Qigong and Fibromyalgia: Randomized Controlled Trials and Beyond

Table 2

Summary of other studies of qigong for fibromyalgia.

Study; Participants, features	Intervention, duration	Outcomes
(1) Creamer et al. 2000 [34]; Pilot study, open trial; Mean age: 47.9 yrs; Attrition: 8/28 (29%) did not complete 5/8 sessions; Note: (1) No control group.; (2) Data following intervention was also reported by Singh et al. (1998) [35]	Attendance at 8 weekly sessions (2.5 hrs each), with educational and cognitive/behavioural component (30 min), relaxation/meditation (60 min), qigong (60 min, form not specified); Duration: 8 weeks; Measures: BL, 8 wks, 4 mos F-UP, 6 mos F-UP	Significant () improvements in FIQ, sleep, patient global, RAND Health Survey (physical function, energy, emotional function, social function, and pain), coping, depression, and function following the intervention. Benefits were generally maintained at 4 and 6 months from BL.; Note: (1) Intent-to-treat analysis of results. (2) Due to multiple interventions during the weekly session, it is not possible to ascribe effects specifically to qigong.
(2) Chen et al. 2006 [36]; Pilot study, open trial; Mean age: 49.8 yrs; Mean FM duration: 6.2 yrs; Attrition: 3/13 (23%) dropped out after 1–3 sessions; data for analysed postintervention; returned for 3 mos F-UP; Note: No control group.	External qigong therapy applied for 5–7 sessions (45 mins) over 3 wks; monthly maintenance session; Intervention duration: 3 weeks; Measures: BL, 3 wks, 1 mo F-UP, 3 mos F-UP	Significant improvements in impact (FIQ), depression (BDI), pain (MPQ, VAS), and anxiety following the intervention. Changes were maintained at 1 and 3 months, although there was some rebound. Pre-post SMD values were 1.1–1.9 at 3 wks, 0.7–1.7 at the 1 mo F-UP, and 0.8–1.4 at the 3 mos F-UP. Sleep (PSQI) scores were not significantly improved.; Note: Two cases had such dramatic and persistent benefit following treatment that they were considered “cured.” Individual outcomes for FIQ, tender points, MPQ, and BDI are presented and indicate minimal post-treatment symptomology.
(3) Lynch et al. 2009 [37]; Pilot study, open trial; Mean age: 51.1 yrs; Mean FM duration: 12.0 yrs; Attrition: 21 (91%) completed 4 wks, 14 (61%) 9 wks, 13 (52%) 3 mos, and 12 (52%) 6 mos.; Note: No control group.	Two half-day (4 hrs) qigong training sessions (level 1 CFQ), weekly review/practice session (90 min), daily home-practice (45 min).; Intervention duration: 9 wks; Measures: BL, 9 wks, 3 mos F-UP, 6 mos F-UP; Note: (1) Level 1 CFQ consists of movements. (2) No measure of home-practice was included.	Significant improvements in pain (NRS), impact (FIQ), and physical function (SF-36), either following treatment or at F-UP.; Note: (1) Analysis conducted on who completed the 6- month trial. (2) Pre-post SMD values for pain, impact, and physical function were 0.6–0.9 following the intervention and at follow-up.
(4) Sawynok et al. 2013 [38]; Case reports,; Age: #1 = 45 yrs, #2 = 57 yrs; FM duration: #1 = 10 yrs, #2 = 20 yrs; Note: (1) Both cases had extensive symptomology (pain, disturbed sleep, and multiple other symptoms) that had progressed over time. (2) Both had previously tried many other therapies (pharmacological, nondrug, complementary methods) but remained symptomatic.	Extensive qigong practice (levels 1 and 2 CFQ). Both attended an initial 8-day workshop in 2008 and subsequently practiced daily for an extended interval (≥1 hr for 6 mos); one undertook repeat training/practice sessions. In 2009 and 2010, both attended additional workshops (8–10 days) and continued extensive daily practice (1.5–3 hrs/day) at times.; Note: (1) Level 1 CFQ consists of movements, while level 2 CFQ consists of meditative practice. (2) These individuals undertook extensive amounts of self-practice of qigong. Motivation to engage and continue came from initial health benefits experienced.	Case  1: initially, less pain, tension, anxiety; over next few months other treatments ceased (antidepressant, massage, chiropractic) and resumed eating foods that she was allergic to; blood pressure normalized. 1 yr F-UP: all medications and supplements had ceased; tooth and jaw pain resolved; sleep improved. 3 yr F-UP: no body-wide pain since 1 yr after starting; pain occasional and localized; tension headaches gone; cognition, sleep, fatigue, mood, skin, and circulation all improved; employment resumed.; Case  2: initially, improved energy and bladder and bowel function; by 6 mos, vast improvement in pain and other symptoms. 1+ yr F-UP: improvement in vision at 8 mos; resumed full-time work. 3+ yr F-UP: resumed eating foods that she was allergic to stopped taking supplements, amitriptyline; resumed her life.; Note: (1) Only qualitative comments are available. (2) The range of symptoms that resolve with extended qigong practice is of particular interest.
