Body-Mind-Spirit Therapy/Qigong

Body-Mind-Spirit Therapy/Qigong

PEP Topic 
Fatigue
Description 

Body-mind-spirit therapy incorporates ideas and approaches from western medicine, Chinese medicine, and philosophies of Buddhism, Taoism, and Confucianism. Qigong is a traditional Chinese discipline involving the practice of aligning breath, movement, and awareness to cultivate and balance qi (chi) or life energy. Medical qigong is a form of the discipline designed to improve health. It incorporates practice of gentle exercise coordinated with relaxation through meditation and breathing. Efficacy of these approaches was evaluated for fatigue, mood status, sleep-wake disturbances, lymphedema, and cognitive impairment.
 

Effectiveness Not Established

Research Evidence Summaries

Campo, R.A., Agarwal, N., Lastayo, P.C., O'Connor, K., Pappas, L., Boucher, K.M., . . . Kinney, A.Y. (2013). Levels of fatigue and distress in senior prostate cancer survivors enrolled in a 12-week randomized controlled trial of Qigong. Journal of Cancer Survivorship, Research and Practice, 8, 60-69.

doi: 10.1007/s11764-013-0315-5
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Study Purpose:

To examine the feasibility and efficacy of a Qigong intervention for improving older prostate cancer survivors’ levels of fatigue and distress

Intervention Characteristics/Basic Study Process:

Qigong intervention twice weekly sessions for 12 weeks led by Qigong master for one hour with DVD provided for home practice. Qigong incorporated standing and sitting exercise, with increased standing exercise with each session. Exercises included five minutes of meditative breath at the beginning and end of each session, opening of the nine gates, muscle change, cavity presses, collecting energy of heaven and earth, rocking chair, Tai Chi ruler, hands skimming the water, pushing and pulling space, cloud hands, body weight resistance

Stretching intervention led by instructors from the exercise and sport science department twice weekly for one hour for 12 weeks. Avoided movement similar to meditation; used sitting and standing that increased intensity with each session. A DVD also was provided for home practice.

Sample Characteristics:

  • N = 29    
  • MEAN AGE = 72 years
  • MALES: 100
  • KEY DISEASE CHARACTERISTICS: Prostate cancer, five-year median diagnosis, 48% on ADT
  • OTHER KEY SAMPLE CHARACTERISTICS: No significant difference was noted between those who completed and those who withdrew from intervention.

Setting:

  • SITE: Single site  
  • SETTING TYPE: Multiple settings  
  • LOCATION: Survivorship and wellness center as well as and home practice

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Multiple phases of care
  • APPLICATIONS: Elder care 

Study Design:

  • Non-blinded RCT, active control

Measurement Instruments/Methods:

  • FACIT–Fatigue
  • Brief Symptom Inventory
  • Borg scale
  • Self-report
  • Class attendance and retention

Results:

Baseline fatigue between groups was not statistically different. Change in fatigue from baseline was statistically improved in the Qigong group compared to the stretch group (p = .02). Home practice reports were not significantly different. Sixty-nine percent in the Qigong arm had a minimally important difference of 3 or more points compared to 38% in stretching. BSI score between groups was significantly different for somatization (p = .048), anxiety (p = .003), and global severity index (p = .002).

Conclusions:

Fatigue and distress were improved in the Qigong group compared to stretching. High attrition was noted in both groups.

Limitations:

  • Small sample (< 30)
  • Risk of bias (no blinding)
  • Findings not generalizable
  • Subject withdrawals ≥ 10%

Nursing Implications:

Qigong as an intervention is a low-risk option for treating fatigue in patients with prostate cancer. Larger RCTs are needed.

Chen, Z., Meng, Z., Milbury, K., Bei, W., Zhang, Y., Thornton, B., . . . Cohen, L. (2013). Qigong improves quality of life in women undergoing radiotherapy for breast cancer: results of a randomized controlled trial. Cancer, 119, 1690–1698.

doi: 10.1002/cncr.27904
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Study Purpose:

To evaluate whether patients with breast cancer undergoing radiotherapy (RT) who practiced qigong would report better quality of life, less fatigue, and less sleep disturbance than did patients in a control group.

Intervention Characteristics/Basic Study Process:

Patients were randomly assigned to a group that received a qigong intervention or to a wait-list control group. Patients were assigned to cohorts to prevent group contamination during the study. Each week, the qigong group participated in five classes lasting 40 minutes each during RT. These patients received printed materials and a DVD of the qigong program. Patients were encouraged to practice qigong techniques on their own. The intervention included relaxation breathing, meditation, walking in a circle while breathing in sync with arm movement, and self-massage. The control group received standard care. Assessments were performed at baseline, in the middle of the RT schedule, during the last week of RT, and at one and three months after treatment.

Sample Characteristics:

  • The sample was comprised of 95 participants (100% female).
  • Mean age was 45 years (range 25–62).
  • All participants had breast cancer.
  • Most participants had stage II or stage III disease.
  • All participants had undergone mastectomy or lumpectomy.
  • Of the participants in both groups, 78% were receiving 25 RT fractions.
  • Most participants were married, and 52.5% had some college or higher education.

