Case Series of Multiple Health Benefits in Those Undertaking Extended Qigong Practice as a Complementary Self-care Practice in an Outpatient Pain Clinic
1. Faculty of Medicine, Dalhousie University, Halifax, Canada
2. Department of Pediatrics, IWK Health Centre, Halifax, Canada
3. Departments of Psychiatry, Anesthesia, Pain Management & Perioperative Medicine, and Pharmacology, Dalhousie University, Halifax, Canada
4. DM Personal Training, Halifax, Canada
5. Departments of Pharmacology, and Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Canada
Academic Editor: Gerhard Litscher
Special Issue: Complementary Medicine and Pain Management
Received: April 01, 2019 | Accepted: June 25, 2019 | Published: June 28, 2019
OBM Integrative and Complementary Medicine 2019, Volume 4, Issue 2, doi:10.21926/obm.icm.1902040
Recommended citation: Curry L, Pike M, Lynch M, Marcon D, Sawynok J. Case Series of Multiple Health Benefits in Those Undertaking Extended Qigong Practice as a Complementary Self-care Practice in an Outpatient Pain Clinic. OBM Integrative and Complementary Medicine 2019; 4(2): 040; doi:10.21926/obm.icm.1902040.
© 2019 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.
Qigong refers to traditional Chinese mind-body practices and can involve postures and movement, attention to breathing, and meditative instructions. Contemporary terminology refers to such practices as meditative movement [1,2] or movement-based embodied contemplative practice . There are many forms of qigong, and heterogeneity of practice forms as well as variations in amounts of practice are challenges for exploring the health benefits of qigong. Nevertheless, there is a growing literature on health benefits of qigong , especially for chronic pain, sleep disorders and depression [5,6,7,8].
Following the publication of a randomized controlled trial which reported that qigong practice (Chaoyi Fanhuan Qigong)  led to reproducible multiple health benefits (improvements in pain, impact, sleep, physical and mental function) in two cohorts of individuals with fibromyalgia (mean pain durations of almost 10 years) , the form of qigong used in that trial has been offered as a voluntary complementary self-care practice at the tertiary care Pain Management Unit in Halifax, Nova Scotia. Two cohorts of individuals with chronic pain of varying origins were monitored in an observational trial using mixed-methods approaches in which quantitative and qualitative data were collected to reflect core domains of function (pain, sleep, mood, impact, quality of life). Mixed-methods approaches are now receiving attention and being valued as a more complete reflection of patient experiences, especially in relation to chronic pain [11,12], and are an important component of observational studies.
In this report, we present qualitative assessments of experiences in six cases in which individuals experienced multiple health benefits from extended practice of qigong covering an interval of 4-11 years of diligent practice. The results of the entire cohort who participated in the observational trial, with both quantitative and qualitative analyses, are being presented in another report (in preparation).
Participants in the observational trial (N=29) attended weekly qigong classes and received instruction in Chaoyi Fanhuan Qigong  by an instructor with 10 years of experience in such at commencement of the trial in 2014 (DM). This form of qigong involves two levels of instruction. Level 1 consists of a core of seven movements practiced as a set, with 10 repetitions of movements 1-5 and 5 repetitions of movements 6-7; each set takes approximately 15 (+/-2) minutes to perform. Level 2 consists of meditative instruction, and involves seated, standing and laying postures. Weekly classes consisted of 120 min sessions with instructions and practice. Participants were encouraged to practice daily for at least 15-45 mins per day when they first began the practice, but for longer when they were experienced. Instruction consisted of six-week blocks offered over the course of the year, with intervals determined by calendar and other events. Information recorded at study entry included age, diagnoses, duration of pain, and medications. Participants completed questionnaires (quantitative, qualitative) at the end of each 6-week block, and self-reported practice times. The information summarized in this report is derived from qualitative questionnaires.
The trial consisted of two cohorts, observed between 2014-15 and 2016-17 (Table 1), and was undertaken as Research in Medicine (RIM) projects by two medical students (MP, LC). For the intervening interval (2015-16), qigong classes continued to be offered at the Pain Management Unit according to the seasonal sessions. All six cases reported in this trial participated in Interval 1 (RIM1) and Interval 2 (RIM2) sessions, and continued throughout the intervening interval, so their total experience with qigong was at least 3 years of practice. All were not new to qigong when they commenced Interval 1, so their practice experiences are even more extensive. Commencement times for each individual are listed in Table 2.
