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.

Seven systematic reviews (SRs) published since 2106 and an additional four RCTs not covered in these reviews were included in this summary. SRs evaluated mainly breast cancer patients, cover a range of outcomes and cancer types and include between nine and 23 studies.  All SRs suffered methodological limitations including significant heterogeneity, small number of patients in the analyses, or high risk of bias of the primary studies, resulting in low or very low-quality evidence.

  • Mental health: Findings are inconclusive. One SR concluded that qigong reduces the symptoms of depression and anxiety (based on pooled analyses of six and five low-quality trials respectively). Another SR showed no effects on depression (based on pooled analyses of four low-quality trials).
  • Fatigue and sleep: Findings are also inconclusive. Two SRs concluded that qigong improves sleep quality whereas another SR showed no effects on sleep disturbance (based on pooled analyses of four low-quality and heterogeneous trials).
  • Quality of life/wellbeing: Evidence favours qigong. Of the overall four SRs, two reported favourable findings (low-quality evidence).
  • Immune function: No new SRs investigated immune function as outcomes. However, the previous systematic review found strong evidence for immune function/biomarkers of inflammation favouring qigong.
  • Haemodynamics: Only preliminary evidence from a very small trial is available for decreased upper limb circumference and increased blood flow in breast cancer patients with lymphoedema.
  • Breathlessness-Fatigue-Anxiety (composite outcome): The biggest and most robust trial failed to show improvements when compared with waiting list.

There are no major safety concerns related to qigong. 

Citation

Pawel Posadzki, Ava Lorenc, CAM Cancer Consortium. Qigong [online document], June 2022.

Document history

Most recently revised and updated in May 2022 by Pawel Posadzki.
Updated in March 2019 by Ava Lorenc
Revised and updated in March 2015 and June 2017 by Rachel Jolliffe.
Updated in May 2012 by Edzard Ernst. 
First published in April 2011, authored by Edzard Ernst.

What is it?

Description

Qigong is an ancient Chinese treatment. According to Traditional Chinese Medicine philosophy, “qigong facilitates the movement of qi, the vital life energy, throughout the body, thereby enhancing health and healing disease” (Kemp 2004). Several different types of qigong 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 (CAM Cancer summary on Tai Chi). It typically involves moving meditation, coordinating slow-flowing movement, deep rhythmic breathing, and a calm meditative state of mind. 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. This “energy” is, however, not energy as defined by science and has so far not been measured reproducibly with scientific methods.

Background and prevalence

Qigong is part of traditional Chinese medicine (TCM) and shares its long history. 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 as a way of maintaining health or preventing diseases. Precise prevalence figures are not available.

Alleged indications

Qigong is often recommended for a wide range of conditions including musculoskeletal pain (Skoglund 2011), tinnitus (Biesinger 2020), stress (Terjestam 2010), burnout (Stenlund 2009), hypertension (Guo 2008) and anxiety (Chow 2007). The treatment is traditionally used by older patients (Jahnke 2010). 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.

Application and providers

Internal qigong is usually practised daily (usually early in the morning or late evening). 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 teachers are often people with no medical background or training who have learnt the technique on a vocational basis. In most countries, ‘qigong practitioner/teacher’ is not a protected title which means anybody, regardless of background, experience or training can adopt it.

Claims of efficacy/mechanism of action

Normalising 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.

In vitro experiments have suggested that external qigong induces apoptosis and inhibition of cancer cell invasion (Yan 2006, Yan 2010, Yan 2012, Yan 2013). Animal experiments have implied that it inhibits tumour growth (Lei 1991). Some studies have suggested that it decreases leukopenia in breast cancer patients (Yeh 2006).

Legal issues and cost

In some countries, e.g. the UK, it is illegal for qigong practitioners to claim to be able to cure cancer.

Internal qigong is often practised in groups and is thus normally inexpensive. External qigong is time-consuming and a practitioner may charge EUR 50-100 per session. Regular treatment/practice is commonly advised.

Does it work?