(5) Sawynok et al. 2013 [39]; Extension trial,; Some trial completers from RCT [29] participated in a 6-month extension phase.; Mean age: 53 yrs; Mean FM duration: 11.5 yrs; (extracted from RCT); Attrition: 7/20 (35%) withdrew; Note: (1) For those completing this trial, 5/13 (38%) had voluntarily undertaken additional qigong training prior to the extension phase. (2) Both quantitative and qualitative outcomes were recorded.	Two half-day (4 hrs) qigong sessions (level 2 CFQ), weekly review/practice session (60 min), daily home-practice (60 min) for 8 wks. Home-practice mix of levels 1 and 2 CFQ.; Duration: 8 wks; Measures: BL, 8 wks, 4 mos F-UP, 6 mos F-UP; Note: (1) Level 2 CFQ consists of meditation instructions. (2) Practice times self-reported at 8 wks and 4 and 6 mos (via checklist of times).	Quantitative measures: For extension trial completers, there were significant reductions in pain (NRS) and impact (FIQ) and improvements in sleep (PSQI) and physical function (SF-36 physical) compared to baseline. Similar quantitative changes observed in those who had voluntarily undertaken additional training () and those who had not (). The former had milder baseline symptomology than the latter.; Qualitative responses: These were considered separately for and subgroups. Narrative comments noted benefits in pain, sleep, physical and mental function, and quality of life as assessed in quantitative measures in the subgroup; comments were more tempered for the subgroup. There were also health benefits in other areas (food allergies, chemical sensitivities, asthma, migraines, blood pressure, and vision) in the subgroup; several discontinued medications (for migraine, asthma, sleep, and pain); additional benefits were not noted by the subgroup.; Note: (1) The subgroup reported the highest home-practice times at 8 wks (~60 min/day), and this was maintained to 6 mos. The subgroup had lower home-practice times at 8 wks (~40 min/day), and this faded over time (~20 min/day). (2) For some in the subgroup, open-ended comments indicated home-practice times of 10–15 hrs/week at some stages.
(6)Sawynok and Lynch 2014 [40]; Retrospective qualitative analysis of comments by participants who completed the RCT [29].; Note: Analysis considered; (a) narrative comments of extension trial completers versus noncompleters and (b) thematic comments by those who practiced per protocol, minimally, or an intermediate amount.	No additional qigong practice. Retrospective analysis of initial 6- month experience with practice of level 1 CFQ. Post hoc consideration clustered around (a) motivation/perseverance and (b) amount of practice.; Note: Per protocol practice: >5 hrs/wk; Minimal practice: <3 hrs/wk; Intermediate practice: >3 <5 hrs/wk	Narrative comments: There was a difference in initial qigong experiences by those who completed the extension trial () versus those who did not complete the extension (), with more favourable health effects reported by completers. Comments recapitulate quantitative measures but also cover other areas.; Thematic comments: There was a clear difference in comments on pain, sleep, and quality of life, by those who practiced per protocol versus those who practiced minimally, and these reflect quantitative differences between the two groups. Those who practiced an intermediate amount also had positive comments on experiences, but there was a difference in tone (more moderated) compared to those who practiced per protocol.

BDI, Beck Depression Inventory; BL, baseline; CFQ, Chaoyi Fanhuan Qigong; FIQ, fibromyalgia impact questionnaire; FM, fibromyalgia; F-UP, follow-up; hrs, hours; mo, month; min, minute; MPQ McGill pain questionnaire; NRS, Numerical Rating Scale; PSQI, Pittsburgh Sleep Quality Index; RCT, randomized controlled trial; SF-36, Short Form-36; SMD, standard mean difference; VAS, Visual Analog Scale; wk(s), week(s); yrs, years.