Qigong | Cam-Cancer

Qigong

Abstract and key points

Qigong is an ancient Chinese therapy aimed at regulating the flow of “vital energy” in the body. It is mainly used as a symptomatic treatment for various types of complaints including those caused by cancer or cancer treatments.

Based on seven systematic reviews and five additional controlled clinical trials, the most convincing and consistent evidence is available for improvements in immune function, fatigue, quality of life, and sleep, and for depression for combined tai chi and qigong. For effects on other outcomes the evidence is heterogeneous or not significant. However, clinical trials generally have methodological limitations and there is heterogeneity in terms of clinical characteristics of the cohorts and assessed outcomes between trials. A cause-effect relationship between the intervention and the outcome remains therefore undocumented.

There are no major safety concerns related to qigong.

Document history

Most recently updated in March 2019 by Ava Lorenc
Revised and updated in June 2017 by Rachel Jolliffe.
Revised and updated in March 2015 by Rachel Jolliffe.
Most recently updated in May 2012 by Edzard Ernst. 
First published in April 2011, authored by Edzard Ernst.

Citation

Ava Lorenc, Rachel Jolliffe, Edzard Ernst, CAM-Cancer Consortium. Qigong [online document]. March, 2019.

What is it?

Description

Qigong is an ancient Chinese treatment. Two different types exist. Internal qigong refers to a physical and mental training method for achieving optimal health in both mind and body which has similarities with tai chi. External qigong refers to a treatment where qigong practitioners direct or emit “energy” to the patient with the intention to clear qi-blockages or to balance the flow of qi within that patient.

Ingredients

Qigong practitioners claim to use energy to heal patients. This “energy” is, however, not energy as defined by science and has so far not been measured reproducibly with scientific methods.

Application and dosage

Internal qigong is usually practised daily. Each session is 20 minutes to 1 hour long and supervised by a person experienced in qigong. External qigong is normally practised 1-2 times per week. Each session normally lasts 30-60 minutes, sometimes several hours.

History/providers

Qigong is part of traditional Chinese medicine (TCM) and shares its long history. Qigong teachers are often people with no medical background or training who have learnt the technique on a vocational basis.

Claims of efficacy/mechanism of action

According to TCM-philosophy, “qigong facilitates the movement of qi, the vital life energy, throughout the body, thereby enhancing health and healing disease”1. Normalizing the flow of qi energy, would, according to qigong proponents, be expected to be helpful for any type of illness, including cancer. Most qigong teachers would claim that this therapy is effective in symptom control rather than in changing the natural history of cancer. Some proponents, however, claim that Guolin Qigong can cure cancer.

In vitro experiments have suggested that external qigong induces apoptosis and inhibition of cancer cell invasion2-5. Animal experiments have implied that it inhibits tumour growth6. Some studies have suggested that it decreases leukopenia in breast cancer patients7.

Alleged indications

Qigong is often recommended for a wide range of conditions including musculoskeletal pain8, tinnitus9, stress10, burnout11, hypertension12 and anxiety13. The treatment is traditionally used by older patients14. In the area of cancer, the main indications are to alleviate the symptoms associated with cancer and cancer therapy, as well as improve quality of life and well-being.

Prevalence of use

In some Asian countries, e.g. China and Korea, qigong has a long tradition and is highly popular. In western countries, qigong is becoming more widely used. Precise prevalence figures are not available.

Legal issues

In some countries, e.g. the UK, it is illegal for qigong practitioners to claim to be able to cure cancer. In most countries, ‘qigong practitioner/teacher’ is not a protected title which means anybody, regardless of background, experience or training can adopt it.

Cost and expenditure

Internal qigong is often practised in groups and is thus normally inexpensive. External qigong is time-consuming and a practitioner may charge £50-100 (Euros 55-110) per session. Regular treatment is commonly advised.

Does it work?

