Randomised controlled trial of Qigong training programme to alleviate arm oedema, reduce shoulder impairment, improve body balance and quality of life in community-dwelling breast cancer survivors

Dr Fong, Siu Ming   (Principal Investigator (PI))

Dr Tian Linwei   (Co-Investigator)

Dr Luk Wai Sum   (Co-Investigator)

Professor Chung Joanne Wai Yee   (Co-Investigator)

26

2015-06-01

2017-07-31

82600

Randomised controlled trial of Qigong training programme to alleviate arm oedema, reduce shoulder impairment, improve body balance and quality of life in community-dwelling breast cancer survivors

carcinoma, mind-body exercise, physical health, rehabilitation

Rehabilitative and Physical Medicine

201410159001

Seed Fund for PI Research – Basic Research

2014

Completed

Breast cancer is the most common malignant disease amongst women, both in Hong Kong1 and worldwide.2 There were 3014 new cases registered in the Hong Kong Cancer Registry in 2010, with an incidence rate of 80.8 per 100,000 people.1 The mortality rate of breast cancer patients is rather low (15 per 100,000 members of the population),1 and the survival rate continues to improve.2 Promoting the health and well-being of the increasing number of breast cancer survivors, many of whom have residual chronic physical impairments,3,4 has thus become a major challenge for healthcare professionals. Conventional breast cancer treatments such as mastectomy and radiotherapy are aggressive, although they can increase the survival rate.3 The treatment sequelae often lead to long-term physical impairments such as lymphoedema and shoulder dysfunction,4 and thus may result in functional limitations (e.g., poor balance performance) and a diminished quality of life (QOL) in survivors.5 From the socio-economic perspective, breast cancer-associated problems incur high medical costs as a result of frequent visits to physicians to seek symptom control.6 Identifying self-treatment strategies that could relieve the chronic symptoms associated with breast cancer and improve QOL in this patient population is thus essential. Evidence from recent meta-analysis supports the value of physical exercise (e.g. aerobic and resistance training) in improving physical function and QOL in cancer survivors.7 In Hong Kong, a predominantly Chinese society, many breast cancer survivors turn to the traditional Chinese mind-and-body integrative exercise Qigong (Appendix 1) rather than aerobic dance or resistance training after conventional cancer treatment.8 Qigong is originated from the traditional Chinese medicine and is used to improve health and energy levels through regular training. Many Chinese women believe strongly that Qigong (internal Qi) can improve physical function and blood flow, and thus prevent the recurrence of cancer,8 although a recent systematic review found little scientific evidence to substantiate that belief.9 Our research team has pioneered research on the potential effects of Qigong in managing chronic symptoms, specifically those of community-dwelling breast cancer survivors.5,10 In our pilot studies, we found that Qigong may reduce upper limb lymphoedema and improve peripheral blood flow velocity,10 shoulder muscular strength and functional well-being5 in this chronic disease population. Although the evidence we produced was not very strong because of the cross-sectional nature of our research design5 and relatively small sample size,10 we have demonstrated that Qigong may be an effective intervention for improving the physical and psychosocial well-being of community-dwelling breast cancer survivors. We recently carried out another small-scale pilot study for the Nature Health Qigong Association (our collaborating association) to assess the practicality and acceptability of conducting a prospective study on the effectiveness of Qigong training for cancer survivors (n = 25, mean age = 55.4 ± 7.5 years). The results show that 12 weeks of Tai Chi Qigong training can improve shoulder joint mobility by 6.37%-8.14% and body balance when standing on one leg. All of the participants welcomed the intervention, producing a good compliance rate, and no adverse effects were reported. These encouraging preliminary data have motivated us to propose a relatively larger study of Qigong use in breast cancer survivors to provide more solid evidence of its effectiveness (to prepare for the application of HMRF from the Food and Health Bureau). Moreover, if the results are positive, our Qigong training regime is transferrable to clinical practice and could have such positive socio-economic implications. The aims of our randomised controlled trial study are: (1) to investigate the effects of Qigong training on upper limb oedema, circulatory status, shoulder flexibility and muscular strength, body balance, and QOL in community-dwelling breast cancer survivors; and (2) to explore the relationship between the impairment outcomes and QOL outcomes. We hypothesize that: (1) the experimental participants will have less impairment and a better QOL after Qigong training compared with the no-training control group; and (2) the impairment parameters will be related to the QOL indexes in the Qigong participants.