

Lynch M, et al. A randomized controlled trial of qigong for fibromyalgia. Arthritis Res Ther. 2012;14:R178.
This randomized controlled trial evaluated a standardized qigong practice used by 100 patients with fibromyalgia. Immediate or delayed practice groups took qigong training for 3 half-days, followed by weekly review and practice sessions for 8 weeks. During this time, participants were also asked to practice at home for 45 to 60 minutes daily. Outcomes recorded at baseline, Week 8, and Months 4 and 6 were pain, impact, sleep, and physical and mental functioning. Qigong demonstrated significant improvements in pain, impact, sleep, and physical and mental functioning for both immediate and delayed-practice groups when compared with the wait-listed/usual care control group at Week 8, with benefits extending beyond this time. There were also significant changes for all measures at all times except mental functioning at Month 4. Post-hoc analysis of self-reported practice indicated a greater benefit with the per-protocol group compared with minimal practice. This study provided reproducible outcomes and demonstrated that regular qigong can provide long-term benefits in several core domains in fibromyalgia and may be a useful adjuvant self-care treatment for this condition.

Tsang HW, et al. Psycho-physical and neurophysiological effects of qigong on depressed elders with chronic illness. Aging Ment Health. 2013;17(3):336-48.
In this randomized controlled trial, the psychological, physical, and neurophysiological effects of a 12-week qigong exercise program on depressed elders with chronic medical illness were examined. The intervention group (n=21) received a total of 36 sessions (3 times weekly for 45 minutes using the Eight-Section Brocades protocol for 2–3 cycles with short breaks in between. Each cycle lasted ~ 10–15 minutes and was considered easy to learn). A comparison group (n=17) was provided with a research assistant for the same duration and frequency who read news articles aloud and led subsequent discussions on the article topics presented. Considered a good comparison activity by experts and often provided in geriatric settings, this comparison activity also served to neutralize the attention given by therapists to the intervention group. At 12 weeks, the qigong group had a significant reduction in depressive symptoms and improvements in self-efficacy, self-concept of physical well-being, and right-hand grip strength, but not cortisol levels vs the comparison group. This trial offers some preliminary evidence that regular qigong practice produces an antidepressive effect.

Oh B, et al. Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial. Ann Oncol. 2010;21:608-614.
In this study, 162 patients with malignant cancer were randomly assigned to a 10-week program of two 90-minute qigong sessions per week in addition to usual care, or a control group that only received usual care. Participants were also encouraged to practice at home daily for at least 30 minutes. The program was modified from a traditional qigong practice to specifically target the needs of cancer patients with respect to aid in the control of emotions and stress and to improve physical function. Quality of life (QoL), fatigue, mood, and inflammation as measured by the presence of C-reactive protein were assessed before and after the 10-week period. QoL, fatigue, and inflammation were significantly improved for the intervention group compared with control patients after their qigong program. However, no follow-up measures were taken to assess whether these effects endured over time. Additional studies evaluating both the “dose-response relationship” and endurance of benefit could help to determine efficient prescriptions for practice in cancer populations.