Supportive/palliative care

Seven systematic reviews of qigong in cancer have been published and are described in table 115-21. They cover a range of outcomes and cancer types and include between nine and 23 studies. The most recent reviews were two reviews published in 2017 and one in 2016, all on various cancers.  One by Van Vu reviewed qigong only and included 15 randomized clinical trials and 8 controlled clinical trials15, and two included (and did not distinguish between) tai chi and qigong, one by Wayne et al of 15 randomized clinical trials16 and one by Klein et al of 11 RCTs17.  The review of qigong only did not perform a meta-analysis and the majority of included studies had a high risk of bias15. Wayne et al16 did conduct a meta-analysis, but their search methods were limited, and they found potential publication bias. Methodological bias was low in 12 studies and high in 3 studies. Klein et al17 searched only two databases, limited inclusion to RCTs with at least 15 participants per group and did not perform a meta-analysis.

Four RCTs (one pilot) and one non-randomized controlled trial have been published that are not included in any of the seven reviews. These trials are described in table 2.

Based on these seven systematic reviews and five additional controlled clinical trials, the most convincing and consistent evidence is available for improvements in fatigue, quality of life, sleep, immune function, and for depression for combined tai chi and qigong. For effects on other outcomes the evidence is heterogeneous or not significant. However, clinical trials generally have methodological limitations and there is heterogeneity in terms of clinical characteristics of the cohorts and assessed outcomes between trials. A cause-effect relationship between the intervention and the outcome remains therefore undocumented.

Mental health

For both depression and anxiety Van Vu et al15 found two studies showing no effect and one showing a significant effect. Mood disturbance was improved in one study. Klein et al17 also found mixed results for mental health. Wayne et al’s16 meta-analysis found significant improvements for depression, but they did not distinguish between tai chi and qigong.

A powered randomised controlled trial in breast cancer (n=158) explored qigong compared to a physical stretching exercise program22. They did not find improvements in anxiety or depression. This study had limitations including high attrition.

A relatively large (n=192) RCT reported increased cortisol levels in the qigong group compared to the waiting list group, indicating higher stress23. However, there were no perceived changes in stress amongst the participants and as exercise can increase salivary cortisol, the authors acknowledge that salivary cortisol may be an inappropriate measure of stress after an exercise intervention.

One randomised controlled trial of cancer survivors (various cancers; n=80) compared qigong to stress management and no intervention24. Heart rate variability improved significantly in both qigong and stress management compared to control, but there was no change in quality of life or fear of recurrence. However, participants had a wide range of survival periods, which differed between groups and may have affected results.

A pilot randomised controlled study in breast cancer (n=50)25 compared qigong to gentle exercise or survivorship support and found improvements in cognitive function and distress, but as a pilot, the study was designed to measure feasibility rather than effectiveness. 

Fatigue and sleep

Van Vu et al15 found that qigong significantly lowered fatigue in seven out of 10 trials. Wayne et al16 conducted a meta-analysis which found significant improvements for fatigue and sleep difficulty, but they did not distinguish between tai chi and qigong. The 2016 systematic review17 concluded that qigong can improve fatigue, from five studies (four of which were also included by Wayne et al), but not sleep (two studies).

Van vu et al15 found no significant effect of qigong on dyspnoea or pain, and mixed results on digestive symptoms.

Quality of life/wellbeing

Van Vu et al15 found 11 studies which measured quality of life. Seven studies showed a significant effect, four showed no effect. Wayne et al’s16 meta-analysis of 11 trials found significant improvements for quality of life, but they did not distinguish between tai chi and qigong. The 2016 systematic review by Klein et al (also tai chi or qigong)17 found improvements in quality of life in four of the five studies that measured quality of life (3 of which were also included by Wayne et al16), although all of the included studies had some potential for bias, particularly due to lack of blinding.  Older reviews also found improvements in quality of life for qigong20 and tai chi/qigong18.

Two RCTs from 2017/2018 found conflicting evidence - The breast cancer trial mentioned above comparing qigong to a physical stretching exercise program22 found significant improvements in quality of life, emotional wellbeing, and breast-cancer specific wellbeing another found no significant differences24.  

Immune function

Klein et al’s systematic review17 found strong evidence for immune function/biomarkers of inflammation. Previous reviews also found improvements in immune function for qigong19,20 and tai chi/qigong18.

