Qigong, which can be characterized in many different ways, is offered as a complementary self-care practice at a tertiary-care pain management unit in Halifax, Nova Scotia. This report provides a quantitative and qualitative assessment of two groups engaged in qigong practice in this context as part of two Research in Medicine (RIM) projects (2014-15, 2016-17). It includes assessments of pain, mood, quality of life, sleep, and fatigue, considers outcomes in relation to the amount of practice, and considers whether health attitudes would help determine who might benefit from the practice. There were 43 participants (28 ongoing practitioners, 15 new to qigong). The ongoing practice group in RIM2 had significant benefits over time in pain, mood, quality of life, and fatigue in quantitative scores, but changes were not significant in RIM 1. There were no differences in any measures in those new to qigong. Qualitative comments in core and other domains reflected good or better outcomes in 16 subjects in the ongoing group who practiced consistently. In those who practiced less, results were more variable. In most of those new to qigong, the practice was limited and comments indicate minimal changes. Those engaged in qigong have a stronger internal health locus of control than control subjects. Diligent qigong practice provides multiple health benefits for those with chronic pain, and qualitative assessments are essential for documenting these effects. For those new to qigong, factors needed to effectively engage practice need to be explored further to optimize program delivery. The trial is registered with
Qigong is a traditional Chinese practice involving specific movements, breathing methods, and meditation and is promoted for health maintenance and improvement. Since the 1980s, and particularly since 2000, there has been considerable interest in qigong as a potential therapeutic modality. Contemporary descriptions of qigong include traditional Chinese exercise [
Fibromyalgia is a chronic pain condition with common comorbidities of sleep and mood disorders [
The present report is an observational study of participants who undertook qigong as a voluntary self-care practice at the pain management unit in Halifax, Nova Scotia. Two groups of individuals were observed (2014-2015, 2016-2017) in the context of Research in Medicine (RIM) projects by two medical students. The trial provided an opportunity to document experiences of those involved in long-term qigong practice over several years (few trials extend beyond 24 weeks) and of those new to the practice (providing insight into knowledge translation from the controlled trial). A mixed-methods approach was used, combining quantitative measures (for pain, mood, quality of life, sleep, and fatigue) and qualitative comments (open-ended comments relating to the same domains). Such approaches provide a more complete reflection of patient experiences, especially with regard to chronic pain [
The aims of the study were (a) to provide quantitative and qualitative assessments of participant experiences of qigong as a complementary practice in a real world-setting of chronic pain management, (b) to consider outcomes in relation to the amount of practice, and (c) to determine whether attitudes might be helpful for predicting who might benefit from the practice. Six of the cases from this observational trial reporting remarkable outcomes with the long-term practice of qigong have already been published as a case series [
This study represents two observational intervals of those who undertook qigong as a voluntary self-care practice at the Queen Elizabeth II Health Science Centre’s Pain Management Unit in Halifax, Nova Scotia, Canada. It was approved by the appropriate Research Ethics Board prior to commencement. In 2012, a published report indicated significant benefits of Chaoyi Fanhuan Qigong (CFQ), a form of qigong available locally (
In total, the study involved 43 subjects, with
Components of an observational trial of qigong as a voluntary self-care practice at a tertiary-care pain management unit.
Interval 1: RIM1 | Interval 2: RIM2 |
---|---|
July 1, 2014–May 31, 2015 | July 1, 2016–May 31, 2017 |
Six 6-week sessions (summer, fall 1, fall 2, winter 1, winter 2, spring) | Six 6-week sessions (summer, fall 1, fall 2, winter 1, winter 2, spring) |
Data collected at interval entry: | |
(1) General: consent, demographics, medical history, qigong practice history | |
(2) Quantitative measures1: BPI, POMS, SF-12, PSQI2, CFS2 | |
(3) Attitudinal measures: HLC | |
Data collected at the end of each 6-week session: | |
(1) Quantitative measures: BPI, POMS, SF-12, PSQI2, CFS2 | |
(2) Qualitative comments: open-ended survey containing questions relating to pain, sleep, other health areas, quality of life, current medication | |
(3) Self-reported practice time: weekly log | |
Number of participants: | Number of participants: |
Discontinuations: | Discontinuations: |
BPI, Brief Pain Inventory; CFS, Chronic Fatigue Scale; HLC, Health Locus of Control; POMS, Profile of Mood Scores; PSQI, Pittsburgh Sleep Quality Index; SF-12 Quality of Life Survey. 1Quantitative measures at interval entry represent baselines only for those who were new to qigong; for those with prior experience, they represent anchor study entered values. 2Quantitative measures relating to sleep and fatigue were included in RIM2; other measures as in RIM1.