Setting:

  • Single site
  • Multiple settings
  • China and the United States

Phase of Care and Clinical Applications:

Participants were undergoing the active antitumor treatment phase of care.

Study Design:

The study was a randomized, controlled trial.

Measurement Instruments/Methods:

  • Brief Fatigue Inventory (BFI)
  • Center for Epidemiologic Studies Depression (CESD) Scale 
  • Pittsburgh Sleep Quality Index (PSQI)
  • Functional Assessment of Cancer Therapy-General (FACT-G)
  • Salivary cortisol samples taken for two consecutive days at waking, 45 minutes after waking, 45 minutes later, eight hours later, and at bedtime

Results:

  • Time had a significant effect in reducing depression, with a significantly greater effect in the qigong group (p = 0.05); however, no significant differences were observed between groups at any time point.
  • Participants with low measures of depression symptoms at baseline showed no significant differences in fatigue, regardless of group. At the end of the study, of participants who had had high measures of depression symptoms at baseline, those in the qigong group had measures of fatigue that were significantly lower (p < 0.05; 2.93 versus 4.19) than those in the control group.
  • No differences were observed between groups in sleep quality, and there was no interaction of depression symptoms with sleep measures.
  • One-third of participants attended 100% of the sessions and 78.3% attended more than 50% of the sessions. Attendance ranged from five to 30 sessions.
  • Sessions involved one to 10 people at a time.
  • No differences were observed between groups in regard to cortisol measures.

Conclusions:

Practicing qigong appears to be beneficial in reducing fatigue and depression during RT and appears to be of most benefit to women with high measures of depression symptoms.

Limitations:

  • The study had a small sample size, with less than 100 participants.
  • The study had risks of bias due to no blinding and no appropriate attentional control condition.
  • Adherence varied. No information was provided regarding participants' qigong practice outside the treatment group.
  • The study was inconclusive in regard to the effectiveness of qigong itself versus the potential effect of the group activity involved in the qigong intervention.
  • Follow-up time was limited.

Nursing Implications:

Qigong, a type of mind-body discipline, appears to have benefit in reducing fatigue and depression over time, particularly among women who have high measures of depression symptoms. Effects were not seen until after RT completion.

Larkey, L.K., Roe, D.J., Weihs, K.L., Jahnke, R., Lopez, A.M., Rogers, C.E., . . . Guillen-Rodriguez, J. (2014). Randomized controlled trial of qigong/tai chi easy on cancer-related fatigue in breast cancer survivors. Annals of Behavioral Medicine. Advance online publication. 

doi: 10.1007/s12160-014-9645-4
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Study Purpose:

To compare a meditative movement practice, Qigong/Tai Chi Easy (QG/TCE), with sham Qigong (SQG), testing the effects of the meditation/breath aspects of QG/TCE on breast cancer survivors’ persistent fatigue and other symptoms

Intervention Characteristics/Basic Study Process:

Hour-long sessions held twice weekly taught breast cancer survivors QE/TCE or SQG for 12 weeks measuring the effect on fatigue, depression, and sleep. Participants were asked to practice at home at least 30 minutes per day.

Sample Characteristics:

  • N = 87  
  • AGE RANGE = 40–75 years
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Breast cancer
  • OTHER KEY SAMPLE CHARACTERISTICS: Stages 0–III; the majority of participants were educated at the level of at least some college and were at higher income levels. 90% were white and non-Latino.

Setting:

  • SITE: Single-site    
  • SETTING TYPE: Outpatient    
  • LOCATION: Mayo Clinic Cancer Center, Scottsdale, AZ

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Late effects and survivorship

Study Design:

This was a double-blinded, randomized, controlled trial. Fatigue was the primary outcome and sleep quality and depression were secondary outcomes.

Measurement Instruments/Methods:

  • Fatigue Symptom Inventory (FSI)
  • The Pittsburgh Sleep Quality Index (PSQI)
  • Beck Depression Inventory (BDI)

Results:

Fatigue decreased in the QG/TCE group compared to the SQG group at postintervention and at the three-month follow-up (p = .024). However, fatigue declined significantly in both groups. Depression and sleep quality did not demonstrate improvement in the QG/TCE group compared to the SQG group at the post-intervention and at the three-month follow-up.

Conclusions:

QG/TCE showed significant improvement over time compared to SQG for fatigue. Both groups showed improvement for fatigue, depression, and sleep dysfunction

Limitations:

  • Small sample (< 100)
  • Findings not generalizable
  • Subject withdrawals ≥ 10%
  • Other limitations/explanation: Blinding of the session instructors is identified as a limitation. The instructors could have unintentionally made a difference in the delivery of the interventions and outcomes. There is a concern that the contrast between the two interventions may have not been enough. The sham intervention is not described fully. There was a greater than 15% drop-out rate with no intent to treat analysis.

Nursing Implications:

Low-intensity exercise may be beneficial in reducing a number of symptoms and improving the well-being of cancer survivors. This study demonstrates that QG/TCE’s focus on meditative movement with a focus on breath appears to have an advantage for improving breast cancer survivors' persistent fatigue. A larger sample and longer intervention time is needed.


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