An RCT by Chuang et al26 (This study is not in Table 2 as Wayne et al16 included this study, but they did not report immune outcomes) found qigong improved white blood cell counts. The trial mentioned above in breast cancer comparing qigong to a physical stretching exercise program22 found significant improvements in TNF-a levels.

Haemodynamics

One non-randomized controlled trial (n=23) found decreased upper limb circumference and increased blood flow in breast cancer patients with lymphedema27. Another trial (n=52) studied nasopharyngeal cancer survivors and found that the qigong group had higher blood flow velocity, lower arterial resistance, higher palmer skin temperature and better aerobic capacity then the control group receiving usual care28. This study is not in Table 2 as Van vu et al15 did include this study, but they did not report these outcomes. Small sample sizes and lack of randomization affect the quality of these trials.

Is it safe?

Adverse events

Van vu et al15 found that four trials reported qigong as safe, with no side effects. One trial reported four adverse events which may have been related to the qigong practice (recurrence of knee pain, and shoulder problems)25.

Contradictions

None on record.

Interactions

None on record. 

References
  1. Kemp CA. Qigong as a therapeutic intervention with older adults. J Holist Nurs 2004; 22: 351-73.
  2. Yan X, Chen H, Jiang H, Zhang C, Hu D, Want J et al. External Qi of Yan Xin Qigong differentially regulates the Akt and extracellular signal-regulated kinase pathways and is cytotoxic to cancer cells but not to normal cells. Int J Biochem & Cell Biol 2006; 38: 2102-13.
  3. Yan X, Shen H, Jiang H, Hu D, Zhang C, Wang J et al. External Qi of Yan Xin Qigong induces apoptosis and inhibits migration and invasion of estrogen-independent breast cancer cells through suppression of Akt/NF-êB signalling. Cell Physiol Biochem 2010; 25: 263-70.
  4. Yan X, Li F, Dozmorov I, Frank MB, Dao M, Centola M et al. External Qi of Yan Xin Qigong induces cell death and gene expression alterations promoting apoptosis and inhibiting proliferation, migration and glucose metabolism in small-cell lung cancer cells. Mol Cell Biochem 2012; 363: 245-55
  5. Yan X, Shen H, Jiang H, Hu D, Wang J and Wu X. External Qi of Yan Xin Qigong inhibits activation of Akt, Erk1/2 and NF-kB and induces cell cycle arrest and apoptosis in colorectal cancer cells. Cell Physiol Biochem 2013; 31: 113-22.
  6. Lei X-T, Bi A-H, Zhang Z-X, Cheng Z-Y. The antitumor effects of qigong-emitted external qi and its influence on the immunologic functions of tumor-bearing mice. J Tongji Med Univ 1991; 11: 253-6.
  7. Yeh M-L, Lee T-I, Chen H-H, Chao T-Y. The influences of Chan-Chuang Qi-gong therapy on complete blood cell counts in breast cancer patients treated with chemotherapy. Cancer Nurs 2006; 29: 149-55.
  8. Skoglund L, Josephson M, Wahlstedt K, Lampa E, Norback D. Qigong training and effects on stress, neck-shoulder pain and life quality in a computerised office environment. Complement Ther Clin Pract 2011; 17: 54-7.
  9. Biesinger E, Kipman U, Schatz S, Langguth B. Qigong for the treatment of tinnitus: a prospective randomized controlled study. J Psychosom Res 2010; 69: 299-304.
  10. Terjestam Y, Jouper J, Johansson C. Effects of scheduled qigong exercise on pupils' well-being, self-image, distress and stress. J Altern Complement Med 2010; 16: 939-44.
  11. Stenlund T, Birgander LS, Lindahl B, Nilsson L, Ahlgren C. Effects of qigong in patients with burnout: a randomized controlled trial. J Rehabil Med 2009; 41: 761-7.