Supportive/palliative care

Seven systematic reviews (SRs) of qigong in cancer have been published since 2016 and are described in table 1. SRs evaluated mainly breast cancer patients; other types of cancer included gastrointestinal/colorectal, lung, as well as other (unspecified) cancer types. SRs evaluated the following outcomes: fatigue (n=3), sleep quality (3), quality of life (n=2), depression (n=2), distress (n=1), anxiety (n=1). All SRs suffered methodological limitations including significant heterogeneity, small number of patients in the analyses, or high risk of bias of the primary studies, resulting in low or very low-quality evidence. An additional four RCTs that are not included in the above systematic reviews are also discussed. The trials also suffered from methodological limitations including small sample sizes with heterogeneous populations, lack of blinding, high drop-out rates, or ascertaining short-terms effects only.

Four SRs were published in 2021. The SR by Wang (2021) evaluated the effects of qigong on fatigue in 384 patients with unspecified cancers; and included 4 RCTs. The results are based on subgroup analyses; are inconsistent, imprecise, and based on not directly comparable data. The SR by Meng (2021) evaluated the effects of qigong in the large and relatively homogenous sample of breast cancer participants (N=1236); and included 17 randomised or non-randomised trials (pooling of which may introduce bias). The SR by Kuo (2021) evaluated the effects of qigong in 904 patients with various types of cancer (predominantly breast). It included 14 studies at high or very high risk of bias; and overall low or very low-quality evidence. The SR by Cheung (2021) evaluated the effects of qigong (or tai chi) in 907 patients with various types of cancer. There were some methodological concerns in all the included studies.

The SR by Van Vu reviewed qigong only and included 15 randomized clinical trials (RCTs) and eight controlled clinical trials Van Vu 2017). Two SRs included (and did not distinguish between) tai chi and qigong, one by Wayne et al of 15 randomized clinical trials (Wayne 2017) and one by Klein et al of 11 RCTs (Klein 2016).  The review of qigong only did not perform a meta-analysis and the majority of included studies were at high risk of bias (Van Vu 2017). Wayne 2017 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 2016 searched only two databases, limited inclusion to RCTs with at least 15 participants per group and did not perform a meta-analysis.

Four randomized controlled trials (RCTs, one pilot) have been published that are not included in any of the seven reviews (Chan 2013, Fong 2014a, Yang 2021, Molassiotis 2021). These trials are described in table 2.

  • Mental health: Findings are inconclusive. One SR concluded that qigong reduces the symptoms of depression and anxiety (based on pooled analyses of six and five low-quality trials respectively). Another SR showed no effects on depression (based on pooled analyses of four low-quality trials).
  • Fatigue and sleep: Findings are also inconclusive. Two SRs concluded that qigong improves sleep quality whereas another SR showed no effects on sleep disturbance (based on pooled analyses of four low-quality and heterogeneous trials).
  • Quality of life/wellbeing: Evidence favours qigong. Of the overall four SRs, two reported favourable findings (low-quality evidence).
  • Immune function: No new SRs investigated immune function as outcomes. However, the previous systematic review found strong evidence for immune function/biomarkers of inflammation favouring qigong.
  • Haemodynamics: Only preliminary evidence from a very small trial is available for decreased upper limb circumference and increased blood flow in breast cancer patients with lymphoedema.
  • Breathlessness-Fatigue-Anxiety (composite outcome): The biggest and most robust trial failed to show improvements when compared with waiting list.

Description of studies

Mental health

For both depression and anxiety the SR by Van Vu 2017 found two studies showing no effect and one showing a significant effect. Mood disturbance was improved in one study. The SR by Klein 2016 also found mixed results for mental health. The SR and meta-analysis by Wayne 2017 found significant improvements for depression, but they did not distinguish between tai chi and qigong.

The SR by Meng (2021) found that in breast cancer patients, qigong reduced the symptoms of depression and anxiety when compared with various controls and had no effect on distress. The review is however burdened with a high risk of bias and its findings need to be interpreted cautiously.

A relatively large (n=192) RCT reported increased cortisol levels in the qigong group compared to the waiting list group, indicating higher stress (Chan 2013). 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.

