Qigong and Fibromyalgia: Randomized Controlled Trials and Beyond
Table 1
Summary of randomized controlled trials (RCTs) of qigong for fibromyalgia. Control groups include passive (normal activities, wait-list) and active groups (education, aerobic exercise, sham exercise, and other interventions).
Study Participants, study features
Intervention, duration, measures
Outcomes
Between group comparisons, except where indicated
(1) Astin et al. 2003 [31] ; QG + MM CG (education support) Mean age: 47.7 yrs Mean FM duration: 5.0 yrs Attrition: 50 (39%) by 8 wks, 61 (48%) by 16 wks, and 67 (49%) by 24 wks Note: The 1st controlled study of QG for fibromyalgia.
Intervention: QG (Dance of Phoenix), mindfulness meditation (MM); 2.5 hr total (QG = 60 min), weekly group session Duration: 8 wks Measures: BL, 8 wks; 4 and 6 mos F-UP
Post-intervention
Follow-up
FIQ
NS
NS
Total myalgic score
NS
NS
SF-36 pain
NS
NS
6 min walk test
NS
NS
Depression (BDI)
NS
NS
Note: (1) Due to high attrition, only those completing the entire protocol were analysed. (2) Within-group comparisons at 8 wks and 4 and 6 mos indicate that both groups had significant improvements over time in FIQ, total myalgic score, SF-36 pain, and depression; effects were manifest at 8 wks and maintained to 24 wks.
(2) Mannerkorpi and Arndow 2004 [32] ; QG + BA CG (normal activities) Mean age: 45 yrs Mean FM duration: 10 yrs Attrition: 14 (39%)
Intervention: QG (style not reported), body awareness (BA) therapy; 1.5 hr total (QG = 20 min), weekly group session Duration: 3 mos (14 sessions) Measures: BL, 3 mos Note: Participants were encouraged to practice at home, but none regularly performed home exercises.
Post-intervention
BARS
FIQ
NS
Handgrip test
NS
Chair test
NS
Note: (1) Due to attrition, only 12 + 10 participated in post-test outcomes. (2) Within-group BARS analysis indicated significant changes in treatment group but not control group; within-group FIQ total score analysis indicates significant changes in control group but not treatment group.
(3) Stephens et al. 2008 [33] ; QG CG (aerobic exercise) Mean age: 13.3 yrs Attrition: 6 (20%) Note: The 1st controlled trial of QG as exercise intervention in children and adolescents with FM.
Intervention: QG exercises (18 postures, style not reported) versus aerobic exercise; 30 min of practice in 1 group session + 2 home sessions each week Duration: 3 mos Measures: BL, 3 mos Note: Adherence monitored by heart rate monitors and diary entries (noted as 60–70%)
Post-intervention, there were significant improvements in physical function, functional capacity, QOL, and fatigue in the aerobics group. Aerobic function, tender point count, pain, and symptom severity improved similarly in both groups; the aerobics group performed better in several measures compared to the QG group. Note: (1) The study addressed both physical fitness and clinical symptoms and monitored multiple outcomes. (2) Intent-to-treat analysis was used.
(4) Haak and Scott 2008 [27] ; QG CG (wait-list) Mean age: 53.3 yrs Mean FM duration: 15.4 yrs Attrition: 1 (2%) Note: At the end of the wait-list interval, subjects received QG training and constituted a delayed training cohort.
Intervention: QG (He Hua Qigong) 11.5 hrs instructions/practice over 7 wks; encouraged to practice at home (2 × 20 min/day); subjects also had 2 external QG sessions Duration: 7 wks Measures: BL, 8 wks, 4 mos F-UP Note: At postintervention, the combination group had high compliance with 93% reporting regular (3–6 days/wk) or daily practice. At 4 mos F-UP, 65% were still practicing and 90% of those on a regular-daily basis.