Demographics for participants in two observational intervals as outlined in Table
RIM1 ( | RIM2 ( | Ongoing ( | New ( | Controls ( | |
---|---|---|---|---|---|
18 : 11 : 0 | 22 : 6 : 1 | 13 : 15 : 0 | 0 : 14 : 1 | 37 : 9 : 0 | |
Age, years (SD) | 53.9 (10.7) | 57.8 (12.1) | 55.4 (10.6) | 52.9 (14.6) | 52.3 (12.3) |
Duration of pain, years (SD) | 15.0 (12.2) | 14.8 (13.1) | 14.8 (13.1) | 12.3 (10.9) | — |
None | 4 | 11 | 0 | 15 | — |
6 weeks level 1 CFQ | 3 | 1 | 3 | 0 | |
>6 weeks level 1 CFQ | 8 | 5 | 9 | 0 | |
Levels 1 and 2 CFQ | 13 | 12 | 15 | 15 | |
Unspecified | 1 | 0 | 1 | 1 | |
Back pain | 83% | 48% | 75% | 73% | — |
Fibromyalgia | 48% | 45% | 50% | 33% | |
Headache | 38% | 31% | 39% | 20% | |
Neuropathic pain | 34% | 31% | 32% | 40% | |
Orofacial pain | 24% | 17% | 21% | 20% | |
Osteoarthritis | 21% | 41% | 21% | 47% | |
Cervical spine | 17% | 14% | 18% | 7% | |
Rheumatoid arthritis | 3% | 10% | 4% | 0% | |
Other | 69% | 72% | 71% | 67% |
CFQ, Chaoyi Fanhuan Qigong; COPD, chronic obstructive pulmonary disease; F, female; M, male; N, number; NSAIDs, nonsteroidal anti-inflammatory drugs. 1Total number of participants
Consistent with recommendations for chronic pain studies [
In order to assess health attitudes, an additional questionnaire related to Health Locus of Control (HLC) was included. This is a set of 11 questions relating to attitudes towards the degree of control one has over illness [
Chaoyi Fanhuan Qigong, CFQ (
This study involves considerable heterogeneity and multiple viewpoints were required to assess outcomes. Quantitative measures were analysed for each interval using paired
The study consisted of
Figure
Average pain (a), average mood (b), and quality of life (c) from the RIM1 study start to 36 weeks of practice. Lower scores indicate less pain, less depression, and lower quality of life, respectively. Numbers below
Figure
Average pain (a), average mood (b), quality of life (c), sleep quality (d), and fatigue (e) from the RIM2 study start to 36 weeks of practice. The orange line represents ongoing participants (
Table
Qualitative comments in 10 participants who reported good outcomes during the observational trial1.