The observational trial was approved by the Nova Scotia Health Authority Research Board.
Table 2 summarizes the experiences of 6 people (4 females, #3, #11, #12, #15; 2 males, #5, #9) who were 44-69 years old at the commencement of Interval 1, who had multiple chronic pain conditions of 3-47 years duration and who underwent extensive qigong practice. All practiced extensively during the two observational intervals (2014-15, 2016-17), and all continued on with practice sessions offered by the clinic in the intervening interval. The two columns reflect experiences in their own words, with some condensation simply to provide a more compact presentation. All participants were not new to qigong in 2014, having encountered it earlier either in the context of being a participant in the randomized controlled trial  or undertaken it as part of the voluntary self-care practice offered in the clinic prior to these observational intervals. Start dates for qigong practice (2006-2013) are listed for each individual in Table 2, and experiences reflect real-world qigong practice of 4-11 years.
Table 1 Components of the observational trial of qigong as a voluntary self-care practice at a tertiary care pain management unit.
Table 2 Summary of qualitative comments of 6 individuals who underwent extensive qigong practice for 4-11 years. Self-reported practice times relate to the two specific observation intervals identified as RIM1 and RIM2 in Table 1.
All cases report major improvements in pain, sleep, mental and physical function, and in various additional other health areas. These additional areas include: irritable bowel syndrome, food and environmental sensitivity, frozen shoulder, plantar fasciitis, neck pain, head trauma, wrist tendonitis (#3), immune function (#9), respiratory function/sleep apnea, mobility (#11), suicidal ideation, depression, anxiety, and post-traumatic stress (#12). Several comment specifically on the profound (even miraculous) nature of their health changes (#3, #4, #11, #12, #15). Most also comment on discontinuation or reduction in medications for pain (#3, #5, #11, #12, #15). One person even reports going from 22 prescriptions for various conditions down to 3 (#11) over the course of her 9 year experience with qigong.
This report presents the experiences of 6 individuals with chronic pain who essentially transform their previously health-compromised lives by diligent and long-term practice of qigong for 4-11 years. Benefits are not limited to pain, but cover a wide range of health conditions and include improvements in sleep and fatigue, mental health and respiratory function. Controlled trials and aggregate analyses indicate benefits of qigong for pain [5,13], sleep and fatigue , mental health [7,8], respiratory function , and multiple other health domains . Several trials which address whether the amount of qigong practice contributes to outcomes within the trial have shown that benefits are related to amount of practice [10,14]. While meta-analyses and other forms of overview analysis often acknowledge that this factor probably matters, few currently stratify analysis around this factor.
The cases reported here involve heterogenous presentations with respect to pain diagnoses, durations and comorbidities, yet all report remarkable and multiple health benefits from extended practice of qigong. Additional case reports attest to remarkable health benefits in chronic pain conditions with long-term qigong practice [16,17,18]. The merit of reporting such real-world experiences is that clinical trials do not examine durations of practice such as those encountered here due to multiple pragmatic factors. Controlled trials of 6-12 months duration are feasible and common, and can compare outcomes to various control groups and to other approaches; they can also address practice thresholds for clinically meaningful benefits in particular health conditions, and determine outcomes in those who adhere to recommended amounts of practice compared to those who engage in minimal practice. In view of outcomes reported here, clinical trials also should incorporate extensions for those who experience benefits during the controlled portion of the trial, allowing for participants to engage in long-term practice and record real-world experiences. Thus, it is this subpopulation who will be motivated to explore possibilities and to engage in extended practice. Furthermore, qigong trials, both controlled and extended, should routinely consider recording qualitative comments in addition to quantitative measures in order to capture the full range of participant experiences. In view of the range of beneficial responses recorded here, mechanistically, qigong must influence multiple regulatory mechanisms that lead to better integrated function of the organism, and exploration of such mechanisms is now occurring . Qigong has both “eastern” (traditional) and “western” (contemporary) presentations, and investigators will need to develop a sense of “bi-culturality” in exploring its effects .
In summary, extended qigong practice: 1) produces improvements in pain, pain control, sleep, and other health areas; 2) improves quality of life, increases energy and activity, improves mood, and decreases use of medications; 3) cultivates an improved outlook on life and the future as an overall effect. These benefits had not been attained by conventional medical treatments over the many years prior to participants starting their qigong, and this makes it essential that continued exploration of the health benefits of qigong takes place. The multi-modal nature of benefits may make it particularly suitable for those with challenging health conditions.