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References
  1. Oh B, Butow P, Mullan B, et al. Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial. Ann Oncol. Mar 2010;21(3):608-614.
  2. Oh B, Butow P, Mullan B, et al. Medical Qigong for cancer patients: pilot study of impact on quality of life, side effects of treatment and inflammation. Am J Chin Med. 2008;36(3):459-472.
  3. Yang Y. The relation between wuji, taiji, and qigong. Available at: http://centerfortaiji.com//newsletter/18July2012/TrainingTip14.html. Center for Taiji & Qigong Studies. Accessed October 7, 2013.
  4. Loh SH. Qigong therapy in the treatment of metastatic colon cancer. Altern Ther Health Med. Jul 1999;5(4):112, 111.
  5. Lee MS, Chen KW, Sancier KM, et al. Qigong for cancer treatment: a systematic review of controlled clinical trials. Acta Oncol. 2007;46(6):717-722.
  6. Lee MS, Lim HJ, Lee MS. Impact of qigong exercise on self-efficacy and other cognitive perceptual variables in patients with essential hypertension. J Altern Complement Med. Aug 2004;10(4):675-680.
  7. Lynch M, Sawynok J, Hiew C, et al. A randomized controlled trial of qigong for fibromyalgia. Arthritis Res Ther. Aug 3 2012;14(4):R178.
  8. Ho RT, Chan JS, Wang CW, et al. A randomized controlled trial of qigong exercise on fatigue symptoms, functioning, and telomerase activity in persons with chronic fatigue or chronic fatigue syndrome. Ann Behav Med. Oct 2012;44(2):160-170.
  9. Biesinger E, Kipman U, Schatz S, et al. Qigong for the treatment of tinnitus: a prospective randomized controlled study. J Psychosom Res. Sep 2010;69(3):299-304.
  10. Tsang HW, Tsang WW, Jones AY, et al. Psycho-physical and neurophysiological effects of qigong on depressed elders with chronic illness. Aging Ment Health. Oct 16 2012.
  11. Yeh SC, Chang MY. The effect of Qigong on menopausal symptoms and quality of sleep for perimenopausal women: a preliminary observational study. J Altern Complement Med. Jun 2012;18(6):567-575.
  12. Tsai YK, Chen HH, Lin IH, et al. Qigong improving physical status in middle-aged women. West J Nurs Res. Dec 2008;30(8):915-927.
  13. Chan AW, Lee A, Suen LK, et al. Tai chi Qigong improves lung functions and activity tolerance in COPD clients: a single blind, randomized controlled trial. Complement Ther Med. Feb 2011;19(1):3-11.
  14. Lee MS, Lee MS, Choi ES, et al. Effects of Qigong on blood pressure, blood pressure determinants and ventilatory function in middle-aged patients with essential hypertension. Am J Chin Med. 2003;31(3):489-497.
  15. Yang Y, Verkuilen J, Rosengren KS, et al. Effects of a Taiji and Qigong intervention on the antibody response to influenza vaccine in older adults. Am J Chin Med. 2007;35(4):597-607.
  16. Yang Y, Verkuilen JV, Rosengren KS, et al. Effect of combined Taiji and Qigong training on balance mechanisms: a randomized controlled trial of older adults. Med Sci Monit. Aug 2007;13(8):CR339-348.
  17. Jahnke RA, Larkey LK, Rogers C. Dissemination and benefits of a replicable Tai Chi and Qigong program for older adults. Geriatr Nurs. Jul-Aug 2010;31(4):272-280.
  18. Chao YF, Chen SY, Lan C, et al. The cardiorespiratory response and energy expenditure of Tai-Chi-Qui-Gong. Am J Chin Med. 2002;30(4):451-461.
  19. Lan C, Chou SW, Chen SY, et al. The aerobic capacity and ventilatory efficiency during exercise in Qigong and Tai Chi Chuan practitioners. Am J Chin Med. 2004;32(1):141-150.
  20. Navarro M. Qigong Improves Quality of Life in Cancer Patients. 9th International Conference of the Society for Integrative Oncology (SIO). Presented October 8, 2012.2012.
  21. Lee TI, Chen HH, Yeh ML. Effects of chan-chuang qigong on improving symptom and psychological distress in chemotherapy patients. Am J Chin Med. 2006;34(1):37-46.
  22. Oh B, Butow PN, Mullan BA, et al. Effect of medical Qigong on cognitive function, quality of life, and a biomarker of inflammation in cancer patients: a randomized controlled trial. Support Care Cancer. Jun 2012;20(6):1235-1242.
  23. Chen K, Yeung R. Exploratory studies of Qigong therapy for cancer in China. Integr Cancer Ther. Dec 2002;1(4):345-370.
  24. Chen KW, Shiflett SC, Ponzio NM, et al. A preliminary study of the effect of external qigong on lymphoma growth in mice. J Altern Complement Med. Oct 2002;8(5):615-621.
  25. Yan X, Li F, Dozmorov I, et al. External Qi of Yan Xin Qigong induces cell death and gene expression alterations promoting apoptosis and inhibiting proliferation, migration and glucose metabolism in small-cell lung cancer cells. Mol Cell Biochem. Apr 2012;363(1-2):245-255.
  26. Yan X, Shen H, Jiang H, et al. External Qi of Yan Xin Qigong Induces apoptosis and inhibits migration and invasion of estrogen-independent breast cancer cells through suppression of Akt/NF-kB signaling. Cell Physiol Biochem. 2010;25(2-3):263-270.
  27. Yeh ML, Lee TI, Chen HH, et al. The influences of Chan-Chuang qi-gong therapy on complete blood cell counts in breast cancer patients treated with chemotherapy. Cancer Nurs. Mar-Apr 2006;29(2):149-155.
  28. Yang Y, Verkuilen J, Rosengren KS, et al. Effects of a traditional Taiji/Qigong curriculum on older adults' immune response to influenza vaccine. Med Sport Sci. 2008;52:64-76.
  29. Lee S. Chinese hypnosis can cause qigong induced mental disorders. BMJ. Mar 18 2000;320(7237):803.
  30. Ng BY. Qigong-induced mental disorders: a review. Aust N Z J Psychiatry. Apr 1999;33(2):197-206.
  31. Xu SH. Psychophysiological reactions associated with qigong therapy. Chin Med J (Engl). Mar 1994;107(3):230-233.
  32. Oh B, Butow P, Mullan B, et al. A critical review of the effects of medical Qigong on quality of life, immune function, and survival in cancer patients. Integr Cancer Ther. Jun 2012;11(2):101-110.
  33. Oh B, Choi SM, Inamori A, Rosenthal D, Yeung A. Effects of qigong on depression: a systemic review. Evid Based Complement Alternat Med. 2013;2013:134737.
  34. Chen Z, Meng Z, Milbury K, et al. Qigong improves quality of life in women undergoing radiotherapy for breast cancer: results of a randomized controlled trial. Cancer. 2013 May 1;119(9):1690-8.
  35. Fong SS, Ng SS, Luk WS, et al. Effects of Qigong Exercise on Upper Limb Lymphedema and Blood Flow in Survivors of Breast Cancer: A Pilot Study. Integr Cancer Ther. 2013 Jun 7. [Epub ahead of print]

Consumer Information

How It Works

Bottom Line: Qigong practice is effective in alleviating stress, pain, anxiety, and fatigue, and improving lung function, mood, and sleep. It is also beneficial for overall health maintenance, particularly in older adults.