Participant number | Practice amount2 | RIM1 comments | RIM2 comments |
---|---|---|---|
14 | 4/week | 6 wks: doing qigong for years; more pain and worse sleep when not doing; 12 wks: myofascial pain flares helped by qigong; 30 wks: minimal flare-ups; greatly improved sleep; no longer needs meds [doing taxes and snow shoveling increase pain] | 6 wks: great improvement in pain, coping skills and mood since CFQ 6+ years ago; blood pressure meds reduced and better maintained; cholesterol pills reduced; no longer need antidepressants, nausea or sleep meds; able to enjoy life so much more; so much better than before qigong; 12 wks: decreased pain meds and no longer need any for breakthrough pain; blood pressure meds reduced 75%; cholesterol pill reduced 50%; less angry and frustrated; 18-36 wks: (as before)5 |
7/week | |||
(started qigong in 2011)3 | |||
17 | 7/week | 6 wks: qigong has given me a life worth living (can walk, play; am calm, peaceful); improved overall health and outlook; 12 wks: no pain; after decades of pain and multiple health issues, years of trying many ways to improve, spending lots of time and money, now all I use is qigong for wellness; eyesight slightly improved; 24 wks: qigong helped so much; now have full, happy, peaceful life; chronic pain gone | — |
(started qigong in 2008) | |||
18 F (74) NEW4 | 5.5/week | 6 wks: sleeping better; friends comment am looking better; gained weight (102 to 110 lbs); more relaxed; doing things not done before; 12 wks: see difference since qigong (weight); do not get pain relief in back, legs, feet at times; more energy; 18 wks: so pleased since qigong; able to things couldn’t do before; some pain relief overall | 6 wks: could never had been able to do the things I can today; much better [quality of life]; 12 wks: (no answer); 18 wks: no new changes; 24 wks: don’t have as much pain in my back; have more energy and can certainly do more things; am much happier that I can go out with friends and not worry; stopped taking pantoprazole; 36 wks: (as before) |
5.5/week | |||
(started qigong in 2014) | |||
22 | 7/week | 6 wks: pain decreased since qigong (facet joint injections increased back pain for 10–14 days); sleep better; program has increased strength and helped with pain; 12 wks: much happier since qigong; better quality of life 90% of the time; 18 wks: doing good; sleep good since starting amitriptyline; 24 wks: don’t feel so involved with pain, easier to cope | 6 wks: pain reduced and more under control; able to function so much better; ups and downs but feel overall have made progress; [sleep] much better; not sleeping as well [heat, outdoor noise]; happier; feel much less moody; more in control of living my life; 12 wks: (as before); 18 wks: getting more sleep, sleeping better and more soundly; less pain throughout the night; more days with lesser pain; 24 wks: notice most improvements in sleep habits; 30 wks: (as before) |
7/week | |||
(started qigong in 2010) | |||
27 | 4.5/week | 6 wks: this is hard; keeps my head clear; stronger inner core; 12 wks: qigong is saving my life; being with group is so important; qigong is very good pain relief; temper more controlled when doing qigong; 18 wks: without qigong life is pretty bad | — |
(started qigong in 2013) | |||
28 | 6.5/week | 6 wks: pain relaxing back to normal; wellbeing improved; depression lifting; sleep returning to normal; 12 wks: easier to relax and unload pain; since qigong have stopped all pain meds; have not needed asthma meds in last year; 18 wks: pain dissipates much more quickly; sleep quality usually better; have stopped asthma and pain meds | — |
(started qigong in 2012) | |||
29 | 7/week | 6 wks: practiced qigong for 2 years; substantial improvements in that time; everything in my life has improved drastically because of the practice; sleep improved; using less and less cannabis; 18 wks: constant improvement for last 2 years; quality of life has improved exponentially | — |
(started qigong in 2012) | |||
30 | 7/week | 6 wks: calmer at times and less depressed; sleep improved; 18 wks: very pleased with qigong; helped get me out of extreme chronic pain and keeps me going | 6 wks: helps overall body, spirit, and mind; was in chronic pain and now no longer; returned to work; able to do housework; better sleeping; more comprehensive, more social, more activities; decrease in zantac; stopped nexium; decreased antidepressant; 12 wks: (as before); 18 wks: (as before); 36 wks: (as before) |
7/week | |||
(started qigong in 2008) | |||
34 | — RIM1 | — | 6 wks: prior to CFQ, pain was like a knife slashing arms and legs 8-9/10; now pain free; improvements of psoriatic arthritis, diabetes, blood irregularities, mental health beyond what anticipated to be possible; overall quality of life greatly improved; improved ability to cope with health issues; no change medications; 12 wks: no pain; went from 500 mg naproxen twice daily 10+ years to no medication; insight into behavior patterns; more resilience; increased ability to calm self; less reactive; reduced insulin by ∼70%; decreased sleep disruption due to worry; more accepting and better able to settle; not confident that would still be alive if not for CFQ; increased relationship quality and quality of life; 18 wks: improvements most noticeable in ability to cope with stressors, awareness of attitudes/beliefs |
7/week | |||
(started qigong in 2010) | |||
42 | — RIM1 | --- | 6 wks: my pain is significantly better; am able to do a lot more things; am not depressed anymore; sleep better; rarely wake up in the middle of the night; my life is much better since started CFQ; feel more confident; less stressed; stopped medication 1.5 year after starting qigong |
6/week | |||
(started qigong in 2015) |
1Good outcomes were characterized post hoc based on the global qualitative comments relating to pain and other health areas. An additional
In the six cases reported separately [
Table
Qualitative comments by 13 participants who had variable outcomes during the observational trial1.