LC conducted data collection and analysis for RIM2, and assisted in manuscript writing. MP conducted data collection and analysis for RIM1. ML assisted in trial design and participant recruitment. DM provided CFQ instruction to participants. JS assisted in trial design and data analysis, and drafted the manuscript. All authors have approved the content of the manuscript.
DM provides community-based instruction in CFQ in Halifax, Nova Scotia. All other authors declare that no competing interests exist.
- Larkey L, Jahnke R, Etnier J, Gonzalez J. Meditative movement as a category of exercise: implications for research. J Phys Act Health. 2009; 6: 230-238. [CrossRef]
- Payne P, Crane-Godreau MA. Meditative movement for depression and anxiety. Front Psychiatry. 2013; 4: 71. [CrossRef]
- Schmalzl L. Crane-Godreau MA, Payne P. Movement-based embodied contemplative practices: definitions and paradigms. Front Hum Neurosci. 2014; 8: 205. [CrossRef]
- Zou L, Pan Z, Yeung A, Talwar S, Wang C, Liu Y, et al. A review study on the beneficial effects of Baduanjin. J Altern Complem Med. 2018; 4: 324-335. [CrossRef]
- Marks R. Qigong exercise and arthritis. Medicines. 2017; 4: 71. [CrossRef]
- Zou L, Yeung A, Quan X, Boyden SD, Wang H. A systematic review and meta-analysis of mindfulness-based (Baduanjin) exercise for alleviating musculoskeletal pain and improving sleep quality in people with chronic diseases. Int J Environ Res Public Health. 2018; 15: 206. [CrossRef]
- Zou L, Yeung A, Li C, Wei GX, Chen KW, Kinser PA, et al. Effects of meditative movements on major depressive disorder: A systematic review and meta-analysis of randomized controlled trials. J Clin Med. 2018; 7: 195. [CrossRef]
- Guo L, Kong Z, Zhang Y. Qigong-based therapy for treating adults with major depressive disorder: A meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2019; 16: 826. [CrossRef]
- Lynch M, Sawynok J, Hiew C, Marcon D. A randomized controlled trial of qigong for fibromyalgia. Arthritis Res Ther. 2012; 14: R178. [CrossRef]
- Neergaard MA, Olesen F, Andersen RS, Sondergaard J. Qualitative description-the poor cousin of health research? BMC Med Res Methodol. 2009; 9: 52. [CrossRef]
- Dorfman D, George MC, Robinson-Papp J, Rahman T, Tamler R, Simpson DM. Patient reported outcome measures of pain intensity: Do they tell us what we need to know? Scand J Pain. 2016; 11: 73-76. [CrossRef]
- Sawynok J, Lynch M. Qigong and fibromyalgia, circa 2017. Medicines. 2017; 4: 37. [CrossRef]
- Chan JSM, Ho RTH, Chung KF, Wang CW, Yao TJ, Ng SM, et al. Qigong exercise alleviates fatigue, anxiety, and depressive symptoms, improves sleep quality, and shortens sleep latency in persons with chronic fatigue syndrome-like illness. Evid-Based Compl Alt Med. 2014; 2014: 106048. [CrossRef]
- Liu SJ, Ren Z, Wang L, Wei GX, Zou L. Mind-body (Baduanjin) exercise prescription for chronic obstructive pulmonary disease: Asystematic review with meta-analysis. Int J Environ Res Public Health. 2018; 15: 1830. [CrossRef]
- Baumgarden J, Klein P, Picard G. Qigong and a tale of two back complaints. Medicines. 2018; 5: 60. [CrossRef]
- Sawynok J. Qigong and chronic pain: Three cases of pain resolution, other health benefits and improved vision with long-term practice of qigong. Fibrom Open Access. 2016; 1: 111.
- Sawynok J, Hiew C, Marcon D. Chaoyi Fanhuan. Qigong and fibromyaglia: Methodological issues and two case reports. J Altern Complem Med. 2013; 19: 383-386. [CrossRef]
- Liang F, Huang Q, Chen R, Qu S, Lu G, Liu J, et al. Healthcare-Related qigong for the prevention of lifestyle-related diseases. OBM ICM. 2017; 2. doi: 10.21926/obm.icm.1702002. [CrossRef]
- Klein P, Picard G, Baumgarden J, Schneider R. Meditative movement, energetic, and physical analyses of three qigong exercises: unification of eastern and western mechanistic exercise theory. Medicines. 2017; 4: 69. [CrossRef]