The RCT by Yang 2021 found that in gastrointestinal cancer patients undergoing chemotherapy, qigong and conventional care reduced the symptoms of depression when compared with conventional care alone.

Fatigue and sleep

The SR by Van Vu 2017 found that qigong significantly lowered fatigue in seven out of 10 trials. Wayne 2017 conducted a meta-analysis which found significant improvements for fatigue and sleep difficulty, but they did not distinguish between tai chi and qigong. The SR by Klein 2016 concluded that qigong can improve fatigue, from five studies (four of which were also included by Wayne et al), but not sleep (two studies).

One SR with meta-analysis by Cheung (2021) found that in breast, non-Hodgkin lymphoma, various, gynaecological, unspecified, colorectal, head and neck or prostate cancer patients, qigong improved sleep quality and reduced fatigue post-intervention (and not after 3 months), but had no effects on depressive symptoms when compared with various controls. Some interventions involved Tai Chi rather than qigong. The evidence was of low quality and limited by methodological shortcomings and considerable heterogeneity.

Another SR by Kuo (2021) found that in patients with breast, colorectal, lung, haematological or unspecified cancers, qigong improved quality of life and sleep; and reduced fatigue, when compared with various controls. These findings are based on low or very low-quality evidence.

Meng (2021) found that in breast cancer patients, qigong had no effect on fatigue and sleep quality when compared with various controls. 

Based on subgroup analyses Wang (2021) found that in 384 patients with unspecified cancer types, qigong reduced fatigue when compared with various controls.

Quality of life/wellbeing

The SR by Van Vu 2017 found 11 studies which measured quality of life. Seven studies showed a significant effect, four showed no effect. The study by Wayne 2017  was a SR and meta-analysis of 11 trials which found significant improvements for quality of life, but they did not distinguish between tai chi and qigong. The 2016 SR by Klein 2016 (also tai chi or qigong) 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 2017), although all of the included studies had some potential for bias, particularly due to lack of blinding.  Older SRs also found improvements in quality of life for qigong (Oh 2012) and tai chi/qigong (Zeng 2014).

A SR by Kuo (2021) found that in patients with lung, breast, or unspecified type/site of cancer, qigong improved quality of life when compared with various controls (based on findings from 5 RCTs).

The SR by Meng (2021) found that in breast cancer patients, qigong improved quality of life when compared with various controls.

The SR by Yang 2021 found that in gastrointestinal cancer patients undergoing chemotherapy, qigong and conventional care improved quality of life when compared with conventional care alone.

Immune function

The SR by Klein 2016 found strong evidence for immune function/biomarkers of inflammation. Previous reviews also found improvements in immune function for qigong (Chan 2012, Oh 2012) and tai chi/qigong (Zeng 2014).

An RCT (Chuang 2017; this study is not included in table 2 as Wayne 2017 included this study but they did not report immune outcomes) found qigong improved white blood cell counts.

Haemodynamics

One non-randomized controlled trial (n=23) found decreased upper limb circumference and increased blood flow in breast cancer patients with lymphedema (Fong 2014a). 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 care (Fong 2014b). This study is not in table 2 as Van Vu 2017 included this study but did not report these outcomes. Small sample sizes and lack of randomization affect the quality of these trials.

Other outcomes/composite outcomes

The SR by Van Vu 2017 found no significant effect of qigong on dyspnoea or pain, and mixed results on digestive symptoms.

The RCT by Molassiotis 2021 found no significant effect of qigong on Breathlessness-Fatigue-Anxiety (cluster outcome) when compared with waiting list controls in 156 lung cancer patients.

Is it safe?

Adverse events

The SR by Van Vu 2017 found that four trials reported qigong as safe, with no side effects. In the SR by Cheung 2021 only three trials reported that there were no adverse-events; whereas most studies did not mention any.

Contradictions

None on record.

Interactions

None on record. 

References

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Cheung DST, Takemura N, Smith R, Yeung WF, Xu X, Ng AYM, et al. Effect of qigong for sleep disturbance-related symptom clusters in cancer: a systematic review and meta-analysis. Sleep Med. 2021;85:108-22.

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