  12. Guo X, Zhou B, Nishimura T, Teramukai S, Fukushima M. Clinical effect of qigong practice on essential hypertension: a meta-analysis of randomized controlled trials. J Altern Complement Med 2008; 14: 27-37.
  13. Chow YW, Tsang HW. Biopsychosocial effects of qigong as a mindful exercise for people with anxiety disorders: a speculative review. J Altern Comp Med 2007; 13: 831-9.
  14. Jahnke RA, Larkey LK, Rogers C. Dissemination and benefits of a replicable Tai Chi and Qigong program for older adults. Geriatr Nurs 2010; 31: 272-80.
  15. Van Vu D, Molassiotis A, Ching SSY, Le TT. Effects of Qigong on symptom management in cancer patients: A systematic review." Complement Ther Clin Pract 2017; 29: 111-121.
  16. Wayne PM, Lee MS, Novakowski J, Osypiuk K, Ligibel J, Carlson LE, Song R. Tai Chi and Qigong for cancer-related symptoms and quality of life: a systematic review and meta-analysis. J Cancer Surviv 2017; 12(2): 256-267.
  17. Klein PJ, Schneider R, Rhoads CJ. Qigong in cancer care: a systematic review and construct analysis of effective Qigong therapy. Support Care Cancer 2016; 24: 3209-3222.
  18. Zeng Y, T Luo, H Xie, M Huang and AS Cheng. Health benefits of qigong or tai chi for cancer patients: a systematic review and meta-analyses. Complement Ther Med 2014; 22: 173-86.
  19. Chan CL, Wang CW, Ho RT, Ng SM, Chan JS, Ziea ET et al. A systematic review of the effectiveness of qigong exercise in supportive cancer care. Support Care Cancer 2012; 20: 1121-33.
  20. Oh B, Butow P, Mullan B, Hale A, Lee MS, Guo X et al. A Critical Review of the Effects of Medical Qigong on Quality of Life, Immune Function, and Survival in Cancer Patients. Integr Cancer Ther 2012; 11: 101-10.
  21. Lee MS, Chen KW, Sancier KM, Ernst E. Qigong for cancer treatment: A systematic review of controlled clinical trials. Acta Oncol 2007; 46: 717-22.
  22. Liu P, You J, Loo TY, Sun Y, He Y, Sit H, et al. The efficacy of Guolin-Qigong on the body-mind health of Chinese women with breast cancer: a randomized controlled trial. Quality of life research 2017; 26(9): 2321‐2331.
  23. Chan THY, Yuen LP, Lee T, Chan JSM, Sham JST and Cha CLW. Effects of Qigong Practice on Salivary Cortisol in Cancer Patients and Their Caregivers: A Randomized Waitlist-Controlled Trial. Psycho-oncology 2013; 22: 245.
  24. Lee YH, Lai GM, Lee DC, Tsai Lai LJ, Chang YP. Promoting Physical and Psychological Rehabilitation Activities and Evaluating Potential Links Among Cancer-Related Fatigue, Fear of Recurrence, Quality of Life, and Physiological Indicators in Cancer Survivors. Integr Cancer Ther 2018; 17(4): 1183-1194.
  25. Myers JS, Mitchell M, Krigel S, Steinhoff A, Boyce-White A, Van Goethem K, et al. Qigong intervention for breast cancer survivors with complaints of decreased cognitive function. Support Care Cancer 2019; 27(4):1395-1403
  26. Chuang T, Yeh M, Chung Y. A nurse facilitated mind-body interactive exercise (Chan-Chuang qigong) improves the health status of non-Hodgkin lymphoma patients receiving chemotherapy: randomised controlled trial. International Journal of Nursing Studies, 2017; 69: 25-33.
  27. Fong SS, SS Ng, WS Luk, JW Chung, JS Ho, M Ying and AW Ma. Effects of qigong exercise on upper limb lymphedema and blood flow in survivors of breast cancer: a pilot study. Integr Cancer Ther 2014; 13(1): 54-61.
  28. Fong SS, Ng SS, Luk WS, Chung JW, Leung JC, Masters RS. Effects of a 6-month Tai Chi Qigong program on arterial hemodynamics and functional aerobic capacity in survivors of nasopharyngeal cancer. J Cancer Surviv 2014; 8: 618-26.

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