Qigong combines body movements, muscle relaxation, meditation, and breathing to improve physical, mental, and emotional health by creating a balanced flow of energy, called “qi” (pronounced chee). In Traditional Chinese Medicine, disturbed or blocked flow of qi can produce discomfort and illness within an individual. Therefore, a free flow of qi is equated with better health.
Studies show that qigong practice can have many positive effects, particularly among patients with cancer, chronic illnesses, and breathing problems, as well as older adults. Benefits include improved lung function, mood, sleep, and quality of life, as well as reduced stress, pain, anxiety, and fatigue. Some studies have shown the amount of benefit corresponds to amount of practice. A blended practice of qigong and tai chi can be considered a low-intensity exercise, and may be especially beneficial for those undergoing rehabilitation.

Purported Uses
  • Anxiety
    Several studies show that qigong may be helpful for anxiety.
  • Blood pressure reduction
    Some studies show that regular qigong practice can positively affect blood pressure levels.
  • Breathing difficulty
    Several studies show that qigong is effective for improving lung function and breathing efficiency, especially in patients with chronic obstructive pulmonary disease.
  • Depression
    Several studies show that qigong has an antidepressive effect.
  • Fatigue
    Several studies show that qigong is effective in reducing chronic fatigue.
  • Fibromyalgia
    A randomized controlled trial of a standardized, 8-week qigong practice was shown to improve symptoms of fibromyalgia.
  • Health maintenance
    A few studies show that qigong can increase activity tolerance and improve balance, endurance and body composition, particularly in older adults.
  • Inflammation
    A randomized study evaluating qigong found that inflammation was greatly reduced after 10 weeks of practice. This was measured using a specific laboratory test.
  • Mental functioning
    In small randomized studies, qigong practice resulted in improved cognitive function, although this evidence relies on self-reporting.
  • Mood
    Several studies suggest qigong practice may improve mood.
  • Numbness
    A small study showed a significant reduction in numbness for breast cancer patients receiving chemotherapy. This may occur because qigong acts as an upper extremity exercise which is often recommended for post-surgery patients to stimulate circulation.
  • Pain
    A few studies have found qigong to positively affect sense of pain in patients after surgery who are receiving chemotherapy and in those who have fibromyalgia.
  • Sleep disturbance
    A preliminary study suggests qigong may have positive effects on sleep quality and perimenopausal symptoms. It also appears that the amount of benefit increases with more practice. In addition, qigong can improve sleep in older adults and patients with fibromyalgia.
  • Stress
    Some studies suggest that qigong can reduce stress in patients with cancer and in older adults.
Research Evidence

Pain, numbness, dizziness in breast cancer patients
In this study, 67 breast cancer patients undergoing chemotherapy were divided into either a qigong practice group for at least 15 minutes daily for 3 weeks, or no practice. Improvements were noted for dizziness, numbness, and pain, as well as some psychological measures such as hopelessness. However, this study was not a randomized trial, which would have made the study more objective.

Mental functioning and inflammation in cancer patients
A study used a tailored Qigong program to address the special needs of cancer patients to control emotions and stress and improve their physical condition. Eighty-one patients were divided into two groups. Both groups received usual care, but one group also added a supervised Qigong class once per week for 10 weeks and was encouraged to practice at home. Patients who participated in the qigong program improved their mental functioning and quality of life. Objective laboratory tests also showed that patients had decreased inflammation.

Fibromyalgia
In this study, 100 patients with fibromyalgia were divided into two groups. Both groups received usual care, but one group took a standard qigong class for 3 half-days, with weekly review and practice sessions for 8 weeks. The other group received the same training 6 months later. Both groups were also asked to practice at home. Patients experienced improvements in several fibromyalgia markers, including pain, sleep, and physical and mental functioning. In addition, benefits extended beyond the training period. The study showed that regular qigong practice could provide long-term benefits for patients suffering from fibromyalgia. Depression and chronic medical conditions in older adults An easy-to-learn qigong practice was tested among depressed older adults with chronic medical illness. One group attended an interactive reading and discussion session 3 times per week for 12 weeks, while the other received qigong instruction for the same duration. At the end of the study, the qigong group had reduced depressive symptoms and improved strength and well-being. The study offers some initial evidence that regular qigong practice may help symptoms of depression.

Do Not Take If
  • Consult your doctor before starting more strenuous forms of qigong practice if you are especially weak, particularly due to chemotherapy.
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