Participant number | Amount of practice2 | RIM1 comments | RIM2 comments |
---|---|---|---|
1 | 5-6/week | 6 wks: pain always less when do qigong regularly; sleep better but still take meds (less); people comment I look better; 12 wks: slip and fall on ice; leg spasms | 6 wks: pain is more manageable; am less tense all the time; on lower dose of antidepressant and 200 mg less gabapentin; sleep is deeper and longer; am able to participate in family functions- before I usually cancelled or left early; 12 wks: (as before)3; 18 wks: (as before) |
6/week | |||
8 | 5-6/week | 6 wks: little better mood; sleeping bit better; feeling much better; 12 wks: easier to manage pain; somewhat better sleep; 18 wks: pain and discomfort constant; getting worse with age; tried everything; spinal fusion not fully fused since 1980s | — |
10 | 4-5/week | 6 wks: less shoulder pain; more relaxed | 6 wks: no fear of spiders; less anxiety; |
3/week | |||
13 | 2-3/week | 6 wks: in pain after class; go home exhausted; 12 wks: pain in joints, pelvis, back; continuous pain, anxiety, depression; 18 wks: qigong seems to help but is exhausting | — |
19 | 3/week | 6 wks: pain and sleep improved with qigong; 12 wks: qigong makes it easier to cope; broken bite plate; increased jaw/neck/head pain; 18 wks: pain seems manageable if do qigong; new bite plate, decreased jaw/ear/neck pain; quality of life has improved; 24 wks: pain was decreased earlier but has now resumed, continuing with qigong | 6 wks: pain certainly is more manageable; usually sleep better and have more energy; pain level reduced, overall wellbeing better and am more able to cope on daily basis; less migraines; able to do more with wrists (chopping etc.); CFQ helps to keep my irritable bowel on track; less tylenol and less headaches; 12 wks: not wearing bite plane at this time and haven't worn wrist splints for some time now; 36 weeks: not waking with nightmares as much; do not take any prescribed meds anymore, except synthroid |
5/week | |||
20 | 2/week | 6 wks: when practice regulatory, less pain; with flare-up, immediate pain reduction with qigong; sleep better; when wake in pain, do (qigong) movements to eliminate pain and go back to sleep; 12 wks: been practicing since 2011 and overall, quality of life and outlook are much improved; 18 wks: continue to have positive outlook knowing that the practice works; 24 wks: when I practice “regularly”, less pain and discomfort - when don’t, as in past month, have increased pain and stiffness | 6 wks: had a frozen shoulder for 30+ years and now have no symptoms; when do regular practice, my hip pain reduced noticeably; [sleep] better with regular practice; 12 wks (as before) |
3/week | |||
25 | 7/week | 6 wks: helped to move and stretch, still same pain; healthier and more relaxed; | — |
26 | 4/week | 6 wks: tried pain meds and many hours of alternative therapies; pain meds cause too many side effects with no pain relief; others give temporary/partial relief only; doing qigong since 2014 and although it helps tolerate pain, still have lots of pain; 12 wks: increased stress [elderly parent] has impacted pain and limited practice | — |
38 | — | — | 6 wks: CFQ has provided positive mental awareness of potential to heal within myself; recently seemed to be releasing pain and muscle distress from more than current injury in last 6 years; [pain] reduced by 50%; have incorporated a wellness program and have improved my physical wellness by at least 100%; wellness/emotional wellness have improved; no change in medications |
6/week |
1Outcomes were characterized as variable based on a global assessment of comments. A further
Table
Qualitative comments by
Participant number | Practice amount2 days/week minutes/day # weeks | RIM2 comments 2016-2017 |
---|---|---|
