The psychosocial and physiological effects of Qigong exercise in integrative medicine : a study of Chinese patients with chronic fatigue syndrome-like illness

Abstract

While “stress is life and life is stress,” unhealthy lifestyles are an important yet often neglected risk factor in stress-related disease. One pervasive social and health issue is chronic fatigue syndrome (CFS), a stress-related disease. CFS is often overlooked, has unknown etiology and no effective treatment. Additionally, most people with CFS do not seek medical attention. In the integrative medicine perspective, an ideal intervention would be easy to adopt through simple lifestyle changes. Qigong exercise, an ancient Eastern self-healing practice, has been long practiced in Chinese communities and may powerfully trigger the healing process in stress-related diseases. This research evaluates the potential of Qigong as a complementary and alternative therapy. The objective was to document subjective (psychosocial) and objective (physiological) changes in individuals with CFS, before and after a Qigong intervention. Two randomized controlled trials were conducted (RCT1 n_1=137, RCT2 n_2=150). Public media attracted large numbers of research volunteers from the community (n_1=1441, n_2=3848). In both trials, extensive online questionnaires allowed individuals with CFS-like illness (i.e., symptoms match CFS, yet without clinical confirmation) to be identified. RCT1 included a 5-week intervention. The intervention in RCT2 was 8 weeks. Five instruments measured psychosocial change (Chalder Fatigue Scale, Hospital Anxiety and Depression Scale, Short-Form-12 health survey for Health-Related Quality of Life, HRQoL, Body-Mind-Spirit Well-being Inventory [Physical Distress and Spirituality subscales], and the Pittsburgh Sleep Quality Index). Physiological change was measured by telomerase activity, and cortisol level. Repeated measures (3 times – baseline, post-intervention, 3mo post-intervention) from experimental and waitlist control groups were compared using analyses of variance (ANOVA) or covariance (ANCOVA), chi-squared test or independent t-test. Correlation analysis, path model and multiple linear regression analysis were also used. In RCT1 Qigong group had reduced fatigue (p<0.001) and depressive symptoms (p=0.002), as well as improved spiritual well-being (p=0.001), mental functioning (p<0.001) and telomerase activity (p=0.029). An effective practice regimen was identified (≥3days/wk, at ≥30min/session). Methods were slightly adjusted with additional measures added for RCT2, which replicated RCT1 findings, and further documented improved subjective sleep quality (p=0.008), reduced physical distress (p=0.002) and reduced cortisol levels (p<0.001). Using full baseline data in RCT2 (n=1409), the average Hong Kong CFS respondent was found to be female, married, 42.5yo, highly educated and employed full-time, experiencing sleep disturbance (~95%), anxiety (>80%), depressive symptoms (68%), and with low HRQoL. A significant dose-response relationship was documented, as was a close relationship among factors of body, mind, spirit and HRQoL. Spiritual well-being had a mediating effect, and may be considered a potential facilitator of psychosocial adjustment. Thus, when health is viewed holistically, spirit is an indispensable component. Qigong exercise may lead to measurable increases in health and well-being through triggering and enhancing the body’s innate self-healing mechanisms, reconnecting body, mind and spirit. Thus, Qigong exercise should be recognized as a possible standalone therapy, or a powerful component of a comprehensive rehabilitation program. Strategies are needed to increase motivation for Qigong lessons and regular practice. Further clarity would come from studies comparing Qigong with other physical exercises, or extending to other diseases.