- Qigong is a modality of Traditional Chinese Medicine.
- Most consistent evidence is for improvements in immune function, fatigue and quality of life.
- Evidence is heterogeneous or non-significant for effects on other outcomes.
- No serious safety concerns have been reported.
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.
Preclinical studies have generated encouraging findings and clinical trials have also yielded mostly promising results. Based on five systematic reviews, the most convincing and consistent evidence is available for improvements in immune function, fatigue and quality of life. For effects on other outcomes the evidence is heterogeneous or not significant. However, clinical trials generally have methodological limitations such as lack of blinding and there is heterogeneity between trials. A cause-effect relationship between the intervention and the outcome remains therefore undocumented.
There are no major safety concerns related to qigong.
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.
Rachel Jolliffe, Edzard Ernst, CAM-Cancer Consortium. Qigong [online document]. June 20, 2017.
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.
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 on a daily basis. 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.
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.
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.
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.
Five systematic reviews of qigong in cancer have been published and are described in table 1. They cover a range of outcomes and cancer types and include between nine and 23 studies. All of the reviews included only randomized or non-randomized controlled clinical trials.
The most recent review published in 2016 included 11 randomized clinical trials which had qigong or tai chi performed as qigong as the main intervention15. The strongest evidence was for fatigue, quality of life (QoL), and immune function/biomarkers of inflammation. For each of these outcomes, four of the five studies assessing these outcomes reported significant group differences in favour of qigong. However, all of the included studies had some potential for bias, particularly due to lack of blinding.
The results of this systematic review are generally in line with those of previous reviews, which also found that the best evidence was for improvements in immune function16,17,18. and quality of life16,18. One older systematic review concluded that the methodological quality of qigong trials was too poor to support its effectiveness for people with cancer19. However, a number of more rigorous, controlled trials have been published since this review with consistent positive findings for some outcomes.
In summary, systematic reviews of qigong for cancer have found some positive results, particularly for fatigue, quality of life and immune function. However, all of the reviews highlight the methodological limitations of the trials.
Controlled clinical trials
Seven RCTs and three non-randomized controlled trials have been published that are not included in any of the above reviews. These trials are described in table 2. Collectively, these trials report mixed results and are heterogeneous in terms of the clinical characteristics of the cohorts and the outcomes assessed. There is evidence from one trial21,22 that adds to the findings of the systematic reviews, which is that the most consistent evidence is for improvements in fatigue, immune function and quality of life. However, two trials found no significant differences in fatigue24,26 and one found no significant differences in quality of life26. There are no consistent findings across the other trials and all of the trials are impeded by methodological limitations.
A 2017 two-arm randomized cross-over trial (n=19) found that qigong and standard endurance training (SET) were equivalent in their impact on psychological outcomes in patients with advanced cancer20. The authors failed to reach their recruitment target and only 19 patients completed both interventions and all assessments, reducing the validity of this trial.
One single-centre randomized controlled trial reported in 21 and 22 (n=100 and n=108 respectively) measured the effects of Chan-Chuang qigong in non-Hodgkin’s lymphoma patients undergoing chemotherapy. Participants in the qigong group had significant improvements in fatigue, white blood cell counts, haemoglobin levels, sleep quality and quality of life, but not platelet counts, compared to the usual care control group. Lack of a placebo control group and the same researcher carrying out the intervention and the data collection reduces the validity of this trial.
A double-blind, randomized controlled pilot study (n=87) explored the effects of a set of combined qigong/tai chi easy exercises on breast cancer survivors23. Both the qigong/tai chi easy and sham qigong groups had improvements in physical and mental health, level of physical activity, self-reported cognitive function and performance in cognitive function tests. There were no significant differences between the two groups except for decreased Body Mass Index (BMI) in the qigong group for a subset of participants who enrolled late in the study. The sham qigong intervention comprised gentle exercise without a meditative/breath focus. The qigong/tai chi easy intervention may not have been different enough from the sham qigong intervention to demonstrate changes in outcomes beyond what gentle exercise can do.
A randomized controlled trial (n=90) measured the impact of a combined qigong/tai chi intervention on sleep and fatigue in prostate cancer patients undergoing radiotherapy24. The qigong/tai chi group reported longer sleep duration midway through radiotherapy compared to the sham qigong group but this was not sustained over time. No differences between groups were reported for other outcomes. The validity of this trial is affected by several limitations described in table 2.
A relatively large (n=192) RCT reported increased cortisol levels in the qigong group compared to the waiting list group, indicating higher stress25. 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.
A very small feasibility randomized controlled trial (n=27) explored qigong for women with metastatic breast cancer26. There were no significant differences in quality of life, fatigue, perceived stress or sexual outcomes between the qigong and meditation control groups.
Three non-randomized controlled trials27-29. have reported mixed results. One study (n=23) found decreased upper limb circumference and increased blood flow in breast cancer patients with lymphedema27. Two studies measured the effects of qigong for nasopharyngeal cancer survivors. The first study (n=52) found no significant improvements in quality of life, functioning or symptoms in either the qigong or standard care group28. The other trial (n=52) 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 care29. Small sample sizes and lack of randomization affect the quality of these trials.
None on record.
None on record.
None on record.
- Kemp CA. Qigong as a therapeutic intervention with older adults. J Holist Nurs 2004; 22: 351-73.
- 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.
- 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.
- 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
- Yan X, H Shen, H Jiang, D Hu, J Wang and X Wu. 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Vanderbyl BL, Mayer MJ, Nash C, Tran AT, Windholz T, Swanson T, Kasymjanova G and Jagoe RT. A comparison of the effects of medical Qigong and standard exercise therapy on symptoms and quality of life in patients with advanced cancer. Support Care Cancer, 2017; doi: 10.1007/s00520-017-3579-x. [Epub ahead of print]
- 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.
- Yeh M, Chung Y. A randomized controlled trial of qigong on fatigue and sleep quality for non-Hodgkin’s lymphoma patients undergoing chemotherapy. European Journal of Oncology Nursing, 2016; 23: 81-86.
- Larkey LK, Roe DJ, Smith L, Millstine D. Exploratory outcome assessment of Qigong/Tai Chi Easy on breast cancer survivors. Complementary Therapies in Medicine, 2016; 29: 196-203.
- McQuade JL, Prinsloo S, Chang DZ, Spelman A, Wei Q, Basen-Engquist K et al. Qigong/tai chi for sleep and fatigue in prostate cancer patients undergoing radiotherapy: a randomized controlled trial. Psycho-Oncology, 2016: 1-8.
- Chan THY, LP Yuen, T Lee, JSM Chan, JST Sham and CLW Cha. Effects of Qigong Practice on Salivary Cortisol in Cancer Patients and Their Caregivers: A Randomized Waitlist-Controlled Trial. Psycho-oncology 2013; 22: 245.
- Oh B, Butow P, Boyle F, Beale P, Costa DSJ et al. Effects of qigong on quality of life fatigue, stress, neuropathy, and sexual function in women with metastatic breast cancer: a feasibility study. International Journal of Physical Medicine & Rehabilitation, 2014; 2(4): doi:10.4172/2329-9096.1000217.
- 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.
- Fong SS, Ng SS, Luk WS, Chung LM, Wong JY, Chung JW. Effects of qigong training on health-related quality of life, functioning, and cancer-related symptoms in survivors of nasopharyngeal cancer: a pilot study. Evid Based Complement Alternat Med. 2014; 2014: 495274.
- 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.