46 not given (26)3 | 4/week | 6 wks: [pain] improvement; fewer full body flare-ups; localized flare-ups resolve more quickly; calmer; easier to identify pain/stress triggers; fatigue hasn’t been quite as bad; calmer before bed; feel rested sometimes; less stress, better able to deal with stress; able to do slightly more than usual; need to rest (bed-ridden) little less often; 12 wks: less [pain] overall; muscles feel like they’re learning to relax; overall decrease in tension, stiffness, and soreness; levels and sleep have improved; decreased panic, anxiety, and depression; waking earlier with a feeling of rest; better able to do activities and to enjoy those activities; nortriptyline decreased from 20 to 10 mg because of qigong. 18 wks: anxiety and depression both lessened; feeling calmer; overall improvements in mental clarity and in sense of self |
37 F (80) | 2/week | 6 wks: CFQ has improved by balance; feel relaxed and more settled after a class; pain has remained consistent depending on my physical activity; no change [in] medications |
39 F (32) | 1/week | 6 wks: [pain spikes] during class and for a day or so afterward; feel more in control of my pain; no change in medications |
41 F (55) | 1.5/week | 6 wks: decrease in joint pain; not waking up as many times; no change medications; 12 wks: some change in pain and energy levels; think gallbladder recovered quicker with CFQ exercises; am happy to find an exercise program that doesn’t leave me feeling worse after; this gives me energy and helps lift spirits |
44 F (50) | 4/week | 6 wks: have new pain area after CFQ but subsides a few hours after session; increased fatigue post session, returns to normal fatigue day 3 post session; do feel a little more peaceful; no sleep changes; do quick bit of the program to relax before bed; helps clear my mind; a little more social; 12 wks: increased pain and soreness; increased fatigue; some decrease in muscle tension; mentally feel better; positivity and hope for improvement; decreased Flexeril and substituted [morning] dose with Tylenol XS for same result |
47 F (60) | 3/week | 6 wks: from the first class have seen improvement; [quality of life] has increased significantly compared to where was before |
48 F (71) | 2-3/week | 6 wks: (no comments); 12 wks: pain a little better when I do [qigong]; feel somewhat better; no medication changes; 18 wks: no real changes [in pain] but helping a little bit |
49 F (47) | 3-4/week | 6 wks: the more I do, the better I feel; less stiff and sore; more energy; still having problems sleeping; more practice at home may help with this; get more done in a day |
50 F (47) | 2.5–3/week | 6 wks: increased pain in right side and heaviness the day after sessions, which subsides and I feel better; more positive when in the sessions; being part of the CFQ program has been a blessing, it has given me something positive to look forward to; 12 wks: more pain in my hands, wrists, ankles and toes; more fatigued during this 6-week session; may also be due to increased activity this session; sleep has been deeper at times; feel very energized after each session; more positive about daily activities |
52 F (60) | 4/week | 6 wks: helps my back [pain] quite a bit, [but not my] neck, legs, and feet; [can] walk a little longer; no medication changes |
1
Considered sequentially, qualitative comments published previously in a separate report [
Table
Health Locus of Control (HLC) scores for those undertaking qigong practice as a voluntary self-care practice at a Pain Management Unit.
Controls | Qigong groups | |||||
---|---|---|---|---|---|---|
All | Ongoing | New | ||||
Health Locus of Control (HLC)1 | 36.07 ± 6.98 | 31.79 ± 6.59 | 30.89 ± 6.85 | 33.47 ± 5.94 | 30.73 ± 7.83 | 31.08 ± 5.82 |
All values in the table are mean ± standard deviation.