Between-group
Within-group P values
Pain (VNS)
Cohen’s d
Pre-post
Pre-F-UP
Intensity
0.63
<0.001
<0.05
Inconvenience
0.73
<0.01
<0.05
Control of pain
0.61
<0.01
NS
Sleep (VNS)
Restoration
0.44
<0.001
<0.01
Quality
NS
<0.001
<0.01
Psychological
STAI (anxiety)
0.66
<0.05
<0.01
BDI (depression)
0.69
<0.01
<0.001
QOL total
0.55
<0.001
<0.01
QOL psychological
0.52
<0.001
<0.001
QOL physical
NS
<0.01
<0.001
Note: (1) Many between-group effect sizes following the intervention are in the moderate-to-large range (0.5–0.8). (2) Combination group data reports postintervention and longer-term outcomes for subjects. (3) While benefits are sustained over time, SMDs at follow-up compared to BL range from 0.2 to 0.7.
(5) Liu et al. 2012 [28] ; QG CG (sham exercise) Mean age: 56.5 yrs Mean FM duration: 9.4 yrs Attrition: 12.5% (2/8) in intervention group Note: This is the only study to use sham exercise as a comparison.
Intervention: QG (Liu Zi Jue Qigong, “Six Healing Sounds”), 2 training sessions, weekly group sessions (45–60 min), daily home-practice (2 × 15–20 min, morning and evening). Sham had the same movements, but no meditation or healing sounds. Duration: 6 wks Measures: BL, 6 wks
Pre-post QG
Pre-post Sham
SF-MPQ (pain)
↓44% ()
↓10% (NS)
MFI (fatigue)
↓25% ()
↓6% (NS)
PSQI (sleep)
↓37% ()
↓10% (NS)
FIQ (impact)
↓44% ()
↓12% (NS)
Note: (1) Between-group Cohen’s d for pain, fatigue, sleep, and impact was 1.56, 1.58, 0.99, and 1.98, respectively. (2) Trial is limited by the small sample size and lack of follow-up data.
Note: Participants asked to keep diary of home-practice. Compliance was moderately high (75–85% daily, 77–79% group sessions).
(6) Lynch et al. 2012 [29] ; QG CG (wait-list) Mean age: 52 yrs Mean FM duration: 9.6 yrs Attrition: 12% (12/100) at 6 mos; 29% (12/42) delayed intervention group Note: (1) The largest QG for FM trial to date. (2) At the end of the wait-list interval, subjects received QG training and constituted a delayed training cohort.
Intervention: QG (Chaoyi Fanhuan Qigong, CFQ); 3 half-day training sessions (4 hrs each); weekly review/practice session (60 min); daily home-practice (45 mins) Duration: 8 wks Measures: BL, 8 wks, 4 and 6 mos F-UP Note: (1) Compliance with practice was reported as average weekly practice time at 8 wks and at 4 and 6 mos F-UPs. (2) For all who completed the 6-month trial, 85% (62/73) practiced ≥ 3 hrs/week and 52% (38/73) ≥5 hrs/week at 8 wks.
Post-QG
4 mo F-UP
6 mo F-UP
NRS (pain)
imm
<0.001
0.01
<0.05
del
0.01
0.005
<0.05
FIQ (impact)
imm
<0.001
0.003
0.007
del
<0.001
0.01
0.05
PSQI (sleep)
imm
0.001
<0.001
0.003
del
0.009
NS*
NS*
SF-36 physical
imm
<0.001
<0.001
0.004
del
<0.01
<0.001
0.01
SF-36 mental
imm
0.002
NS
NS
del
0.004
NS
NS*
Note: (1) Individual QG groups (imm, del) showed good reproducibility when compared to wait-list. (2) in combination group analysis. (3) Combination group data reports post-intervention and follow-up data for the who completed the trial to 6 months; it includes participants from both the immediate and the delayed intervention groups. (4) Combination group SMD values compared to wait-list are 0.81 (0.67, 0.56 at F-UP) for pain, 1.16 (0.63, 0.57 at F-UP) for impact, 0.71 (0.60, 0.52 at F-UP) for sleep, 0.80 (0.72, 0.56 at F-UP) for physical function, and 0.79 (0.23, 0.49 at F-UP) for mental function. (5) In the per protocol group (practiced ≥5 hrs/week at 8 wk), SMD values versus wait-list are pain 1.17 (0.96, 0.93 at F-UP), impact 1.67 (0.88, 0.88 at F-UP), sleep 1.04 (0.97, 0.71 at F-UP), physical function 0.95 (0.93, 0.79 at F-UP), and mental function 1.07 (0.39, 0.62 at F-UP).
