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.
Klein, P.J., Schneider, R., & Rhoads, C.J. (2016). Qigong in cancer care: A systematic review and construct analysis of effective Qigong therapy. Supportive Care in Cancer, 24, 3209–3222.
STUDY PURPOSE: To assess the strength of evidence addressing qigong therapy in supportive cancer care and describe the definition of effective qigong therapy in supportive cancer care
TYPE OF STUDY: Systematic review
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Elder care
For the purpose of the reviewer’s comments, results were limited to the primary symptom of fatigue and two common concurrent symptoms, depression and fatigue. Five of the 11 studies included fatigue as an outcome measure. Measures improved significantly in groups using some form of qigong or tai chi intervention in four studies and showed no difference in the fifth study. Mixed benefits on depression were reported. No significant differences in sleep were reported. Constructs of qigong therapy were identified as slow, gentle, repetitious, flowing, weight-bearing movements, breath regulation, mindfulness, meditation, energy cultivation, and relaxation.
The authors reported growing research evidence that the practice of qigong has benefits for managing fatigue and improving quality of life in individuals with cancer. However, outcomes on mediation of inflammation/immune support, depression, anxiety, stress, mood, sleep, systolic blood pressure, and survival rate were reported as mixed, and, as only 4 or the 11 studies included samples from the U.S. (N = 389 of 831 participants included in the review [47%]), the validity of the conclusion is questionable for a broader to application to general supportive care across all populations with cancer.
Logically consistent operational and conceptual definitions of qigong are needed for future research. Additional evidence is needed prior to recommending qigong to be integrated into cancer care. Access to trained qigong practitioners is needed for application to research across broad populations of patients with cancer.
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.
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.
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.
Participants were undergoing the active antitumor treatment phase of care.
The study was a randomized, controlled trial.
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.
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.
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
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.
This was a double-blinded, randomized, controlled trial. Fatigue was the primary outcome and sleep quality and depression were secondary outcomes.
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.
QG/TCE showed significant improvement over time compared to SQG for fatigue. Both groups showed improvement for fatigue, depression, and sleep dysfunction
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.
Liu, C., Hsiung, P., Chang, K., Liu, Y., Wang, K., Hsiao, F., . . . Chan, C. (2008). A study on the efficacy of body-mind-spirit group therapy for patients with breast cancer. Journal of Clinical Nursing, 17, 2539–2549.
To examine the effects of body-mind-spirit group therapy on anxiety, depression, and holistic well-being among women with breast cancer
Patients in the control group received standard care. Patients in the experimental group received standard care plus 10 sessions of weekly group therapy, 180 minutes per session. Therapy integrated concepts and practices, such as qigong exercises of vital energy, massage, meditation, positive thinking, group mutual support, long-term survivors’ sharing, songs, home assignments, and exercises. These activities were based on traditional Chinese medicine, the Eastern philosophies of Taoism and Confucianism, and the practice of Buddhism. The goal of the activities were to manage physical, psychosocial, and spiritual distress. Sessions included qigong exercises provided for 20 minutes each week by a qigong master and body-mind-spirit group assignments that included sharing and singing. The qigong master facilitated the first 20 minutes of each session. Then the primary investigator and co-investigators, working as mental health nurses, managed the rest of each session. Co-investigators held a 90-minute focus group interview after the last group therapy session. They conducted the interview in Mandarin and transcribed it. A bilingual researcher translated the transcription.
A coinvestigator implemented the randomization so that the patients, physician, and primary investigator were blinded to the randomization process. The primary investigator conducted groups after randomization and completion of initial surveys. Participants completed a baseline questionnaire after informed consent. After two months of intervention, participants completed a postintervention questionnaire.
Mixed-methods design incorporating a randomized controlled trial and focus-group interviews
Culturally sensitive body-mind-spirit group therapy reduced anxiety among outpatients with breast cancer.
Mental health nurses who provide group therapy for patients with cancer could help to enhance quality of care in psycho-ontological nursing. Further research with older and younger women — as well as with patients in stages I, III, and relapse — are suggested.
Overcash, J., Will, K.M., & Lipetz, D.W. (2013). The benefits of medical qigong in patients with cancer: A descriptive pilot study. Clinical Journal of Oncology Nursing, 17, 654–658.
To determine if medical Qigong changed fatigue, depression, and sleep in patients with cancer and survivors
Participants were asked to review and complete a packet of information with instruments before their first class and after their last class. They were involved in a one and a half-hour class for five weeks that included the history of Qigong and movements for relaxation that they were encouraged to perform on their own.
Descriptive pre- and post-test design
Of the 38 participants, 38 completed the preintervention, 22 completed the postintervention, 16 did not attend the class, 15 completed the pre/post PSQI, and 19 completed the CES-D and BFI. There was a reduction in depression. The study found only CES-D scores to be improved postintervention, and all the scores were more favorable after the classes. Sleep scores were improved after classes.
This pilot study indicated a reduction in depression with the use of medical Qigong after five weeks. This is shorter than other studies in the literature that were performed over a 12-week period. The findings are limited by the small sample size.
Complementary and alternative medicine therapies are an alternative to offer patients for symptom management, especially to potentially help with depression. Nurses can educate patients about these types of alternatives to alleviate the symptoms of cancer treatment and its aftereffects. The findings of this study were limited by the sample size and high rate of patients who did not participate and did not show the effects of the intervention.