This report documents the experiences of 43 people living with chronic pain (mean pain durations 12–15 years) who attended a tertiary-care pain management unit and undertook qigong as a self-care practice in addition to their usual medical care between 2014 and 2017. There is considerable heterogeneity in amounts of practice, both in the number of years of experience and in amounts of ongoing practice, and in outcomes as reflected in qualitative comments. Multiple viewpoints and subgroup considerations were required to derive meaningful information, and the dataset might best be considered as an extended case series. Pooled quantitative scores for pain, mood, and quality of life showed no longitudinal differences for ongoing qigong subjects during RIM1 but significant benefits during RIM2. With those new to qigong practice, there was little change in their scores. Results of the quantitative assessments are unremarkable and include many limitations in terms of standardized data collection and analysis methods. Of greater interest and importance in this study are qualitative comments related to the same domains, which provide a different view of health experiences, especially when considered as subgroups in relation to the amount of practice.
The experienced group represents those who have practiced qigong for >3 years (classes were offered each year; those continuing from RIM1 to RIM2 continued during the intervening, nonobserved year) and longer (up to 11 years). This information is of considerable value, as controlled trials for qigong in health areas relevant to chronic pain populations generally reflect durations of 6–24 weeks [
The seeming mismatch between quantitative and qualitative assessments for the ongoing practice group requires consideration. For these participants, entered values against which postpractice values are compared do not represent baselines due to the ongoing nature of their practice. In absolute terms, entered pain levels are in the moderate range and less than those in the new group and those in a larger trial of fibromyalgia subjects [
Those new to qigong must be considered separately, as their experiences with the practice differ vastly from others, and the aims of considering their outcomes differ. One new participant practiced diligently throughout, had good outcomes, and is included along with ongoing practitioners. Others attended only limited numbers of sessions and had lower daily and weekly practice times. Their outcomes are not as good as outcomes at 8–16 weeks in the controlled trial of this form of qigong in fibromyalgia [
With regard to mechanisms by which health benefits occur, contemporary viewpoints consider endocrine, immune, and inflammatory biology mediation of mind-body therapies in general [
The current study included an assessment of HLC. A more internal locus is associated with better outcomes with pain and depression [
This report documents multiple health benefits over time in those with chronic pain who practice qigong, with benefits related to the amount of practice. Qualitative comments are essential for portraying these effects. Qigong can be characterized in several ways (see Introduction). The language of instruction can seem strange at times; it requires considerable diligence in practice, and it is not for everyone. However, given the profound nature of changes in subgroups described in this observational trial, further exploration of the potential for benefits in multiple health areas needs to occur. Both controlled trials over a specified interval and extension trials are needed, and with the latter approach especially, qualitative comments are essential to reflect experiences more completely.
Brief Pain Inventory
Chaoyi Fanhuan Qigong
Chronic Fatigue Scale
Chronic obstructive pulmonary disease
Female
Health locus of control
Male
Number
Nonsteroidal anti-inflammatory drugs
Profile of Mood Scores
Pittsburgh Sleep Quality Index
Quality of Life Survey.
Data are available upon request to the principal investigator.
This study was approved by the Nova Scotia Health Authority Research Ethics Board.
Each person consented to participate in the study and for study results to be published.
DM conducted the qigong classes for the pain management unit. She also conducts community-based qigong classes. All other authors have no conflicts of interest relevant to this study.
LC conducted data collection and analysis for RIM2 and assisted in manuscript development. MP developed the protocol and conducted data collection and data analysis for RIM1. ML was involved in protocol development and trial organization. DM was the qigong instructor for the trial. JS was involved in the trial organization, data analysis, and drafting the manuscript. All authors provided input into and approved the final wording.
The authors acknowledge all participants in this trial for their contributions to medical science, some of whom engaged in extraordinary amounts of practice. MP and LC received summer studentships as part of the Research in Medicine program at Dalhousie University. Qigong instruction was supported by funds from the Pain Management Unit.