(7) Maddali Bongi et al. 2012 [30] (RM + QG ; QG + RM ) CG (RM over the first 7 weeks) Mean age: 57.3 yrs Mean FM duration: 7.2 Attrition: 0% once training commenced (but 8/38 withdrew following randomization)
Note: (1) Comparative trial between
two active methods considered as “mind-body” practices. Both groups represent potentially active interventions. (2) Initial 7 weeks is comparison trial; the remainder of study represents a crossover trial but can also be considered an add-on trial.
Group1: RM + QG Group2: QG + RM 7 wks (1 wk break) + 7 wks 2 sessions/week for wks 1–3 1 session/week for wks 4–7 (total 10 sessions, 45–60 mins) RM: home exercise of 30 min/day during intervention Duration: 15 wks, F-UP 12 wks after completing the 2nd method Measures: BL, 7 wks (T1), 15 wks (T2), 27 wk F-UP Note: (1) Detailed description of QG and RM provided (QG style not specified). (2) RM practiced daily for 30 mins, but this was not specified for QG.
Pre-post P values (within group)
Group 1: RM + QG
After RM
After QG
F-UP
FIQ
<0.001
<0.001
<0.001
HAQ
<0.001
<0.001
<0.001
NRS (pain)
<0.001
<0.001
<0.001
RPS (pain)
<0.001
<0.001
<0.001
NRS (sleep)
NS
NS
NS
HADS-A
<0.001
<0.001
<0.001
HADS-D
NS
<0.001
<0.001
SF-36 PCS
<0.001
<0.001
<0.001
SF-36 MCS
NS
NS
NS
Group 2: QG + RM
After QG
After RM
F-UP
FIQ
<0.05
<0.001
<0.05
HAQ
<0.001
<0.001
<0.001
NRS (pain)
<0.001
<0.001
<0.001
RPS (pain)
<0.001
<0.001
<0.001
NRS (sleep)
NS
<0.05
NS
HADS-A
<0.001
<0.001
<0.001
HADS-D
<0.001
<0.001
<0.001
SF-36 PCS
<0.05
<0.001
<0.001
SF-36 MCS
NS
NS
NS
Note: (1) QG and RM produce comparable benefits compared to BL over a range of outcomes when applied as an initial intervention. When they are implemented as a sequential intervention, most outcomes are not different from the end of the first intervention. (2) Effects are generally maintained in the follow-up interval to 6 mos. (3) SMD values for FIQ, HAQ, RPS, HADS-A, HADS-D, and SF-36 PCS generally range from 0.7 to 1.5 in both groups (8 wks–6 mos).
BA, body awareness; BARS, body awareness rating scale; BDI, Beck Depression Inventory; BL, baseline; CG, control or comparison group; del, delayed intervention group; FIQ, fibromyalgia impact questionnaire; FM, fibromyalgia; F-UP, follow-up; HADS, Hospital Anxiety and Depression Scale (A-anxiety, D-depression); HAQ, health assessment questionnaire; hrs, hours; imm, immediate intervention group; MFI, Multidimensional Fatigue Inventory; MM, mindfulness meditation; mos, months; NRS, numerical rating scale; NS, nonsignificant (); PSQI, Pittsburgh Sleep Quality Index; QG, qigong group; QOL, quality of life; RM, Rességuier method; RPS Regional Pain Scale; SF-36, short form-36 (MCS mental component summary, PCS physical component summary); SF-MPQ, short form- McGill pain questionnaire; SMD, standard mean difference; STAI, State Anxiety Inventory; T1, treatment 1; T2, treatment 2; VNS, visual numerical scale; wks, weeks; yrs, years.
